{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T19:24:12Z","timestamp":1777577052718,"version":"3.51.4"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2021,1,21]],"date-time":"2021-01-21T00:00:00Z","timestamp":1611187200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,1,21]],"date-time":"2021-01-21T00:00:00Z","timestamp":1611187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Functional Gut Diagnostics"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Prior to antireflux surgery, most patients with symptoms of gastroesophageal reflux disease (GERD) have been taking long-term proton pump inhibitors (PPIs). PPIs have been shown to cause changes to the intestinal microbiota, such as small intestinal bacterial overgrowth (SIBO), which is characterised by symptoms of gas bloating. Patients undergoing antireflux surgery are not routinely screened for SIBO, yet many patients experience gas-related symptoms postoperatively.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Data from consecutive patients (<jats:italic>n<\/jats:italic>\u2009=\u2009104) referred to a speciality reflux centre were retrospectively assessed. Patients underwent a routine diagnostic workup for GERD including history, endoscopy, oesophageal manometry and 24-h pH-impedance monitoring off PPIs. Intestinal dysbiosis was determined by hydrogen and methane breath testing with a hydrogen-positive result indicative of SIBO and a methane-positive result indicative of intestinal methanogen overgrowth (IMO).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>60.6% of patients had intestinal dysbiosis (39.4% had SIBO and 35.6% had IMO). Patients with dysbiosis were more likely to report bloating (74.6% vs 48.8%; <jats:italic>P<\/jats:italic>\u2009=\u20090.01) and belching (60.3% vs 34.1%; <jats:italic>P<\/jats:italic>\u2009=\u20090.01). The oesophageal acid exposure time\u00a0and number of reflux episodes were similar between dysbiosis and non-dysbiosis groups, but patients with dysbiosis were more likely to have a positive reflux-symptom association (76.2% vs 31.7%; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), especially for regurgitation in those with SIBO (<jats:italic>P<\/jats:italic>\u2009=\u20090.01). Hydrogen gas production was significantly greater in patients with a positive reflux-symptom association for regurgitation (228.8\u00a0ppm vs 129.1\u00a0ppm, <jats:italic>P<\/jats:italic>\u2009=\u20090.004) and belching (mean AUC 214.8\u00a0ppm vs 135.9\u00a0ppm, <jats:italic>P<\/jats:italic>\u2009=\u20090.02).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The prevalence of intestinal dysbiosis is high in patients with GERD, and these patients are more likely to report gas-related symptoms prior to antireflux surgery. Independently, SIBO may be a contributory factor to refractory reflux symptoms and gas bloating in antireflux surgery candidates.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00464-020-08229-5","type":"journal-article","created":{"date-parts":[[2021,1,21]],"date-time":"2021-01-21T16:03:31Z","timestamp":1611245011000},"page":"7112-7119","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["The prevalence of intestinal dysbiosis in patients referred for antireflux surgery"],"prefix":"10.1007","volume":"35","author":[{"given":"Jordan J.","family":"Haworth","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Boyle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andres","family":"Vales","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3521-2671","authenticated-orcid":false,"given":"Anthony R.","family":"Hobson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,1,21]]},"reference":[{"key":"8229_CR1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2019.08.056","author":"R Bell","year":"2019","unstructured":"Bell