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1、REVIEWCURRENTOPINIONSmallintestinalbacterialovergrowth:whatitisandwhatitisnotEamonnM.M.QuigleyPurposeofreviewTocriticallyreviewrecentliteratureonsmallintestinalbacterialovergrowth(SIBO).RecentfindingsWhenoriginallydescribed,SIBOwasaddedtothelistofcauseso
2、fthemalabsorptionsyndromeandthepathophysiologyofitsconsequencesforthedigestionandabsorptionofvariousnutrientswasgraduallyrevealed.Morerecently,SIBOwasincriminatedasacauseofdiarrhea,especiallyintheelderly.However,thesuggestionthatSIBOmaybeacausativefactor
3、inirritablebowelsyndromeandofitsconstituentsymptomshassparkeddebateandcontroversyontheverydefinitionofSIBO.Thisdebaterevolvesaroundthetestsemployedandthediagnosticcut-offvalues(forbacterialnumbers)usedtodiagnoseSIBOinclinicalpractice.SummaryAfundamentalp
4、roblemwithSIBO,andonethatallowscontroversytosimmer,isthelackofauniversallyacceptedandappliedgoldstandardforthediagnosisofSIBO.Hopefully,theapplicationofmolecularmicrobiologicalmethodstothecharacterizationofthesmallintestinalmicrobiomewilltellus,onceandfo
5、rall,whatisnormalandwhen‘abnormality’istrulyresponsibleforsymptomsanddisease.Meanwhile,therapyremains,forthemostpart,empiricalandisbasedonthecorrection,whereverpossible,ofanyunderlyingcause,attentiontonutritionaldeficiencies,andtheuseofantibiotics.Keywor
6、dsdiarrhea,hydrogenbreathtest,jejunalculture,malabsorption,smallintestinalbacterialovergrowthINTRODUCTIONentertainedshifteddramaticallyfromthoseafore-Whenoriginallydescribedinaseriesofclassicalmentionedsituationsinwhichaplausiblebasisforclinicalandpathop
7、hysiologicalstudiesperformedthedevelopmentofSIBOwasevidentanditsclinicaltowardthemiddleofthelastcentury,smallintes-consequences(steatorrhea,B12deficiency,protein-tinalbacterialovergrowth(SIBO)couldbelosingenteropathy)visible,toasituationinwhichsuccinctly
8、definedas‘clinicaland/orlaboratorySIBOisincriminatedasthecauseofabroadspec-evidenceofmaldigestion/malabsorptionrelatedtotrumofintestinalandextraintestinalills.Agoodqualitativeand/orquantitativealterationsintheexampleofthis
