Perspectives in clinical gastroenterology and hepatologyBreath Testing for Small Intestinal Bacterial Overgrowth: Maximizing Test Accuracy
Section snippets
Pathophysiology of Small Intestinal Bacterial Overgrowth
Several key mechanisms play a role in preventing bacteria overgrowth in the proximal gut including gastric acid; the migrating motor complex; integrity of the intestinal mucosa; the gut immune system; enzymatic activities of intestinal, pancreatic, and biliary secretions; direct effects of commensal bacterial within the small bowel; and the physical barrier created by the ileocecal valve.7 A number of conditions capable of adversely affecting one or more of these protective mechanisms have been
Small-Bowel Aspiration and Quantitative Culture
Small-bowel aspiration for quantitative culture traditionally has been regarded as the gold standard for the diagnosis of SIBO. Because it is imperative not to contaminate the sample, aspiration is performed either through an endoscopically or fluoroscopically confirmed guidewire-placed sterile catheter.33, 34 It is also important that the specimen be transferred promptly to the appropriate laboratory for culturing under aerobic and anaerobic conditions. However, small bowel culturing
Concluding Remarks
There remains a need for a gold standard test for SIBO. The invasive nature of testing, lack of standardization, sampling error, the need for dedicated infrastructure, and high cost cast doubt on the legitimacy of small-bowel aspiration and quantitative culture as a gold standard. Breath testing provides a solution to some of the practical issues that detract from aspiration and quantitative culture, but suffers from its own limitations. Proper patient selection, test preparation, standardized
References (78)
The continuing crisis in antibiotic resistance
Int J Antimicrob Agents
(2010)Resistance to antibiotics: are we in the post-antibiotic era?
Arch Med Res
(2005)- et al.
Small intestinal bacterial overgrowth
Infect Dis Clin North Am
(2010) - et al.
Small intestinal bacterial overgrowth and thiamine deficiency after Roux-en-Y gastric bypass surgery in obese patients
Nutr Res
(2008) - et al.
Enteric microbial flora, bacterial overgrowth, and short-bowel syndrome
Clin Gastroenterol Hepatol
(2006) - et al.
High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal
Am J Gastroenterol
(2003) - et al.
Chronic intestinal pseudo-obstruction: clinical features, diagnosis, and therapy
Gastroenterol Clin North Am
(2011) - et al.
Immune dysfunction and infections in patients with cirrhosis
Clin Gastroenterol Hepatol
(2011) Chronic pancreatitis and persistent steatorrhea: what is the correct dose of enzymes?
Clin Gastroenterol Hepatol
(2011)- et al.
Bacterial overgrowth without clinical malabsorption in elderly hypochlorhydric subjects
Gastroenterology
(1994)
Increased incidence of small intestinal bacterial overgrowth during proton pump inhibitor therapy
Clin Gastroenterol Hepatol
Methods and functions: breath tests
Best Pract Res Clin Gastroenterol
Breath tests for gastrointestinal disease: the real deal or just a lot of hot air?
Gastroenterology
Detection of small intestine bacterial overgrowth by means of a 14C-D-xylose breath test
Gastroenterology
Comparison of the 1-gram [14C]xylose, 10-gram lactulose-H2, and 80-gram glucose-H2 breath tests in patients with small intestine bacterial overgrowth
Gastroenterology
Volume, composition, and source of intestinal gas
Gastroenterology
A new chromatographic instrument for measuring trace concentrations of breath-hydrogen
J Chromatogr
Stability of human methanogenic flora over 35 years and a review of insights obtained from breath methane measurements
Clin Gastroenterol Hepatol
Using breath tests wisely in a gastroenterology practice: an evidence-based review of indications and pitfalls in interpretation
Am J Gastroenterol
The diagnosis of small bowel bacterial overgrowth. Reliability of jejunal culture and inadequacy of breath hydrogen testing
Gastroenterology
Breath-hydrogen test for small-intestinal bacterial colonisation
Lancet
Diagnosis of small intestinal bacterial overgrowth in patients with cirrhosis of the liver: poor performance of the glucose breath hydrogen test
J Hepatol
Macrocytic anemia in association with intestinal strictures and anastomosis
Bull Johns Hopkins Hospital
Small intestinal bacterial overgrowth
Scand J Gastroenterol
Results of small intestinal bacterial overgrowth testing in irritable bowel syndrome patients: clinical profiles and effects of antibiotic trial
Adv Med Sci
Abnormal breath testing in IBS: a meta-analysis
Dig Dis Sci
Clinical predictors of small intestinal bacterial overgrowth by duodenal aspirate culture
Aliment Pharmacol Ther
The role of small intestinal bacterial overgrowth in postgastrectomy patients
Neurogastroenterol Motil
Small intestinal bacterial overgrowth in patients with lower gastrointestinal symptoms and a history of previous abdominal surgery
Arch Surg
Intestinal bacterial overgrowth after Roux-en-Y gastric bypass
Obes Surg
The prevalence of overgrowth by aerobic bacteria in the small intestine by small bowel culture: relationship with irritable bowel syndrome
Dig Dis Sci
Small bowel bacterial overgrowth and type 1 diabetes
Eur Rev Med Pharmacol Sci
Small intestinal bacterial overgrowth in systemic sclerosis
Rheumatology (Oxford)
Small intestinal bacterial overgrowth in patients suffering from scleroderma: clinical effectiveness of its eradication
Am J Gastroenterol
Prevalence of small intestine bacterial overgrowth diagnosed by quantitative culture of intestinal aspirate in celiac disease
J Clin Gastroenterol
Partially responsive celiac disease resulting from small intestinal bacterial overgrowth and lactose intolerance
BMC Gastroenterol
Breath hydrogen test using water-diluted lactulose in patients with gastrointestinal amyloidosis
Dig Dis Sci
The thyroid and the gut
J Clin Gastroenterol
Small intestinal bacterial overgrowth in gastroparesis
Dig Dis Sci
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This article has an accompanying continuing medical education activity on page e119. Learning Objective–At the end of this activity, the successful learner will be able to understand measures to improve the diagnostic accuracy of breath testing for suspected small intestinal bacterial overgrowth.
Conflicts of interest The authors disclose no conflicts.