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Cited by 780Gastrointestinal motility and disordersGut microbiota and healthMicroscopic Colitis

Eradication of Small Intestinal Bacterial Overgrowth Reduces Symptoms of Irritable Bowel Syndrome

Pimentel, Mark, Chow, Evelyn J, Lin, Henry C·2000·American Journal of Gastroenterology
DOI 10.1111/j.1572-0241.2000.03368.x
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Abstract

OBJECTIVES: Irritable bowel syndrome is the most common gastrointestinal diagnosis. The symptoms of irritable bowel syndrome are similar to those of small intestinal bacterial overgrowth. The purpose of this study was to test whether overgrowth is associated with irritable bowel syndrome and whether treatment of overgrowth reduces their intestinal complaints. METHODS: Two hundred two subjects in a prospective database of subjects referred from the community undergoing a lactulose hydrogen breath test for assessment of overgrowth were Rome I criteria positive for irritable bowel syndrome. They were treated with open label antibiotics after positive breath test. Subjects returning for follow-up breath test to confirm eradication of overgrowth were also assessed. Subjects with inflammatory bowel disease, abdominal surgery, or subjects demonstrating rapid transit were excluded. Baseline and after treatment symptoms were rated on visual analog scales for bloating, diarrhea, abdominal pain, defecation relief, mucous, sensation of incomplete evacuation, straining, and urgency. Subjects were blinded to their breath test results until completion of the questionnaire. RESULTS: Of 202 irritable bowel syndrome patients, 157 (78%) had overgrowth. Of these, 47 had follow-up testing. Twenty-five of 47 follow-up subjects had eradication of small intestinal bacterial overgrowth. Comparison of those that eradicated to those that failed to eradicate revealed an improvement in irritable bowel syndrome symptoms with diarrhea and abdominal pain being statistically significant after Bonferroni correction (p < 0.05). Furthermore, 48% of eradicated subjects no longer met Rome criteria (chi2 = 12.0, p < 0.001). No difference was seen if eradication was not successful. CONCLUSIONS: Small intestinal bacterial overgrowth is associated with irritable bowel syndrome. Eradication of the overgrowth eliminates irritable bowel syndrome by study criteria in 48% of subjects.

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Crossref · 10.1111/j.1572-0241.2000.03368.x

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14 of 14 references verified0 citation errors · 0 not checkable

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  • Up to 25% of patients who meet criteria for IBS-D have idiopathic bile acid diarrhoea, demonstrated by abnormal retention following SeHCAT scanning, or total 48-hour faecal bile acid levels.

    “Up to 25% of patients who meet criteria for IBS-D have idiopathic bile acid diarrhoea, demonstrated by abnormal retention following 23-seleno-25-homotaurocholic acid (SeHCAT) scanning, 47 or total 48-hour faecal bile acid levels. 48”

    From Irritable bowel syndrome (2020) · cites this paper as [47]

  • Data from meta-analyses indicating increased prevalence of SIBO in IBS, symptom overlap between the two conditions, and improvement of symptoms with antibiotic treatment support the hypothesis that alterations in the intestinal microbiota may have a role in the pathogenesis of IBS, at least in some patients.

    “Nonetheless, the data from meta-analyses indicating increased prevalence of SIBO in IBS, the symptom overlap between the two conditions, and the improvement of symptoms with antibiotic treatment (47, 49, 59, 103, 131, 135, 136, 193) further support the hypothesis that alterations in the intestinal microbiota may have a role in the pathogenesis of IBS, at least in some patients.”

    From Intestinal microbiota and immune function in the pathogenesis of irritable bowel syndrome (2013) · cites this paper as [135]

  • Early studies demonstrated symptom improvement in IBS patients whose SIBO was successfully treated with antibiotics, including neomycin, metronidazole, and rifaximin.

    “Early studies demonstrated symptom improvement in IBS patients whose SIBO was successfully treated with antibiotics, including neomycin, metronidazole, and the nonabsorbable antibiotic rifaximin (47, 49, 59, 103, 131, 135, 136, 193).”

    From Intestinal microbiota and immune function in the pathogenesis of irritable bowel syndrome (2013) · cites this paper as [135]

  • Neomycin caused a 50% improvement in global IBS symptoms compared to placebo-treated patients.

    “Pimentel et al [285] have demonstrated that neomycin caused a 50% improvement in global IBS symptoms compared to placebo-treated patients”

    From Gut microbiota role in irritable bowel syndrome: New therapeutic strategies (2016) · cites this paper as [285]

  • Neomycin induced a rapid clinical resistance.

    “but also induced a rapid clinical resistance”

    From Gut microbiota role in irritable bowel syndrome: New therapeutic strategies (2016) · cites this paper as [285]

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Authors
Pimentel, M., Chow, E. J., & Lin, H. C.
Affiliations
Cedars-Sinai Medical Center (US)
Corresponding author
Pimentel, Mark
ORCID
Pimentel, Mark
Venue
American Journal of Gastroenterology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2000-12
Volume
95
Issue
12
Pages
3503-3506
ISSN
0002-9270 (ISSN-L)
DOI
10.1111/j.1572-0241.2000.03368.x
OpenAlex
W2077005896
Cited by
780
References
14
Citations by year
2026: 9 · 2025: 19 · 2024: 19 · 2023: 18 · 2022: 10 · 2021: 20 · 2020: 22 · 2019: 32 · 2018: 28 · 2017: 26 · 2016: 26 · 2015: 47 · 2014: 45 · 2013: 34 · 2012: 31
FWCI
22.39
Type
journal article
Language
en
Open access
closed
Locations
  • The American Journal of Gastroenterology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
  • Health Sciences › Medicine › Epidemiology › Microscopic Colitis
Keywords
small intestinal bacterial overgrowth, irritable bowel syndrome, antibiotic eradication, lactulose breath test, Rome criteria, bloating, abdominal pain, diarrhea, symptom improvement
MeSH terms
Adult, Anti-Bacterial Agents, Bacterial Infections, Breath Tests, Colonic Diseases, Functional, Female, Humans, Intestine, Small, Male, Surveys and Questionnaires, Prevalence, Databases, Factual

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