{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T23:48:39Z","timestamp":1790207319476,"version":"4.1.0"},"reference-count":47,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2022,10,12]],"date-time":"2022-10-12T00:00:00Z","timestamp":1665532800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Small Intestinal Bacterial Overgrowth (SIBO) is a form of dysbiosis that involves increased bacterial colonization of the small intestine with some of the bacteria more characteristic of the colon microbiota. The prevalence of SIBO over recent decades has been estimated to range from 2.5 to 22% (depending on the source) and to increase with age and among individuals with comorbidities. Recently, an increase in the number of diagnosed SIBO cases has been observed, which is primarily due to the availability of noninvasive breath tests that facilitate the diagnostic process. However, SIBO is still both a diagnostic and a therapeutic problem. This review presents the pathophysiology, manifestations, diagnostics, and recommended management of SIBO.<\/jats:p>","DOI":"10.3390\/jcm11206017","type":"journal-article","created":{"date-parts":[[2022,10,12]],"date-time":"2022-10-12T20:53:29Z","timestamp":1665608009000},"page":"6017","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":50,"title":["How to Recognize and Treat Small Intestinal Bacterial Overgrowth?"],"prefix":"10.3390","volume":"11","author":[{"given":"Barbara","family":"Skrzyd\u0142o-Radoma\u0144ska","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Medical University of Lublin, Jaczewskiego 8, 20-950 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6887-0094","authenticated-orcid":false,"given":"Bo\u017cena","family":"Cukrowska","sequence":"additional","affiliation":[{"name":"Department of Pathomorphology, The Children Memorial Health Institute, Aleja Dzieci Polskich 20, 04-730 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/0002-9343(66)90226-9","article-title":"Postgastrectomy blind loop syndrome: Megaloblastic anemia secondary to malabsorption of folic acid","volume":"41","author":"Barrett","year":"1966","journal-title":"Am. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1093\/ajcn\/25.12.1409","article-title":"The metabolic and nutritional consequences of bacterial overgrowth in the small intestine","volume":"25","author":"Neale","year":"1972","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1828","DOI":"10.1016\/j.mayocp.2016.07.025","article-title":"Small Intestinal Bacterial Overgrowth: A Primary Care Review","volume":"91","author":"Krajicek","year":"2016","journal-title":"Mayo Clin. Proc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e00078","DOI":"10.14309\/ctg.0000000000000078","article-title":"Small Intestinal Bacterial Overgrowth: Clinical features and therapeutic management: Clinical features and therapeutic management","volume":"10","author":"Rao","year":"2019","journal-title":"Clin. Transl. Gastroenterol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"664","DOI":"10.3389\/fpsyt.2020.00664","article-title":"Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome\u2013An Update","volume":"11","author":"Takakura","year":"2020","journal-title":"Front. Psychiatry"},{"key":"ref_6","first-page":"e8860","article-title":"Small Intestinal Bacterial Overgrowth: Comprehensive Review of Diagnosis, Prevention, and Treatment Methods","volume":"12","author":"Achufusi","year":"2020","journal-title":"Cureus"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1007\/s11894-015-0482-9","article-title":"How to Test and Treat Small Intestinal Bacterial Overgrowth: An Evidence-Based Approach","volume":"18","author":"Rezaie","year":"2016","journal-title":"Curr. Gastroenterol. Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1097\/MCG.0000000000001150","article-title":"Risk Factors Associated with Upper Aerodigestive Tract or Coliform Bacterial Overgrowth of the Small Intestine in Symptomatic Patients","volume":"54","author":"Bohm","year":"2020","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e00073","DOI":"10.14309\/ctg.0000000000000073","article-title":"Characterization of Proximal Small Intestinal Microbiota in Patients with Suspected Small Intestinal Bacterial Overgrowth: A Cross-Sectional Study","volume":"10","author":"Shin","year":"2019","journal-title":"Clin. Transl. Gastroenterol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1111\/apt.12456","article-title":"Review article: Small intestinal bacterial overgrowth\u2013Prevalence, clinical features, current and developing diagnostic tests, and treatment","volume":"38","author":"Grace","year":"2013","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"165","DOI":"10.14309\/ajg.0000000000000501","article-title":"ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth","volume":"115","author":"Pimentel","year":"2020","journal-title":"Am. J. Gastroenterol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1111\/j.1365-2036.2011.04625.x","article-title":"Clinical predictors of small intestinal bacterial overgrowth by duodenal aspirate culture","volume":"33","author":"Choung","year":"2011","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1007\/s00535-018-1476-9","article-title":"Prevalence and predictors of small intestinal bacterial overgrowth in irritable bowel syndrome: A systematic review and meta-analysis","volume":"53","author":"Chen","year":"2018","journal-title":"J. Gastroenterol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"190","DOI":"10.14309\/ajg.0000000000000504","article-title":"Small Intestinal Bacterial Overgrowth in Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of Case-Control Studies","volume":"115","author":"Shah","year":"2020","journal-title":"Am. J. Gastroenterol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1023\/A:1010722314493","article-title":"Small Intestine Bacterial Overgrowth and Metabolic Bone Disease","volume":"46","author":"Veneto","year":"2001","journal-title":"Dig. Dis. