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Am J Gastroenterol. 2020 Feb;115(2):165-178. doi: 10.14309/ajg.0000000000000501.

ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth.

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Medically Associated Science and Technology (MAST) Program, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA.
Division of Gastroenterology/Hepatology, Augusta University, Augusta, Georgia, USA.


Small intestinal bacterial overgrowth is defined as the presence of excessive numbers of bacteria in the small bowel, causing gastrointestinal symptoms. This guideline statement evaluates criteria for diagnosis, defines the optimal methods for diagnostic testing, and summarizes treatment options for small intestinal bacterial overgrowth. This guideline provides an evidence-based evaluation of the literature through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process. In instances where the available evidence was not appropriate for a formal GRADE recommendation, key concepts were developed using expert consensus.

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