Asian-Pacific consensus on small intestinal bacterial overgrowth in gastrointestinal disorders: An initiative of the Indian Neurogastroenterology and Motility Association

Abstract

In the clinical setting, small intestinal bacterial overgrowth (SIBO) is a frequent, but under-diagnosed entity. SIBO is linked to various gastrointestinal (GI) and non-GI disorders with potentially significant morbidity. The optimal management of SIBO is undefined while there is a lack of published consensus guidelines. Against this background, under the auspices of the Indian Neurogastroenterology and Motility Association (INMA), formerly known as the Indian Motility and Functional Diseases Association (IMFDA), experts from the Asian-Pacific region with extensive research and clinical experience in the field of gut dysbiosis including SIBO developed this evidence-based practice guideline for the management of SIBO utilizing a modified Delphi process based upon 37 consensus statements, involving an electronic voting process as well as face-to-face meetings and review of relevant supporting literature. These statements include 6 statements on definition and epidemiology; 11 on etiopathogenesis and pathophysiology; 5 on clinical manifestations, differential diagnosis, and predictors; and 15 on investigations and treatment. When the proportion of those who voted either to accept completely or with minor reservations was 80% or higher, the statement was regarded as accepted. The members of the consensus team consider that this guideline would be valuable to inform clinical practice, teaching, and research on SIBO in the Asian-Pacific region as well as in other countries.

Indian consensus statements on irritable bowel syndrome in adults: A guideline by the Indian Neurogastroenterology and Motility Association and jointly supported by the Indian Society of Gastroenterology

“…1 and 2), symptom type, dietary practices and psychological issues. The stubbornness of refractory IBS may be explained by multi-dimensional pathophysiological mechanisms, including altered gut motility, intestinal barrier dysfunction, gut microbiota dysbiosis, including SIBO, gut immune dysfunction, visceral hypersensitivity, bile acid malabsorption, FODMAP sensitivity, psychological factors and altered gut-brain interactions [11,17,139,140]. Investigations directed to these pathophysiological mechanisms, based on the local availability, should be undertaken (Figs.…”

Understanding Our Tests: Hydrogen-Methane Breath Testing to Diagnose Small Intestinal Bacterial Overgrowth

“…A sterile technique is used, and the sample is rapidly transported to the laboratory for seeding appropriate media to yield more precise colony counts. Cultures with colony counts ≥10 3 are considered diagnostic of SIBO ( 1 , 3 ), but the normal ranges of colony counts vary greatly along the length of the gut, increasing in the more distal regions of the GI tract, and there remains some controversy about the exact colony counts that define SIBO ( 7 , 75 ).…”

“…This threshold is supported in a 16S ribosomal RNA gene sequencing–based study, which found that a culture-based cutoff of >10 3 cfu/mL correlated well with clinical symptoms, breath test results, and sequencing ( 6 ). Debate on the appropriate diagnostic threshold remains, for instance, the Asian-Pacific consensus guidelines support the use of both diagnostic thresholds ( 7 ). Variable sampling and processing techniques have been an additional limitation with the use of small bowel aspirates.…”

Indian Journal of Gastroenterology 2018–2022: Looking back from the Editor’s desk!

“…One of the promises was to attract the submission of Indian consensus and even Asian consensus on important issues in digestive diseases. In the last five years, five important consensuses on different digestive diseases got published, of which two are Asian consensus [17][18][19][20][21][22]. These consensus documents are on common gastrointestinal diseases such as chronic constipation, dietary issues in inflammatory bowel disease, gastroesophageal reflux disease, Helicobacter pylori infection, portal hypertensive upper gastrointestinal bleeding and small intestinal bacterial overgrowth [17][18][19][20][21][22].…”

“…In the last five years, five important consensuses on different digestive diseases got published, of which two are Asian consensus [17][18][19][20][21][22]. These consensus documents are on common gastrointestinal diseases such as chronic constipation, dietary issues in inflammatory bowel disease, gastroesophageal reflux disease, Helicobacter pylori infection, portal hypertensive upper gastrointestinal bleeding and small intestinal bacterial overgrowth [17][18][19][20][21][22]. I would also like to thank the supporting societies such as the Indian Society of Gastroenterology and the Indian Neurogastroenterology and Motility Association (earlier named Indian Motility and Functional Diseases Association) for undertaking these important scientific activities.…”