R, Lipham J, Louie BE, Williams V, Luketich J, Hill M, Richards W, Dunst C, Lister D, McDowell-Jacobs L, Reardon P, Woods K, Gould J, Buckley FP, Kothari S, Khaitan L, Smith CD, Park A, Smith C, Jacobsen G, Abbas G, Katz P (2019) Magnetic sphincter augmentation superior to proton pump inhibitors for regurgitation in a 1-year randomized trial. Clin Gastroenterol Hepatol. https:\/\/doi.org\/10.1016\/j.cgh.2019.08.056","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"5","key":"8229_CR2","doi-asserted-by":"publisher","first-page":"1537","DOI":"10.1007\/s00464-012-2611-y","volume":"27","author":"LA Humphries","year":"2013","unstructured":"Humphries LA, Hernandez JM, Clark W, Luberice K, Ross SB, Rosemurgy AS (2013) Causes of dissatisfaction after laparoscopic fundoplication: the impact of new symptoms, recurrent symptoms, and the patient experience. Surg Endosc 27(5):1537\u20131545. https:\/\/doi.org\/10.1007\/s00464-012-2611-y","journal-title":"Surg Endosc"},{"key":"8229_CR3","doi-asserted-by":"publisher","first-page":"1908","DOI":"10.1136\/bmj.f1908","volume":"346","author":"AM Grant","year":"2013","unstructured":"Grant AM, Cotton SC, Boachie C, Ramsay CR, Krukowski ZH, Heading RC, Campbell MK (2013) Minimal access surgery compared with medical management for gastro-oesophageal reflux disease: five year follow-up of a randomised controlled trial (REFLUX). BMJ Clin Res 346:1908. https:\/\/doi.org\/10.1136\/bmj.f1908","journal-title":"BMJ Clin Res"},{"issue":"19","key":"8229_CR4","doi-asserted-by":"publisher","first-page":"1969","DOI":"10.1001\/jama.2011.626","volume":"305","author":"JP Galmiche","year":"2011","unstructured":"Galmiche JP, Hatlebakk J, Attwood S, Ell C, Fiocca R, Eklund S, Langstrom G, Lind T, Lundell L (2011) Laparoscopic antireflux surgery vs esomeprazole treatment for chronic GERD: the LOTUS randomized clinical trial. JAMA 305(19):1969\u20131977. https:\/\/doi.org\/10.1001\/jama.2011.626","journal-title":"JAMA"},{"key":"8229_CR5","doi-asserted-by":"publisher","DOI":"10.1093\/dote\/doz025","author":"AC Currie","year":"2019","unstructured":"Currie AC, Bright T, Thompson SK, Smith L, Devitt PG, Watson DI (2019) Acceptable outcomes after fundoplication-different views are held by patients, GPs, and surgeons. Dis Esophagus. https:\/\/doi.org\/10.1093\/dote\/doz025","journal-title":"Dis Esophagus"},{"issue":"2","key":"8229_CR6","doi-asserted-by":"publisher","first-page":"182","DOI":"10.5056\/jnm18001","volume":"24","author":"Y Kinoshita","year":"2018","unstructured":"Kinoshita Y, Ishimura N, Ishihara S (2018) Advantages and disadvantages of long-term proton pump inhibitor use. J Neurogastroenterol Motil 24(2):182\u2013196. https:\/\/doi.org\/10.5056\/jnm18001","journal-title":"J Neurogastroenterol Motil"},{"issue":"5","key":"8229_CR7","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1136\/gutjnl-2015-310861","volume":"65","author":"MA Jackson","year":"2016","unstructured":"Jackson MA, Goodrich JK, Maxan M-E, Freedberg DE, Abrams JA, Poole AC, Sutter JL, Welter D, Ley RE, Bell JT, Spector TD, Steves CJ (2016) Proton pump inhibitors alter the composition of the gut microbiota. Gut 65(5):749. https:\/\/doi.org\/10.1136\/gutjnl-2015-310861","journal-title":"Gut"},{"issue":"5","key":"8229_CR8","doi-asserted-by":"publisher","first-page":"740","DOI":"10.1136\/gutjnl-2015-310376","volume":"65","author":"F Imhann","year":"2016","unstructured":"Imhann F, Bonder MJ, Vich Vila A, Fu J, Mujagic Z, Vork L, Tigchelaar EF, Jankipersadsing SA, Cenit MC, Harmsen HJM, Dijkstra G, Franke L, Xavier RJ, Jonkers D, Wijmenga C, Weersma RK, Zhernakova A (2016) Proton pump inhibitors affect the gut microbiome. Gut 65(5):740. https:\/\/doi.org\/10.1136\/gutjnl-2015-310376","journal-title":"Gut"},{"issue":"6","key":"8229_CR9","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1016\/j.cgh.2009.12.022","volume":"8","author":"L