Small Intestinal Bacterial Overgrowth

SIBO in Gastroparesis: Sci-fi or Science Fact?

“…Presumably in patients with documented gastroparesis, that is not the case as-if anything-impaired gastric emptying should be associated with slower transit, with a predicted higher rate of false-negative studies. While one cannot exclude differential emptying of solids and liquids in this population (as scintigraphic gastric emptying in this study measured the rate of solid food disappearance), these data suggest that concerns regarding high false-negative rates for SIBO breath testing in patients with documented gastroparesis may be overstated [2]. That patients with an early hydrogen rise had statistically more bloating than those patients with gastroparesis supports the clinical usefulness of the LBT.…”

“…The current gold standard is C10 5 bacteria colony-forming units/mL in a jejunal aspirate, a test hampered by difficulties obtaining a sterile specimen, non-uniform distribution, the requirement for an invasive procedure (enteroscopy), lack of capability for quantitative culture by most microbiology laboratories, difficulties with cultivating most bacterial strains, and even in optimal situations, poor reproducibility [1,2]. For these reasons, breath testing is a useful indirect measure of SIBO.…”

“…In addition to these factors, there are also numerous criteria that have been proposed for a positive carbohydrate breath test, further muddying the waters [4]. Due to all of these factors, there has been a wide range quoted for sensitivity (17-89 %) and specificity (44-100 %) in the literature [2,5]. Nonetheless, sensitivity and specificity calculation are likely to have little meaning in the absence of a universally accepted gold standard.…”

Prevalence of Small Intestine Bacterial Overgrowth in Patients With Gastrointestinal Symptoms

“…Small intestine bacterial overgrowth (SIBO) is a heterogeneous syndrome, which can be characterized by an increase in the number and/or presence of an atypical microbiota in the small intestine (5,15) . It is known that although the gold standard for the diagnosis of overgrowth is still the presence of 1 x 10 5 to 10 6 colony forming units/mL (cfu/mL) in the jejunal aspirate, this definition has been challenged in the present scenario (2,5) .…”

“…The examination considered the gold standard for SIBO diagnosis is the jejunal aspirate culture, which is not routinely performed because it requires a complex technique and is costly (15) . In clinical practice, the most widely used method is the Hydrogen (H 2 ) breath test which has good sensitivity and specificity for the diagnosis (5,15,21) .…”