Regarding diet, studies have focused on diets with a reduction in fermentable products, involving an approach with few fibers and no gluten. However, the recurrence rate after treatment with antibiotics is high, showing that there are no universally accepted treatment approaches for SIBO. H-SIBO is associated with an overgrowth of gram-positive bacteria in the small intestine and usually manifests with diarrheal symptoms. The treatment of M-SIBO tends to be easier than that of H-SIBO and is often associated with constipation. M-SIBO is associated with delayed small bowel and colon motility and is produced under anaerobic conditions. The antibiotics used are based on whether SIBO is associated with methane production (M-SIBO) or hydrogen production (H-SIBO). Rifaximin has been shown to be effective in the treatment of SIBO, despite the heterogeneity found in the studies as well as the lack of a recommendation regarding the dose and duration of treatment. In terms of treatment, the use of antibiotics is currently the gold standard for eradicating bacterial overgrowth. Given the diagnostic limitations, data on the prevalence of SIBO in the general population are unreliable, and the association of SIBO with the main risk factors is supported. ![]() The indication of colonization by methanogens, which are not bacteria but belong to the Archaea domain, led to the proposal of a new term called intestinal overgrowth of methanogens. The noninvasive diagnostic method most commonly used in clinical practice is the measurement of hydrogen gas and/or methane exhaled in the breath after the ingestion of a fixed amount of a carbohydrate substrate. Such symptoms may be due to poor absorption of nutrients or changes in intestinal permeability, as well as the inflammation and/or immune activation that result from pathological bacterial fermentation in the small intestine. The main gastrointestinal symptoms are nausea, diarrhea and/or constipation, flatulence, distension and abdominal pain. Given the growing knowledge on the intestinal microbiota and its role in health and disease processes, a series of studies have linked SIBO with diseases such as irritable bowel syndrome (IBS), inflammatory bowel disease, nonalcoholic fatty liver disease, postgastrectomy syndrome and several other conditions that are considered risk factors for the development of SIBO. However, when changes in any of these mechanisms occur, SIBO can develop. In the physiological state, there are mechanisms to prevent excessive colonization of bacteria in the small intestine, such as an acidic stomach pH, pancreatic enzymes, the intestinal immune system, small intestine peristalsis, the ileocecal valve and the intestinal barrier itself. Small intestinal bacterial overgrowth (SIBO) is defined as a clinical condition caused by excessive numbers of small intestinal bacteria (≥ 10 3 CFU/mL) that include predominantly gram-negative aerobic and anaerobic species. Thus, there is still not enough scientific evidence to support a specific type of diet for the treatment of SIBO. ![]() ![]() Some studies have evaluated diets in the treatment of SIBO however, the studies are of low methodological quality, making extrapolation of the results to clinical practice unfeasible. The gold-standard treatment is based on the use of antibiotics to eradicate bacterial overgrowth. Individuals with SIBO may present gastrointestinal symptoms ranging from nausea, diarrhea and/or constipation, and flatulence to distension and abdominal pain, resulting from poor absorption of nutrients or changes in intestinal permeability. It is known that changes in the intestinal microbiota occur due to several factors, such as the use of medication, age, lifestyle and diseases, which can modify intestinal homeostasis and lead to excessive growth of bacteria in the small intestine, triggering a clinical condition called small bowel bacterial overgrowth (SIBO). The intestinal microbiota and its role in health and disease processes have been the subject of several studies.
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