![]() The status of SIBO rests ultimately on our ability to accurately and reproducibly diagnose it (Table 4). 115 Second, as reviewed in the preceding section, a The Diagnosis of SIBO–Current Challenges First, risk factors for SIBO (hypochlorhydria, dysmotility, and impaired immune response) have been described among those affected. ![]() This is plausible on a number of grounds. ![]() That SIBO could cause diarrhea in the absence of other clinical features of maldigestion or malabsorption (steatorrhea, malnutrition, and vitamin and nutrient deficiencies) was recognized more than half a century ago and noted to be especially prevalent among the elderly. It can be readily observed that, whereas the likelihood of a positive test for SIBO varies SIBO as a Cause of Maldigestion and Malabsorptionįrom the discussion of factors that normally maintain microbial homeostasis in the small intestine one can readily predict those circumstances where SIBO and resultant malabsorption are likely to occur: anatomic anomalies or surgical rearrangements that foster stasis or the exposure of the proximal small intestinal to colonic microbiota, loss of the antibacterial effects of gastric acid, bile, or pancreatic enzymes, and impaired motility promoting stasis and defective immune surveillance of SIBO Associated With Symptoms or Clinical Entities in the Absence of Evidence of Maldigestion/Malabsorption Table 1 presents several representative studies of SIBO prevalence in symptomatic and asymptomatic control populations,23, 24, 25, 26, 27, 28, 29, 30 whereas Table 2 presents common disorders that have been associated with SIBO. In the absence of any community-based data, our only information on the prevalence of SIBO is mostly derived from retrospective surveys in symptomatic or at-risk cohorts. SIBO associated with Epidemiology and Risk Factors SIBO as a cause of maldigestion/malabsorption here the clinical presentation can be related to the effects of contaminating organisms on host morphology or function that, in turn, result in the clinical consequences typically associated with SIBO, such as steatorrhea, diarrhea, protein losing-enteropathy, and/or specific deficiency states. In discussing the epidemiology, etiology, and pathophysiology of SIBO we distinguish between 2 potential clinical manifestations of SIBO: 1. In discussing current approaches to the diagnosis of SIBO it is vital to remember that this is the context in which many of our currently used The Clinical Spectrum of SIBO Then referred to as “the blind loop syndrome,” SIBO was recognized as representing the consequences of bacterial overgrowth in, or “contamination” of, the small intestine leading to a malabsorption syndrome. Our concept of SIBO has evolved considerably over time and a review of this history is vital toward an understanding of where we are today. One hopes that the application of an ever-expanding armamentarium of modern molecular microbiology to the human small intestinal microbiome in both health and disease will ultimately resolve this impasse and provide an objective basis for the diagnosis of SIBO. Furthermore, the pathophysiological plausibility that underpins SIBO as a cause of maldigestion/malabsorption is lacking in regard to its purported role in irritable bowel syndrome, for example. However, issues with the specificity of these same breath tests have clouded their interpretation and aroused some skepticism regarding the role of SIBO in this expanded clinical repertoire. The advent and ready availability of breath tests generated a dramatic expansion in both the rate of diagnosis of SIBO and the range of associated gastrointestinal and nongastrointestinal clinical scenarios. ![]() Coincident with advances in medical science, diagnostic testing evolved from small bowel culture to breath tests and on to next-generation, culture-independent microbial analytics. Such colonization resulted in clinical signs, symptoms, and laboratory abnormalities that were explicable within a coherent pathophysiological framework. The concept of small intestinal bacterial overgrowth (SIBO) arose in the context of maldigestion and malabsorption among patients with obvious risk factors that permitted the small bowel to be colonized by potentially injurious colonic microbiota.
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