Small intestinal bacterial overgrowth

Small intestinal bacterial overgrowth (SIBO), also termed bacterial overgrowths, or small bowel bacterial overgrowth syndrome (SBBOS), is a disorder of excessive bacterial growth in the small intestine. Unlike the colon (or large bowel), which is rich with bacteria, the small bowel usually has fewer than 10,000 organisms per millilitre. Patients with bacterial overgrowth typically develop symptoms including nausea, bloating, vomiting, diarrhea, malnutrition, weight loss and malabsorption which is caused by a number of mechanisms.

The diagnosis of bacterial overgrowth is made by a number of techniques, with the gold standard diagnosis being an aspirate from the jejunum that grows in excess of 10⁵bacteria per millilitre. Risk factors for the development of bacterial overgrowth include dysmotility, anatomical disturbances in the bowel, including fistulae, diverticula and blind loops created after surgery, and resection of the ileo-cecal valve, gastroenteritis induced alterations to the small intestine as well as the use of certain medications, including proton pump inhibitors. Small bowel bacterial overgrowth syndrome is treated with an elemental diet or else antibiotics, which may be given in a cyclic fashion to prevent tolerance to the antibiotics sometimes followed by prokinetic drugs to prevent recurrence if dysmotility is a suspected cause.