Review Article

Small Intestinal Bacterial Overgrowth

Prevalence, Clinical Features, Current and Developing Diagnostic Tests, and Treatment

E. Grace; C. Shaw; K. Whelan; H. J. N. Andreyev


Aliment Pharmacol Ther. 2013;38(7):674-688. 

In This Article


Small intestinal bacterial overgrowth is a significant clinical problem, which is difficult to diagnose accurately and for which the optimal therapeutic options are not defined. The concept of discovering novel biomarkers in biofluids or VOCs from biological samples to aid with SIBO diagnosis is attractive. The advantages of these techniques are manifold: rapid, non-invasive and requiring minimal preanalysis sample preparation. Of course, there is one major obstacle in both cases – the lack of a 'gold standard' diagnostic test for SIBO. This will make the interpretation of data challenging.

To validate the possible usefulness of any of these techniques in SIBO, diagnosis would necessitate the use of carefully defined groups of patients. There would then be potential to define a highly sensitive and specific test, which could revolutionise the diagnosis, and therefore management, of SIBO. In addition, the techniques described could identify novel biomarkers, potentially allowing patient stratification to facilitate a more personalised approach to tailoring antibiotic treatment to the individual. Thus, there would be a reduced alteration of the symbiotic GI microbiota caused by unnecessary antibiotic administration.

As the techniques are designed to detect all of the biochemical metabolites present simultaneously in a single measurement, it is likely that one or more will be shown to be superior to the currently available diagnostic methods for SIBO. Proving this hypothesis could open a new avenue in gastroenterology practice and research.