SIBO

Use of Probiotics and Synbiotics in the Treatment of Small Intestinal Bacterial Overgrowth (SIBO) and Other Gastrointestinal Symptoms After Metabolic Bariatric Surgery: a Systematic Review and Meta-Analysis.

Wagner NRF, Fernandes R, Teixeira Frota Reichmann M, Lopes MCP, Welc LLS, Campos ACL · Obesity surgery · 2025

Metabolic bariatric surgery is considered the most effective treatment for severe obesity, however it may be associated with the development of Small Intestinal Bacterial Overgrowth (SIBO) and other gastrointestinal symptoms (GIS). This study conducted a systematic review and meta-analysis to evaluate the effects of probiotics or synbiotics on GIS and SIBO in post- metabolic bariatric surgery patients. Five studies that investigated the effect of probiotics or synbiotics in the treatment of post-surgery GIS were included in the review, with three focusing on SIBO. For the meta-analysis, three studies assessed GIS, and two examined SIBO. The results showed that probiotics did not offer significant benefits in treating GIS or SIBO in these patients.

Proton pump inhibitors are not associated with an increased risk of Clostridioides difficile infection: a systematic review and meta-analysis of randomized controlled trials.

Floria DE, Obeidat M, Váncsa S, Kávási SB, Földvári-Nagy L, Hegyi P · Gut microbes · 2025 · n=880

Observational studies reported conflicting results regarding the association between proton pump inhibitors (PPIs) and intestinal dysbiosis. We assessed the risk of enteric infections, including Clostridioides difficile infection (CDI), and small intestinal bacterial overgrowth (SIBO) among PPI users compared to non-users in randomized controlled trials (RCTs). A systematic search was conducted on April 15th, 2025 (CRD42023403322). Eligible RCTs compared adults treated with PPIs versusplacebo or alternative therapies. Risk ratios (RR) with corresponding 95% confidence interval (CI) were calculated using random effects models. Eight RCTs with 29,880 participants reported CDI rates. No significant difference was observed between PPI users and non-users (RR = 1.19, 95% CI: 0.75; 1.89). Four RCTs totaling 27,254 participants compared PPIs to H2-receptor blockers, showing no significant difference in CDI risk (RR = 0.72, 95% CI: 0.49; 1.07). Similarly, three RCTs

The efficacy of probiotics, prebiotics or synbiotics in scleroderma: A systematic review.

Wach AA, Storman D, Więckowski K, Wojtaszek-Główka M, Żabicka W, Krupka K · Clinical nutrition ESPEN · 2025 · n=56

Pathogenesis of systemic scleroderma is a complex subject. Previous research has emphasized a possible contribution of the intestinal microbiome in developing symptoms. The use of probiotic formulas brings benefit in treatment of various autoimmune diseases, but the evidence for scleroderma is still not exhaustive. No official recommendations have been formulated on this topic, nor has the existing evidence been evaluated. We aimed to assess the efficacy of probiotics, prebiotics, or synbiotics in patients with scleroderma with a focus on the improvement of symptoms and change in the quality of life (QoL) both measured using validated scales, small intestinal bacterial overgrowth (SIBO) eradication, as well as change in the intensity of interstitial lung disease and occurrence of pulmonary hypertension. We performed a systematic search for randomized trials that assessed the beneficial and harmful effects of pro-, pre-, and synbiotics in patients with scleroderma. Pairs of authors in

Small Intestinal Bacterial Overgrowth and Pediatric Obesity-A Systematic Review.