Lombardo","year":"2010","unstructured":"Lombardo L, Foti M, Ruggia O, Chiecchio A (2010) Increased incidence of small intestinal bacterial overgrowth during proton pump inhibitor therapy. Clin Gastroenterolo Hepatol 8(6):504\u2013508. https:\/\/doi.org\/10.1016\/j.cgh.2009.12.022","journal-title":"Clin Gastroenterolo Hepatol"},{"issue":"4","key":"8229_CR10","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1111\/j.1365-2362.2010.02419.x","volume":"41","author":"D Compare","year":"2011","unstructured":"Compare D, Pica L, Rocco A, De Giorgi F, Cuomo R, Sarnelli G, Romano M, Nardone G (2011) Effects of long-term PPI treatment on producing bowel symptoms and SIBO. Eur J Clin Investig 41(4):380\u2013386. https:\/\/doi.org\/10.1111\/j.1365-2362.2010.02419.x","journal-title":"Eur J Clin Investig"},{"issue":"11","key":"8229_CR11","doi-asserted-by":"publisher","first-page":"1103","DOI":"10.1111\/apt.12304","volume":"37","author":"C Jacobs","year":"2013","unstructured":"Jacobs C, Coss Adame E, Attaluri A, Valestin J, Rao SS (2013) Dysmotility and proton pump inhibitor use are independent risk factors for small intestinal bacterial and\/or fungal overgrowth. Aliment Pharmacol Ther 37(11):1103\u20131111. https:\/\/doi.org\/10.1111\/apt.12304","journal-title":"Aliment Pharmacol Ther"},{"issue":"5","key":"8229_CR12","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1038\/ajg.2017.46","volume":"112","author":"A Rezaie","year":"2017","unstructured":"Rezaie A, Buresi M, Lembo A, Lin H, McCallum R, Rao S, Schmulson M, Valdovinos M, Zakko S, Pimentel M (2017) Hydrogen and methane-based breath testing in gastrointestinal disorders: the North American Consensus. Am J Gastroenterol 112(5):775\u2013784. https:\/\/doi.org\/10.1038\/ajg.2017.46","journal-title":"Am J Gastroenterol"},{"issue":"6","key":"8229_CR13","doi-asserted-by":"publisher","first-page":"1443","DOI":"10.1007\/s10620-007-0065-1","volume":"53","author":"R Khoshini","year":"2008","unstructured":"Khoshini R, Dai SC, Lezcano S, Pimentel M (2008) A systematic review of diagnostic tests for small intestinal bacterial overgrowth. Dig Dis Sci 53(6):1443\u20131454. https:\/\/doi.org\/10.1007\/s10620-007-0065-1","journal-title":"Dig Dis Sci"},{"issue":"2","key":"8229_CR14","doi-asserted-by":"publisher","first-page":"165","DOI":"10.14309\/ajg.0000000000000501","volume":"115","author":"M Pimentel","year":"2020","unstructured":"Pimentel M, Saad RJ, Long MD, Rao SSC (2020) ACG clinical guideline: small intestinal bacterial overgrowth. Am J Gastroenterol 115(2):165\u2013178. https:\/\/doi.org\/10.14309\/ajg.0000000000000501","journal-title":"Am J Gastroenterol"},{"issue":"4","key":"8229_CR15","doi-asserted-by":"publisher","first-page":"046002","DOI":"10.1088\/1752-7155\/2\/4\/046002","volume":"2","author":"A Eisenmann","year":"2008","unstructured":"Eisenmann A, Amann A, Said M, Datta B, Ledochowski M (2008) Implementation and interpretation of hydrogen breath tests. J Breath Res 2(4):046002. https:\/\/doi.org\/10.1088\/1752-7155\/2\/4\/046002","journal-title":"J Breath Res"},{"issue":"7","key":"8229_CR16","doi-asserted-by":"publisher","first-page":"1351","DOI":"10.1136\/gutjnl-2017-314722","volume":"67","author":"CP Gyawali","year":"2018","unstructured":"Gyawali CP, Kahrilas PJ, Savarino E, Zerbib F, Mion F, Smout A, Vaezi M, Sifrim D, Fox MR, Vela MF, Tutuian R, Tack J, Bredenoord AJ, Pandolfino J, Roman S (2018) Modern diagnosis of GERD: the Lyon Consensus. Gut 67(7):1351\u20131362. https:\/\/doi.org\/10.1136\/gutjnl-2017-314722","journal-title":"Gut"},{"issue":"11","key":"8229_CR17","doi-asserted-by":"publisher","first-page":"2647","DOI":"10.1007\/s00464-010-1267-8","volume":"24","author":"D Stefanidis","year":"2010","unstructured":"Stefanidis