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It is best described as a pathophysiological state that may contribute to symptoms or other pathology in a wide range of gastrointestinal conditions that include disorders of gut\u2010brain interaction, inflammatory bowel disease, and chronic liver disease. The controversy surrounding SIBO largely rests on diagnostic limitations of currently widely used diagnostic tests. The gold standard test of bacterial culture of proximal small intestinal fluid will miss the majority of bacteria, has severe methodological limitations, and is clinically uncommonly used. Breath\u2010hydrogen testing after oral glucose or lactulose ingestion is associated with falsely positive and negative results, due largely to the inability to accurately define where in the gastrointestinal tract the hydrogen is being generated. Such performance characteristics raise concerns regarding its application to clinical decision\u2010making in the individual patient. Therapies such as antibiotics can normalize breath test findings and ameliorate symptoms, but whether this is due to an action on the small intestinal microbiota is uncertain. It is proposed that conceptual modifications that include the assessment of the mucosa\u2010associated microbiota in biopsies obtained with minimal contamination, molecular and functional characterization of the microbiota, rather than purely culture\u2010based density of bacteria, and expansion of the definition of SIBO to small intestinal dysbiosis will facilitate more precision and resolve the controversial place of SIBO in clinical practice.<\/jats:p>","DOI":"10.1002\/jgh3.70419","type":"journal-article","created":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T06:39:23Z","timestamp":1778913563000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Critical Review: The Past, Present, and Future of Small Intestinal Bacterial Overgrowth (\n                    <scp>SIBO<\/scp>\n                    )"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0710-1691","authenticated-orcid":false,"given":"Ayesha","family":"Shah","sequence":"first","affiliation":[{"name":"Faculty of Health, Medicine and Behavioural Sciences The University of Queensland  Brisbane Queensland Australia"},{"name":"Department of Gastroenterology &amp; Hepatology Princess Alexandra Hospital  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0206-2358","authenticated-orcid":false,"given":"Gerald","family":"Holtmann","sequence":"additional","affiliation":[{"name":"Faculty of Health, Medicine and Behavioural Sciences The University of Queensland  Brisbane Queensland Australia"},{"name":"Department of Gastroenterology &amp; Hepatology Princess Alexandra Hospital  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9108-1712","authenticated-orcid":false,"given":"Peter R.","family":"Gibson","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology School of Translational Medicine, Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/003591576005300823"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11894-015-0436-2"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOG.0000000000001135"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-025-09156-y"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/17474124.2023.2207008"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOG.0000000000000928"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.13622"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tim.2024.02.013"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000000501"},{"key":"e_1_2_13_11_1","first-page":"77","article-title":"Small Bowel Transit Time of Food in Man: Measurement, Regulation and Possible Importance","volume":"96","author":"Read N. 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