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1038\/ajg.2017.46","article-title":"Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus","volume":"112","author":"Rezaie","year":"2017","journal-title":"Am. J. Gastroenterol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.14309\/ajg.0000000000000200","article-title":"Small Intestinal Bacterial Overgrowth Is Common in Chronic Pancreatitis and Associates with Diabetes, Chronic Pancreatitis Severity, Low Zinc Levels, and Opiate Use","volume":"114","author":"Lee","year":"2019","journal-title":"Am. J. Gastroenterol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1007\/s10620-009-0826-0","article-title":"Frequency and Factors Associated with Small Intestinal Bacterial Overgrowth in Patients with Cirrhosis of the Liver and Extra Hepatic Portal Venous Obstruction","volume":"55","author":"Lakshmi","year":"2010","journal-title":"Dig. Dis. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"259","DOI":"10.5114\/pg.2018.78343","article-title":"Guidelines on the management of irritable bowel syndrome: In memory of Professor Witold Bartnik","volume":"13","author":"Pietrzak","year":"2018","journal-title":"Gastroenterol. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1111\/nmo.12516","article-title":"Small intestinal bacterial overgrowth: Duodenal aspiration vs glucose breath test","volume":"27","author":"Erdogan","year":"2015","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.gie.2014.01.008","article-title":"Increasing duodenal intraepithelial lymphocytosis found at upper endoscopy: Time trends and associations","volume":"80","author":"Shmidt","year":"2014","journal-title":"Gastrointest. Endosc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1097\/01.mcg.0000247994.34957.ae","article-title":"Intraepithelial \u03b3\u03b4+ Lymphocytes: A Comparative Study Between Celiac Disease, Small Intestinal Bacterial Overgrowth, and Irritable Bowel Syndrome","volume":"41","author":"Adames","year":"2007","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.3109\/00365521.2015.1027261","article-title":"Molecular assessment of differences in the duodenal microbiome in subjects with irritable bowel syndrome","volume":"50","author":"Tang","year":"2015","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1933313","DOI":"10.1080\/19490976.2021.1933313","article-title":"Methane positive small intestinal bacterial overgrowth in inflammatory bowel disease and irritable bowel syndrome: A systematic review and meta-analysis","volume":"13","author":"Gandhi","year":"2021","journal-title":"Gut Microbes"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"16","DOI":"10.5056\/jnm19113","article-title":"Breath Tests for the Non-invasive Diagnosis of Small Intestinal Bacterial Overgrowth: A Systematic Review with Meta-analysis","volume":"26","author":"Losurdo","year":"2020","journal-title":"J. Neurogastroenterol. Motil."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1007\/s10620-020-06623-6","article-title":"Small Intestinal Bacterial Overgrowth Syndrome: A Guide for the Appropriate Use of Breath Testing","volume":"66","author":"Massey","year":"2021","journal-title":"Dig. Dis. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1007\/s10620-020-06776-4","article-title":"Every Breath Test You Take: Practical Advice on Breath Testing Used to Detect Small Intestinal Bacterial Overgrowth","volume":"66","author":"Camilleri","year":"2021","journal-title":"Dig. Dis. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.1038\/s41395-018-0195-4","article-title":"A Systematic Review and Meta-Analysis Evaluating the Efficacy of a Gluten-Free Diet and a Low FODMAPS Diet in Treating Symptoms of Irritable Bowel Syndrome","volume":"113","author":"Dionne","year":"2018","journal-title":"Am. J. Gastroenterol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1136\/gutjnl-2015-311339","article-title":"FODMAPs alter symptoms and the metabolome of patients with IBS: A randomised controlled trial","volume":"66","author":"McIntosh","year":"2017","journal-title":"Gut"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1136\/gutjnl-2021-325214","article-title":"Efficacy of a low FODMAP diet in irritable bowel syndrome: Systematic review and network meta-analysis","volume":"71","author":"Black","year":"2021","journal-title":"Gut"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1023\/B:DDAS.0000011605.43979.e1","article-title":"A 14-Day Elemental Diet Is Highly Effective in Normalizing the Lactulose Breath Test","volume":"49","author":"Pimentel","year":"2004","journal-title":"Dig. Dis. