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This research studies goal was to determine whether there is a link between small intestinal bacterial overgrowth (SIBO) and abdominal pain related functional gastrointestinal disorders (AP-FGID) in children.  The study enrolled 161 children who were diagnosed with AP-FGID using the Rome III criteria.  Each child was given a glucose hydrogen breath test to determine the presence of SIBO.  The result was that 23 children (14.3%) were positive for SIBO.  Interestingly the children that tested positive had similar symptoms – change in frequency of form of stool, loss of appetite and belching.

The hydrogen breath test continues to be the best alternative for diagnosing small intestinal bacterial overgrowth (SIBO).  In this peer reviewed article the researchers critically reviewed papers from 1990 to the present concerning the topic of SIBO diagnosis.  There conclusion was that the hydrogen breath test – both the lactulose and glucose versions – remain the most viable testing method to determine SIBO.

Dr. Anthony Lembo of Beth Israel Deaconess Medical Center announced that he will present the results of TARGET 3 at the American College of Gastroenterology meeting.  TARGET 3 is a Phase 3 study of the efficacy and safety of repeat treatment with rifaximin in subjects with IBS-D that previously responded to an initial treatment course of rifaximin and subsequently experienced a recurrence of their IBS-D symptoms.  Rifaximin, is widely used to treat small intestinal bacterial overgrowth, but is not currently approved for use in IBS-D and is currently under review by the FDA. The TARGET 3 study was designed with both an open-label and a double-blind phase.

A recent study done at the Boston Children’s Hospital shows that H2-receptor antagonists significantly increases the incidence of small intestinal bacterial overgrowth (SIBO) in children.  In the study group 46% of children taking the antiacids tested positive for SIBO.  Whereas only 18% of children complaining of stomach pain but not being treated were positive for SIBO.  These results support the conclusion that acid-suppression therapy changes the gastric microflora and can introduce new problems.  More study needs to be done to determine what doses of acid –suppression therapy would effectively treat the gastric distress symptoms but not lead to SIBO.

This research focused on the benefits of using probiotic therapy for patients with chronic liver disease, small intestinal bacterial overgrowth (SIBO) and intestinal permeability problems.  The study enrolled 53 patients who consumed for 4 weeks a cocktail of 6 bacterial species. The result was that SIBO was resolved in many of the patients but intestinal permeability was not.  This led the researchers to conclude that in liver disease patients’ probiotics are effective treatment for SIBO.

Rifaximin is the antibiotic of choice for treating small intestinal bacterial overgrowth (SIBO).  However, many patients prefer to avoid antibiotic therapy and use natural remedies.  This study looked at the efficacy of using a herbal capsules BID containing following commercial herbal preparations: Dysbiocide^®, FC-Cidal^TM, Candibactin-AR^®, Candibactin-BR^® versus using rifaximin.  Three hundred and ninety six (396) subjects were tested using the lactulose hydrogen breath test.  In this group 104 patients became the focus of the study because they tested positive for SIBO and had a follow-up breath test to determine the outcome of the therapy.  The study group had 37 subjects taking the herbal therapy and 67 elected to use rifaximin.  After a month of therapy the subjects were tested and 46% taking the herbal treatment tested negative whereas only 34% of the rifaximin subjects tested negative.  Adverse side effects for rifaximin affected 6 subjects but only 1 subject had an adverse reaction from the herbal therapy.  More study is necessary to confirm the results but these findings a promising for patients looking for an alternative to antibiotic therapy.

Proton pump inhibitors (PPI’s) can affect the microbiota of the intestinal tract.  As a result, it has been suggested that people taking PPI‘s might be at a higher risk for small intestinal bacterial overgrowth (SIBO).  This hypothesis was tested in a retrospective study of 1,191 patients of which 566 were on PPI therapy.  Each these subjects received a glucose hydrogen breath test to check for the presence of SIBO. The result was no correlation was found that showed taking PPI’s increased the risk for SIBO.  The only increased risk was age – regardless of consumption of PPI’s.

Previous research has established that small intestinal bacterial overgrowth (SIBO) is common in patients with chronic pancreatitis caused by excessive consumption of alcohol.  This new research examined if SIBO is also prevalent in patients with chronic idiopathic pancreatitis.  68 patients were enrolled in the study – 46 had idiopathic chronic pancreatitis and 22 had alcoholic.  Each subject was tested with the glucose hydrogen breath test.  The result was that there was a high prevalence of SIBO in both types of pancreatitis.

The hydrogen breath test shows the bacterial fermentation of unabsorbed intestinal carbohydrates. Malabsorption of carbohydrates is a key trigger of irritable bowel syndrome type symptoms such as diarrhea and/or constipation, bloating, excess flatulence, headaches and lack of energy.  When bacteria is present in the small intestine this bacteria will metabolize the carbohydrates producing the IBS like symptoms.  The authors of this research believe that patients with persistent symptoms of abdominal bloating and distension despite dietary intervention should take a hydrogen breath test to determine if they have small intestinal bacterial overgrowth (SIBO).  A proper diagnosis of SIBO can lead to effective treatment of the condition and relief of the IBS symptoms.

Altered small intestinal motility increases the risk of developing small intestinal bacterial overgrowth (SIBO).  Hypothyroidism is known to alter small intestinal motility.  This research conducted in India evaluated the link and found that patients with hypothyroidism have a high propensity to develop SIBO.  The researchers used the hydrogen breath test to detect SIBO.  Fortunately, both antibiotics and probiotics can effectively manage the symptoms of SIBO.