D, Hope WW, Kohn GP, Reardon PR, Richardson WS, Fanelli RD (2010) Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc 24(11):2647\u20132669. https:\/\/doi.org\/10.1007\/s00464-010-1267-8","journal-title":"Surg Endosc"},{"issue":"8","key":"8229_CR18","doi-asserted-by":"publisher","first-page":"2135","DOI":"10.1007\/s10620-009-1012-0","volume":"55","author":"AB Sahakian","year":"2010","unstructured":"Sahakian AB, Jee SR, Pimentel M (2010) Methane and the gastrointestinal tract. Dig Dis Sci 55(8):2135\u20132143. https:\/\/doi.org\/10.1007\/s10620-009-1012-0","journal-title":"Dig Dis Sci"},{"issue":"1","key":"8229_CR19","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1097\/SLA.0b013e31823899f8","volume":"255","author":"JA Broeders","year":"2012","unstructured":"Broeders JA, Bredenoord AJ, Hazebroek EJ, Broeders IA, Gooszen HG, Smout AJ (2012) Reflux and belching after 270 degree versus 360 degree laparoscopic posterior fundoplication. Ann Surg 255(1):59\u201365. https:\/\/doi.org\/10.1097\/SLA.0b013e31823899f8","journal-title":"Ann Surg"},{"issue":"2","key":"8229_CR20","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/j.cgh.2015.07.032","volume":"14","author":"EC Lin","year":"2016","unstructured":"Lin EC, Massey BT (2016) Scintigraphy demonstrates high rate of false-positive results from glucose breath tests for small bowel bacterial overgrowth. Clin Gastroenterol Hepatol 14(2):203\u2013208. https:\/\/doi.org\/10.1016\/j.cgh.2015.07.032","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"3","key":"8229_CR21","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1136\/gut.2009.205476","volume":"60","author":"D Yu","year":"2011","unstructured":"Yu D, Cheeseman F, Vanner S (2011) Combined oro-caecal scintigraphy and lactulose hydrogen breath testing demonstrate that breath testing detects oro-caecal transit, not small intestinal bacterial overgrowth in patients with IBS. Gut 60(3):334\u2013340. https:\/\/doi.org\/10.1136\/gut.2009.205476","journal-title":"Gut"},{"issue":"1","key":"8229_CR22","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1007\/s00535-017-1371-9","volume":"53","author":"T Su","year":"2018","unstructured":"Su T, Lai S, Lee A, He X, Chen S (2018) Meta-analysis: proton pump inhibitors moderately increase the risk of small intestinal bacterial overgrowth. J Gastroenterol 53(1):27\u201336. https:\/\/doi.org\/10.1007\/s00535-017-1371-9","journal-title":"J Gastroenterol"},{"key":"8229_CR23","first-page":"131","volume":"10","author":"JA Velasco","year":"2019","unstructured":"Velasco JA, Baltazar-Alba I, G\u00f3mez-Hermosillo LF, Casillas-Moreno J, Ulloa-Ruiz FF, Godoy-Castro VM, Mercado-J\u00e1uregui LA, Rangel-Orozco MF, D\u00edaz-Aceves PE, Olvera-Garc\u00eda VA, Guzm\u00e1n-Lepe A (2019) Frecuencia de sobrecrecimiento bacteriano de intestino delgado en pacientes con funduplicatura Nissen. Revista M\u00e9dica 10:131\u2013136","journal-title":"Revista M\u00e9dica"},{"key":"8229_CR24","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2016.02.032","author":"DA Drossman","year":"2016","unstructured":"Drossman DA (2016) Functional gastrointestinal disorders: history, pathophysiology, clinical features and Rome IV. Gastroenterology. https:\/\/doi.org\/10.1053\/j.gastro.2016.02.032","journal-title":"Gastroenterology"},{"issue":"11","key":"8229_CR25","doi-asserted-by":"publisher","first-page":"719","DOI":"10.4240\/wjgs.v8.i11.719","volume":"8","author":"S Tolone","year":"2016","unstructured":"Tolone S, Gualtieri G, Savarino E, Frazzoni M, de Bortoli N, Furnari M, Casalino G, Parisi S, Savarino V, Docimo L (2016) Pre-operative clinical and instrumental factors as antireflux surgery outcome predictors. World J Gastrointest Surg 8(11):719\u2013728. https:\/\/doi.org\/10.4240\/wjgs.v8.i11.719","journal-title":"World