Koller AM, Săsăran MO, Mărginean CO · Nutrients · 2025

Background/Objectives: Childhood obesity is a growing global concern linked to metabolic disorders such as nonalcoholic fatty liver disease (NAFLD). Small intestinal bacterial overgrowth (SIBO) may exacerbate these conditions by promoting systemic inflammation and metabolic dysfunction. This review evaluates the prevalence of SIBO in obese children, its association with inflammatory and metabolic markers, and the efficacy of diagnostic and therapeutic strategies. Methods: A systematic search of PubMed, Scopus, and Web of Science (2010-present) was conducted using Boolean operators: ('small intestinal bacterial overgrowth' OR 'SIBO') AND 'prevalence' AND ('low-grade inflammatory markers' OR 'metabolic status') AND 'gut microbiome' AND 'dysbiosis' AND 'obese children'. Results: The data show that SIBO is frequently observed in obese pediatric populations and is associated with gut dysbiosis, impaired nutrient absorption, and reduced production of short-chain fatty acids. These changes co

SMALL INTESTINAL BACTERIAL OVERGROWTH IN PEOPLE WITH CYSTIC FIBROSIS: SYSTEMATIC REVIEW.

Landim MLL, Ribeiro JD, Borgli DSP, Bonilha DRQM, Lomazi EA, Servidoni MFCP · Arquivos de gastroenterologia · 2025

In patients with cystic fibrosis (pwCF) acid suppression therapy, gastrointestinal dysmotility, and post-operative bowel status, may predispose to the development of small intestinal bacterial overgrowth (SIBO). SIBO may continue to be present in the progression of the disease even on modulators. Breath testing is the most simple, non-invasive and available method for diagnosing SIBO. There are some divergencies over the operational procedures used to carry out and interpret breath tests in pwCF. We performed a systematic review of SIBO in pwCF to assess the methods used in breath tests and the existence of causal relationship between SIBO and following CF co-morbidities: liver disease, fat absorption, and eating disorders. We searched the PubMed, Cochrane Library, Embase, LILACS, MEDLINE, OpenGray, medRxiv, Google Scholar, and CAPES databases up to March 20, 2024. We selected clinical cohort and case-control studies to assess SIBO in cwCF. We selected studies that met the following

Show Me What You Have Inside-The Complex Interplay between SIBO and Multiple Medical Conditions-A Systematic Review.

Sroka N, Rydzewska-Rosołowska A, Kakareko K, Rosołowski M, Głowińska I, Hryszko T · Nutrients · 2022

The microbiota, as a complex of microorganisms in a particular ecosystem, is part of the wider term-microbiome, which is defined as the set of all genetic content in the microbial community. Imbalanced gut microbiota has a great impact on the homeostasis of the organism. Dysbiosis, as a disturbance in bacterial balance, might trigger or exacerbate the course of different pathologies. Small intestinal bacterial overgrowth (SIBO) is a disorder characterized by differences in quantity, quality, and location of the small intestine microbiota. SIBO underlies symptoms associated with functional gastrointestinal disorders (FGD) as well as may alter the presentation of chronic diseases such as heart failure, diabetes, etc. In recent years there has been growing interest in the influence of SIBO and its impact on the whole human body as well as individual systems. Therefore, we aimed to investigate the co-existence of SIBO with different medical conditions. The PubMed database was searched up t

Diagnosis and treatment options for chronic abdominal pain after Roux-en-Y gastric bypass.

Oviedo RJ, Altieri MS, Aylward L, Banerjee A, Noria SF, Seeger CM · Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery · 2026

Roux-en-Y gastric bypass (RYGB) is a widely performed and well-established metabolic and bariatric surgery (MBS) procedure around the world based on its high efficacy and low complication profile when offered to appropriately selected candidates. However, it is still associated with chronic abdominal pain confounded by nonspecific symptoms and signs that many times lead to a delay in diagnosis or excessive and unnecessary testing that may put patients at risk for long-term complications and adverse events. Among the most important causes of chronic abdominal pain after RYGB are marginal ulcers, intussusception, internal hernias, bile reflux gastritis, dumping syndrome, small intestinal bacterial overgrowth (SIBO), candy cane syndrome, biliary pathology, vascular etiologies, and gastroesophageal reflux disease (GERD). A comprehensive literature review based on the highest-level available published manuscripts has been conducted with the goal of providing the readers and members from the

European Consensus on Malabsorption-UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN. Part 1: Definitions, Clinical Phenotypes, and Diagnostic Testing for Malabsorption.

