Small Intestinal Bacterial Overgrowth.pdf

112 Gastroenterology Hepatology Volume 3, Issue 2 February 2007 Small Intestinal Bacterial Overgrowth: A Comprehensive Review Andrew C. Dukowicz, MD, Brian E. Lacy, PhD, MD, and Gary M. Levine, MD Dr. Dukowicz is a fellow in the Section of Gastroenterology and Hepatology at the Dartmouth-Hitchcock Medical Center. Dr. Lacy serves as an Associate Professor of Medicine at the Dartmouth Medical School and practices in the section of Gastroenterology and Hepatology at the Dartmouth-Hitchcock Medical Center. Dr. Levine is a Professor of Medicine at Dartmouth Medical School and practices in the Section of Gastroenterology and Hepatology at the Dartmouth-Hitchcock Medical Center. Address correspondence to: Brian Lacy, PhD, MD, Section of Gastroenterology and Hepatology, Area 4C, Dartmouth- Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756; Abstract: Small intestinal bacterial overgrowth (SIBO), defined as excessive bacteria in the small intestine, remains a poorly understood disease. Initially thought to occur in only a small number of patients, it is now apparent that this disorder is more prevalent than previ- ously thought. Patients with SIBO vary in presentation, from being only mildly symptomatic to suffering from chronic diarrhea, weight loss, and malabsorption. A number of diagnostic tests are currently available, although the optimal treatment regimen remains elusive. Recently there has been renewed interest in SIBO and its putative association with irritable bowel syndrome. In this comprehensive review, we will discuss the epidemiology, pathogenesis, clinical mani- festations, diagnosis, and treatment of SIBO. Keywords Bacterial overgrowth, small intestinal bacterial overgrowth, diarrhea, bloating, motility disorders, antibiotics Small intestinal bacterial overgrowth (SIBO) is defined as the presence of excessive bacteria in the small intestine. SIBO is frequently implicated as the cause of chronic diarrhea