Treatment of small intestinal bacterial overgrowth
- Mark Pimentel, MD, FRCP(C)
Mark Pimentel, MD, FRCP(C)
- Director, GI Motility Program
- Cedars-Sinai Medical Center
Small intestinal bacterial overgrowth (SIBO) is a condition of excessive colonization of the small intestine by bacteria (most commonly anaerobic bacteria). It can be associated with mucosal inflammation and nutrient malabsorption. Affected patients may be asymptomatic or have one or more symptoms including bloating, abdominal discomfort, diarrhea, dyspepsia, and, in severe cases, weight loss.
This topic review will discuss the treatment of SIBO. The etiology, pathogenesis, clinical manifestations, and diagnosis of SIBO are presented separately. (See "Small intestinal bacterial overgrowth: Etiology and pathogenesis" and "Clinical manifestations and diagnosis of small intestinal bacterial overgrowth".)
TREATMENT OF SMALL INTESTINAL BACTERIAL OVERGROWTH
The mainstay of treatment of small intestinal bacterial overgrowth (SIBO) is antibiotic therapy. If present, the underlying cause/disease should be treated. Dietary manipulation and surgical therapy may also be helpful.
Treatment of the underlying disease — The underlying cause of SIBO may be small intestinal stasis due to anatomic abnormalities (eg, diverticulosis, surgical blind loops or strictures), abnormal small intestinal motility (eg, drug-induced dysmotility, diabetes), abnormal communication between the proximal and distal intestine (eg, fistula), or may be multifactorial in etiology (eg, hypochlorhydria, chronic pancreatitis, associated with irritable bowel syndrome) (table 1). These are discussed separately. (See "Small intestinal bacterial overgrowth: Etiology and pathogenesis", section on 'Epidemiology'.)
●Nonsurgical conditions associated with intestinal stasis should be corrected when possible. This includes the elimination or substitution of drugs known to decrease intestinal motility (eg, narcotics, benzodiazepines).
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