Lenti MV, Hammer HF, Tacheci I, Burgos R, Schneider S, Foteini A · United European gastroenterology journal · 2025

Malabsorption is a complex and multifaceted condition characterised by the defective passage of nutrients into the blood and lymphatic streams. Several congenital or acquired disorders may cause either selective or global malabsorption in both children and adults, such as cystic fibrosis, exocrine pancreatic insufficiency (EPI), coeliac disease (CD) and other enteropathies, lactase deficiency, small intestinal bacterial overgrowth (SIBO), autoimmune atrophic gastritis, Crohn's disease, and gastric or small bowel resections. Early recognition of malabsorption is key for tailoring a proper diagnostic work-up for identifying the cause of malabsorption. A patient's medical and pharmacological history is essential for identifying risk factors. Several examinations such as endoscopy with small intestinal biopsies, non-invasive functional tests and radiological imaging are useful in diagnosing malabsorption. Because of its high prevalence, CD should always be looked for in cases of malabsorpt

CLINICAL PRACTICE GUIDELINES FOR THE PERIOPERATIVE NUTRITION, METABOLIC, AND NONSURGICAL SUPPORT OF PATIENTS UNDERGOING BARIATRIC PROCEDURES - 2019 UPDATE: COSPONSORED BY AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS/AMERICAN COLLEGE OF ENDOCRINOLOGY, THE OBESITY SOCIETY, AMERICAN SOCIETY FOR METABOLIC & BARIATRIC SURGERY, OBESITY MEDICINE ASSOCIATION, AND AMERICAN SOCIETY OF ANESTHESIOLOGISTS - EXECUTIVE SUMMARY.

Mechanick JI, Apovian C, Brethauer S, Garvey WT, Joffe AM, Kim J · Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2019

Objective: The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society, American Society of Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. Methods: Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. Results: New or updated topics in this CPG include: contextualization in an adiposity-based chronic disease complications-centric model, nuance-based and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health-care arena. There are 85 numbered

Effect, Tolerability, and Safety of Exclusive Palatable Elemental Diet in Patients With Intestinal Microbial Overgrowth.

Rezaie A, Chang BW, de Freitas Germano J, Leite G, Mathur R, Houser K · Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2025

Elemental diets (EDs) have desirable safety and efficacy profiles in several clinical settings partly because of modulation of gut microbiome. Palatability of EDs remains the main barrier to compliance/adherence, and their effect has not been prospectively explored in microbiome-driven disorders, such as small intestinal bacterial overgrowth (SIBO) and intestinal methanogen overgrowth (IMO). We aimed to assess the effect, tolerance, and safety of a novel palatable ED (PED) in subjects with IMO and/or SIBO. Adult subjects with positive lactulose breath tests for SIBO and/or IMO completed 1 week of screening, 2 weeks of exclusive oral PED, and 2 weeks of follow-up during reintroduction of regular diet. Primary end point was changes in stool microbiome after PED and reintroduction of regular diet. Secondary end points included tolerability, rate of normalization of lactulose breath tests, change in stool form based on daily diary and artificial intelligence-analyzed images, symptomatic r

Do Herbal Supplements and Probiotics Complement Antibiotics and Diet in the Management of SIBO? A Randomized Clinical Trial.

Redondo-Cuevas L, Belloch L, Martín-Carbonell V, Nicolás A, Alexandra I, Sanchis L · Nutrients · 2024

Small intestinal bacterial overgrowth (SIBO) arises from dysbiosis in the small intestine, manifesting with abdominal symptoms. This study aims to assess the efficacy of combined antibiotic therapy, herbal supplements, probiotics, and dietary modifications in SIBO management. A total of 179 SIBO-diagnosed patients underwent clinical evaluation and breath testing. Patients were categorized into hydrogen (H2-SIBO) and methane (CH4-SIBO) groups. The control group received standard antibiotic therapy and a low-FODMAP diet, while the intervention group received additional herbal antibiotics, probiotics, and prebiotics. After treatment, both groups exhibited reduced gas levels, particularly in CH4-SIBO. Clinical remission rates were higher in the intervention group, especially in CH4-SIBO cases. Logistic regression analysis showed gas concentrations at diagnosis as significant predictors of treatment success. In conclusion, adjunctive herbal supplements and probiotics did not significantly i

Impact of Saccharomyces boulardii CNCM I-745 on Bacterial Overgrowth and Composition of Intestinal Microbiota in Diarrhea-Predominant Irritable Bowel Syndrome Patients: Results of a Randomized Pilot Study.

