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Increasing evidence indicates that SIBO exerts systemic effects beyond the gut, contributing to metabolic, neurological, cardiovascular, dermatological, and autoimmune conditions. Current management strategies include nonsystemic antibiotics such as rifaximin, dietary interventions (low\u2010FODMAP and biphasic diets), and nutraceuticals including berberine, oregano oil, peppermint oil, garlic derivatives, vitamins, and magnesium. Despite demonstrated clinical efficacy, challenges persist, including high recurrence rates, antimicrobial resistance, and long\u2010term disruption of gut microbiota. Nutraceutical and dietary approaches offer promising patient\u2010centered alternatives but require stronger clinical validation. This review critically examines the multifactorial pathophysiology of SIBO, emphasizing gut\u2013brain axis dysregulation, microbial dysbiosis, oxidative stress, impaired intestinal motility, anatomical abnormalities, hypochlorhydria, bile acid malabsorption, and immune dysfunction. It synthesizes current diagnostic and therapeutic strategies, highlighting antibiotics, dietary approaches, and nutraceuticals, while distinguishing robust evidence from observational or preclinical findings. Finally, it identifies key research priorities, including improved diagnostics, global clinical trials, and microbiome\u2010 and genetics\u2010based personalized treatments for sustained remission.<\/jats:p>","DOI":"10.1002\/mnfr.70541","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T20:27:30Z","timestamp":1782851250000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Small Intestinal Bacterial Overgrowth: Microbiome Dysregulation, Gut\u2013Brain Axis Disruption, and Systemic Consequences"],"prefix":"10.1002","volume":"70","author":[{"given":"Ayman","family":"Furqan","sequence":"first","affiliation":[{"name":"Faculty of Food Science and Nutrition Bahauddin Zakariya University  Multan Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Tauseef","family":"Sultan","sequence":"additional","affiliation":[{"name":"Faculty of Food Science and Nutrition Bahauddin Zakariya University  Multan Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9453-936X","authenticated-orcid":false,"given":"Muhammad Usman","family":"Khalid","sequence":"additional","affiliation":[{"name":"Faculty of Food Science and Nutrition Bahauddin Zakariya University  Multan Pakistan"},{"name":"American Heart Center  USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1505-6184","authenticated-orcid":false,"given":"Muhammad","family":"Waqar","sequence":"additional","affiliation":[{"name":"Food Technology and Innovation Research Center of Excellence School of Agricultural Technology and Food Industry Walailak University, Thai Buri, Tha Sala Nakhon Si Thammarat Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Maaz","sequence":"additional","affiliation":[{"name":"Faculty of Food Science and Nutrition Bahauddin Zakariya University  Multan Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laiba","family":"Tanvir","sequence":"additional","affiliation":[{"name":"Faculty of Food Science and Nutrition Bahauddin Zakariya University  Multan Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rameen","family":"Naeem","sequence":"additional","affiliation":[{"name":"Faculty of Food Science and Nutrition Bahauddin Zakariya University  Multan Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mutjardah","family":"Zarrish","sequence":"additional","affiliation":[{"name":"Faculty of Food Science and Nutrition Bahauddin Zakariya University  Multan Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrin R. M.","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Department of Chemistry Preparatory Year Program Batterjee Medical College  Jeddah Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gamal A.","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Department of Natural Products and Alternative Medicine Faculty of Pharmacy King Abdulaziz University  Jeddah Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7143-260X","authenticated-orcid":false,"given":"Md. Sakhawot","family":"Hossain","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Food Technology Jashore University of Science and Technology  Jashore Bangladesh"},{"name":"Department of Nutrition and Food Engineering Daffodil International University, Savar  Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hagar M.","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Department of Medical Laboratory Analysis College of Medical &amp; Health Sciences Liwa University  Abu Dhabi UAE"},{"name":"Department of Applied Medical Chemistry Medical Research Institute Alexandria University  Alexandria Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"e_1_2_16_2_1","doi-asserted-by":"publisher","DOI":"10.2147\/CEG.S360563"},{"key":"e_1_2_16_3_1","doi-asserted-by":"publisher","DOI":"10.1267\/ahc.20011"},{"key":"e_1_2_16_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ifset.2022.103161"},{"key":"e_1_2_16_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12906\u2010018\u20102409\u20100"},{"key":"e_1_2_16_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.coph.2022.102284"},{"key":"e_1_2_16_7_1","unstructured":"Allimax(2025) Small Intestinal Bacterial Overgrowth (SIBO) & Allicin: An Evidence\u2010Informed Overview Available at:https:\/\/allimax.us\/blogs\/research\u2010studies\/small\u2010intestinal\u2010bacterial\u2010overgrowth\u2010sibo\u2010amp\u2010allicin\u2010an\u2010evidence\u2010informed\u2010overview(Accessed: 17 March 2026)."},{"key":"e_1_2_16_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/nutrit\/nuac030"},{"key":"e_1_2_16_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/10408398.2022.2137776"},{"key":"e_1_2_16_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhazmat.2023.131468"},{"issue":"2","key":"e_1_2_16_11_1","first-page":"151","article-title":"Small Intestinal Bacterial Overgrowth Syndrome Prevalence in Romanian Patients With Inflammatory Bowel Disease","volume":"42","author":"Andrei M.","year":"2016","journal-title":"Current Health Sciences Journal"},{"key":"e_1_2_16_12_1","first-page":"30","article-title":"Syndrome of Bacterial Overgrowth in Patients With the Reduced Stomach Acid Secretion: Some Aspects of the Diagnosis","volume":"12","author":"Ardatskaia M. 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