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1053\/j.gastro.2020.06.090","article-title":"AGA Clinical Practice Update on Small Intestinal Bacterial Overgrowth: Expert Review","volume":"159","author":"Quigley","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2031","DOI":"10.1111\/j.1572-0241.2008.02030.x","article-title":"Small Intestinal Bacterial Overgrowth Recurrence After Antibiotic Therapy","volume":"103","author":"Lauritano","year":"2008","journal-title":"Am. J. Gastroenterol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1080\/17474124.2021.2005579","article-title":"Efficacy of rifaximin in treating with small intestine bacterial overgrowth: A systematic review and meta-analysis","volume":"15","author":"Wang","year":"2021","journal-title":"Expert Rev. Gastroenterol. Hepatol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1111\/apt.13928","article-title":"Systematic review with meta-analysis: Rifaximin is effective and safe for the treatment of small intestine bacterial overgrowth","volume":"45","author":"Gatta","year":"2017","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"4491","DOI":"10.3748\/wjg.v23.i25.4491","article-title":"Eubiotic properties of rifaximin: Disruption of the traditional concepts in gut microbiota modulation","volume":"23","author":"Ponziani","year":"2017","journal-title":"World J. Gastroenterol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2455","DOI":"10.1007\/s10620-017-4598-7","article-title":"Repeat Rifaximin for Irritable Bowel Syndrome: No Clinically Significant Changes in Stool Microbial Antibiotic Sensitivity","volume":"62","author":"Pimentel","year":"2017","journal-title":"Dig. Dis. Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1038\/nrgastro.2014.66","article-title":"Expert consensus document: The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic","volume":"11","author":"Hill","year":"2014","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.anaerobe.2008.02.001","article-title":"Human-derived probiotic Lactobacillus reuteri demonstrate antimicrobial activities targeting diverse enteric bacterial pathogens","volume":"14","author":"Spinler","year":"2008","journal-title":"Anaerobe"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.anaerobe.2014.07.004","article-title":"In vitro evaluation of the probiotic and functional potential of Lactobacillus strains isolated from fermented food and human intestine","volume":"30","author":"Ren","year":"2014","journal-title":"Anaerobe"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"6463","DOI":"10.1007\/s00253-019-09978-7","article-title":"Adhesion mechanisms mediated by probiotics and prebiotics and their potential impact on human health","volume":"103","author":"Rastall","year":"2019","journal-title":"Appl. Microbiol. Biotechnol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1007\/s11695-020-04900-x","article-title":"Effects of Probiotics Supplementation on Gastrointestinal Symptoms and SIBO after Roux-en-Y Gastric Bypass: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial","volume":"31","author":"Wagner","year":"2021","journal-title":"Obes. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1007\/s10620-019-05830-0","article-title":"Effectiveness of Saccharomyces boulardii and Metronidazole for Small Intestinal Bacterial Overgrowth in Systemic Sclerosis","volume":"65","author":"Jara","year":"2020","journal-title":"Dig. Dis. Sci."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1007\/s12602-018-9401-3","article-title":"Effect of a Preparation of Four Probiotics on Symptoms of Patients with Irritable Bowel Syndrome: Association with Intestinal Bacterial Overgrowth","volume":"11","author":"Leventogiannis","year":"2019","journal-title":"Probiotics Antimicrob. Proteins"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1007\/s10620-018-4945-3","article-title":"Effect of Bifidobacterium infantis 35624 (Align) on the Lactulose Breath Test for Small Intestinal Bacterial Overgrowth","volume":"63","author":"Kumar","year":"2018","journal-title":"Dig. Dis. Sci."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1097\/MCG.0000000000000814","article-title":"Probiotics for Preventing and Treating Small Intestinal Bacterial Overgrowth: A meta-analysis and systematic review of current evidence","volume":"51","author":"Zhong","year":"2017","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e162","DOI":"10.1038\/s41424-018-0030-7","article-title":"Brain fogginess, gas and bloating: A link between SIBO, probiotics and metabolic acidosis","volume":"9","author":"Rao","year":"2018","journal-title":"Clin. Transl. Gastroenterol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/20\/6017\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:52:44Z","timestamp":1760143964000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/20\/6017"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,12]]},"references-count":47,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["jcm11206017"],"URL":"https:\/\/doi.org\/10.3390\/jcm11206017","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,12]]}}}