Bustos Fernández LM, Man F, Lasa JS · Digestive diseases (Basel, Switzerland) · 2023 · n=54

Small intestinal bacterial overgrowth (SIBO) is associated with diarrhea-predominant irritable bowel syndrome (IBS-D). Probiotics like Saccharomyces boulardii CNCM I-745 (Sb) may be efficacious in balancing the microbiota. This randomized open label study assessed the effect of Sb in patients with bacterial overgrowth associated with IBS-D and its impact on the intestinal microbiota. Patients were randomized to receive Sb + dietary advice (Sb + DA) or dietary advice (DA) only for 15 days. SIBO was assessed by the lactulose hydrogen breath test (LHBT). Symptoms were assessed with the IBS Symptom Severity Scale (IBS-SSS) and stool consistency with the Bristol Stool Form Scale. Microbiota and mycobiota were analyzed by 16S rDNA and ITS2. 54 patients were included, among whom 48 (27 Sb + DA, 21 DA) were evaluated. Decrease of hydrogen excretion was slightly higher in Sb + DA group, 41% versus 29% in DA group, and IBS-SSS total score were reduced by -134 and -93, respectively. The proport

Hydrogen-Positive Small Intestinal Bacterial Overgrowth (SIBO) in Japanese Patients With Chronic Intestinal Pseudo-Obstruction (CIPO): A Cross-Sectional Study.

Igarashi T, Tominaga K, Yokoyama K, Wakabayashi T, Kojima Y, Kawata Y · Cureus · 2025

Evidence for small intestinal bacterial overgrowth (SIBO) in chronic intestinal pseudo‑obstruction (CIPO) remains limited in Asian populations and by gas phenotype. This study aimed to determine the prevalence and gas phenotype distribution (hydrogen-positive SIBO vs. intestinal methanogen overgrowth) in Japanese patients with CIPO using glucose breath testing and to describe associated clinical features. This single‑center cross‑sectional study was conducted at Niigata University, Niigata, Japan (April 2019-March 2022), and included 10 CIPO outpatients and 10 healthy controls. Participants fasted for 12 hours and avoided high-fiber foods for 24 hours before testing. Glucose breath testing (50 g, institutional SOP) measured hydrogen (H₂) and methane (CH₄); positivity followed North American Consensus criteria (ΔH₂ ≥20 ppm by 90 min; CH₄ ≥10 ppm). The primary outcome was hydrogen‑positive SIBO (H₂&#

[SIBO, from myth to reality].

Escoda T, Retornaz F, Plauzolles A, Halfon P · La Revue de medecine interne · 2025

Digestive functional disorders are among the most frequent reasons for medical consultation and a significant source of medical wandering. Therapeutic management of these patients is difficult, particularly due to the absence of specific treatment linked to an incomplete understanding of the pathophysiological mechanisms. In a certain number of these patients, the symptoms are accompanied by a small intestinal bacterial overgrowth (SIBO). This entity, historically identified in specific post-surgical situations, seems finally very common and associated with very diverse pathologies. The diagnosis of SIBO is currently being made more accessible through the development of breathing tests. Therapeutic management, based mainly on antibiotic therapy and diet, remains to date largely empirical because it is based on few studies but the growing interest in SIBO should make it possible to identify effective treatments during robust clinical trials.

Small Intestinal Bacterial and Fungal Overgrowth: Health Implications and Management Perspectives.

Soliman N, Kruithoff C, San Valentin EM, Gamal A, McCormick TS, Ghannoum M · Nutrients · 2025

Small Intestinal Bacterial Overgrowth (SIBO) and Small Intestinal Fungal Overgrowth (SIFO) are distinct yet often overlapping conditions characterized by an abnormal increase in microbial populations within the small intestine. SIBO results from an overgrowth of colonic bacteria, while SIFO is driven by fungal overgrowth, primarily involving Candida species. Both conditions present with nonspecific gastrointestinal (GI) symptoms such as bloating, abdominal pain, diarrhea, and malabsorption, making differentiation between SIBO and SIFO challenging. This review aims to elucidate the underlying mechanisms, risk factors, diagnostic challenges, and management strategies associated with SIBO and SIFO. A comprehensive review of current literature was conducted, focusing on the pathophysiology, diagnostic modalities, and therapeutic approaches for SIBO and SIFO. SIBO is commonly associated with factors such as reduced gastric acid secretion, impaired gut motility, and structural abnormalitie

Does Colectomy Predispose to Small Intestinal Bacterial (SIBO) and Fungal Overgrowth (SIFO)

n=100 · NCT03216239 · COMPLETED · COMPLETED

After subtotal colectomy, 40% of patients report abdominal pain, gas and diarrhea, and poor quality of life; whose etiology is unknown. The investigators determined whether small intestinal bacterial (SIBO or fungal overgrowth SIFO) could cause these sympotoms (\> 1 year).

Effect of a Low FODMAP Diet on SIBO Breath Test Positivity

n=14 · NCT04627727 · TERMINATED · TERMINATED

Bloating is the most common symptom associated with disorders of brain-gut interaction (i.e., functional bowel disorders) such as irritable bowel syndrome, a disorder characterized by abdominal pain and altered bowel habits which affects up to 11% of world population. A common cause of bloating is small intestinal bacterial overgrowth (SIBO), a condition defined by excessive and/or abnormal type of bacteria in the small bowel. The potential role of SIBO for irritable bowel syndrome (IBS) was initially proposed by Pimentel et al. Using lactulose breath tests (LBTs), 78% of patients with IBS were also diagnosed with SIBO. After antibiotic therapy, 48% of patients no longer met the Rome criteria for IBS. A recent systematic review and meta-analysis concluded that the prevalence of SIBO is increased in IBS.

Rifaximin Therapy Versus Low FODMAP Diet In Irritable Bowel Syndrome: A Randomised Controlled Trial

n=100 · NCT04841980 · UNKNOWN · UNKNOWN

Functional gastrointestinal disorders (FGIDs) are common and from the most recent global epidemiology study, an estimated 40% of the world population suffer from the condition. FGIDs cause significant morbidity to patients, despite not influencing mortality. IBS is among the most important functional gastrointestinal disorder with an estimated 3.8 to 9.2 % of the general population worldwide were affected by this disorder. Rifaximin (gut specific antibiotic) and low FODMAP diet (dietary based therapy) were proven to be effective in treating irritable bowel syndrome (IBS), however there was no head-to-head study comparing both treatments. This study will help doctors to understand the efficacy of different IBS/SIBO treatments. With the evaluation of factors that can predict treatment response, doctor could potentially treat IBS and SIBO more effectively in future. The purpose of the study is to compare the clinical symptoms and psychological improvement in patients with irritable bowel syndrome (IBS) after treatment with Rifaximin versus treatment with low FODMAP diet. The factors that is associated with treatment response will also be evaluated. In IBS patients with small intestinal bacterial overgrowth (SIBO), eradication rate of SIBO will be evaluated.

Small intestinal bacterial overgrowth (SIBO) therapy

Cochrane

Cochrane Library offers systematic reviews and meta-analyses, providing high-quality evidence regarding various SIBO therapies. This resource is crucial for understanding the efficacy of different treatment approaches.

SIBO

TRIP Database

TRIP Database is a clinical search engine designed to allow users to quickly and easily find high-quality evidence for clinical practice. It aggregates evidence from various sources on SIBO.

Cochrane Library searches for 'small intestinal bacterial overgrowth'

Cochrane

The Cochrane Library provides a collection of systematic reviews and meta-analyses, offering high-quality evidence to inform healthcare decision-making related to SIBO.