J Gastrointest Surg"},{"issue":"8","key":"8229_CR26","doi-asserted-by":"publisher","first-page":"2940","DOI":"10.1007\/s00464-013-2861-3","volume":"27","author":"M Frazzoni","year":"2013","unstructured":"Frazzoni M, Piccoli M, Conigliaro R, Manta R, Frazzoni L, Melotti G (2013) Refractory gastroesophageal reflux disease as diagnosed by impedance-pH monitoring can be cured by laparoscopic fundoplication. Surg Endosc 27(8):2940\u20132946. https:\/\/doi.org\/10.1007\/s00464-013-2861-3","journal-title":"Surg Endosc"},{"issue":"2","key":"8229_CR27","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1111\/j.1572-0241.2006.00458.x","volume":"101","author":"AI Sharara","year":"2006","unstructured":"Sharara AI, Aoun E, Abdul-Baki H, Mounzer R, Sidani S, Elhajj I (2006) A randomized double-blind placebo-controlled trial of rifaximin in patients with abdominal bloating and flatulence. Am J Gastroenterol 101(2):326\u2013333. https:\/\/doi.org\/10.1111\/j.1572-0241.2006.00458.x","journal-title":"Am J Gastroenterol"},{"issue":"1","key":"8229_CR28","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1007\/s10620-007-9839-8","volume":"53","author":"J Yang","year":"2008","unstructured":"Yang J, Lee HR, Low K, Chatterjee S, Pimentel M (2008) Rifaximin versus other antibiotics in the primary treatment and retreatment of bacterial overgrowth in IBS. Dig Dis Sci 53(1):169\u2013174. https:\/\/doi.org\/10.1007\/s10620-007-9839-8","journal-title":"Dig Dis Sci"},{"issue":"8","key":"8229_CR29","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1097\/MCG.0b013e3181c64c90","volume":"44","author":"K Low","year":"2010","unstructured":"Low K, Hwang L, Hua J, Zhu A, Morales W, Pimentel M (2010) A combination of rifaximin and neomycin is most effective in treating irritable bowel syndrome patients with methane on lactulose breath test. J Clin Gastroenterol 44(8):547\u2013550. https:\/\/doi.org\/10.1097\/MCG.0b013e3181c64c90","journal-title":"J Clin Gastroenterol"},{"issue":"6","key":"8229_CR30","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1111\/apt.13945","volume":"45","author":"VP Tan","year":"2017","unstructured":"Tan VP, Liu KS, Lam FY, Hung IF, Yuen MF, Leung WK (2017) Randomised clinical trial: rifaximin versus placebo for the treatment of functional dyspepsia. Aliment Pharmacol Ther 45(6):767\u2013776. https:\/\/doi.org\/10.1111\/apt.13945","journal-title":"Aliment Pharmacol Ther"},{"issue":"12","key":"8229_CR31","doi-asserted-by":"publisher","first-page":"2113","DOI":"10.1007\/s10620-006-9306-y","volume":"51","author":"I Nastaskin","year":"2006","unstructured":"Nastaskin I, Mehdikhani E, Conklin J, Park S, Pimentel M (2006) Studying the overlap between IBS and GERD: a systematic review of the literature. Dig Dis Sci 51(12):2113\u20132120. https:\/\/doi.org\/10.1007\/s10620-006-9306-y","journal-title":"Dig Dis Sci"},{"issue":"10","key":"8229_CR32","doi-asserted-by":"publisher","first-page":"1232","DOI":"10.3748\/wjg.v16.i9.1232","volume":"16","author":"SS Yarandi","year":"2010","unstructured":"Yarandi SS, Nasseri-Moghaddam S, Mostajabi P, Malekzadeh R (2010) Overlapping gastroesophageal reflux disease and irritable bowel syndrome: increased dysfunctional symptoms. World J Gastroenterol 16(10):1232\u20131238. https:\/\/doi.org\/10.3748\/wjg.v16.i9.1232","journal-title":"World J Gastroenterol"},{"issue":"9","key":"8229_CR33","doi-asserted-by":"publisher","first-page":"949","DOI":"10.1001\/jama.2015.0954","volume":"313","author":"WD Chey","year":"2015","unstructured":"Chey WD, Kurlander J, Eswaran S (2015) Irritable bowel syndrome: a clinical review. JAMA 313(9):949\u2013958. https:\/\/doi.org\/10.1001\/jama.2015.0954","journal-title":"JAMA"},{"issue":"39","key":"8229_CR34","doi-asserted-by":"publisher","first-page":"14105","DOI":"10.3748\/wjg.v20.i39.14105","volume":"20","author":"PJ Kennedy","year":"2014","unstructured":"Kennedy PJ, Cryan JF, Dinan TG, Clarke G (2014) Irritable bowel syndrome: a microbiome-gut-brain axis disorder? World J Gastroenterol 20(39):14105\u201314125. https:\/\/doi.org\/10.3748\/wjg.v20.i39.14105","journal-title":"World J Gastroenterol"},{"issue":"9","key":"8229_CR35","doi-asserted-by":"publisher","first-page":"3618","DOI":"10.1128\/AAC.00161-10","volume":"54","author":"C Darkoh","year":"2010","unstructured":"Darkoh C, Lichtenberger LM, Ajami N, Dial EJ, Jiang Z-D, DuPont HL (2010) Bile acids improve the antimicrobial effect of rifaximin. Antimicrob Agents Chemother 54(9):3618\u20133624. https:\/\/doi.org\/10.1128\/AAC.00161-10","journal-title":"Antimicrob Agents Chemother"},{"issue":"6","key":"8229_CR36","doi-asserted-by":"publisher","first-page":"1168","DOI":"10.1136\/gutjnl-2016-312574","volume":"66","author":"L Zhong","year":"2017","unstructured":"Zhong L, Shanahan ER, Raj A, Koloski NA, Fletcher L, Morrison M, Walker MM, Talley NJ, Holtmann G (2017) Dyspepsia and the microbiome: time to focus on the small intestine. Gut 66(6):1168. https:\/\/doi.org\/10.1136\/gutjnl-2016-312574","journal-title":"Gut"},{"issue":"9","key":"8229_CR37","doi-asserted-by":"publisher","first-page":"1073","DOI":"10.1111\/j.1365-2036.2012.05070.x","volume":"35","author":"BF Kessing","year":"2012","unstructured":"Kessing BF, Bredenoord AJ, Velosa M, Smout AJPM (2012) Supragastric belches are the main determinants of troublesome belching symptoms in patients with gastro-oesophageal reflux disease. Alimen pharmacol Ther 35(9):1073\u20131079. https:\/\/doi.org\/10.1111\/j.1365-2036.2012.05070.x","journal-title":"Alimen pharmacol Ther"},{"issue":"3","key":"8229_CR38","doi-asserted-by":"publisher","first-page":"398","DOI":"10.5056\/jnm15002","volume":"21","author":"N Koukias","year":"2015","unstructured":"Koukias N, Woodland P, Yazaki E, Sifrim D (2015) Supragastric belching: prevalence and association with gastroesophageal reflux disease and esophageal hypomotility. J Neurogastroenterol Motil 21(3):398\u2013403. https:\/\/doi.org\/10.5056\/jnm15002","journal-title":"J Neurogastroenterol Motil"}],"container-title":["Surgical Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-020-08229-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00464-020-08229-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-020-08229-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T14:16:00Z","timestamp":1637158560000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00464-020-08229-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,21]]},"references-count":38,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["8229"],"URL":"https:\/\/doi.org\/10.1007\/s00464-020-08229-5","relation":{},"ISSN":["0930-2794","1432-2218"],"issn-type":[{"value":"0930-2794","type":"print"},{"value":"1432-2218","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,21]]},"assertion":[{"value":"26 May 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 December 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 January 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Anthony Hobson is the cofounder of Functional Gut Diagnostics and has an equity interest in the company. In addition, Jordan Haworth receives income from Functional Gut Diagnostics as a serving employee. The authors Nicholas Boyle and Andres Vales declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}},{"value":"The study was a retrospective audit of clinic data, and all patients included in the study had provided written informed consent at the time of testing that their data to be used anonymously for research and audit purposes in line with the Care Quality Commission (UK) guidelines.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}