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Small intestinal bacterial overgrowth in patients with irritable bowel syndrome
Open accessAbstract
Background: Small intestinal bacterial overgrowth (SIBO) has been proposed to be common in irritable bowel syndrome (IBS), with altered small-bowel motility as a possible predisposing factor. Aim: To assess the prevalence of SIBO, by culture of small-bowel aspirate, and its correlation to symptoms and motility in IBS. Methods: 162 patients with IBS who underwent small-bowel manometry and culture of jejunal aspirate were included. Cultures from 26 healthy subjects served as controls. Two definitions of altered flora were used: the standard definition of SIBO (⩾10 5 colonic bacteria/ml), and mildly increased counts of small-bowel bacteria (⩾95th centile in controls). Results: SIBO (as per standard definition) was found in 4% of both patients and controls. Signs of enteric dysmotility were seen in 86% of patients with SIBO and in 39% of patients without SIBO (p = 0.02). Patients with SIBO had fewer phase III activities (activity fronts) than patients without SIBO (p = 0.08), but otherwise no differences in motility parameters were seen. Mildly increased bacterial counts (⩾5×10 3 /ml) were more common in patients with IBS than in controls (43% vs 12%; p = 0.002), but this was unrelated to small intestinal motility. No correlation between bacterial alterations and symptom pattern was observed. Conclusions: The data do not support an important role for SIBO according to commonly used clinical definitions, in IBS. However, mildly increased counts of small-bowel bacteria seem to be more common in IBS, and needs further investigation. Motility alterations could not reliably predict altered small-bowel bacterial flora.
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“Studies using small intestinal aspiration, considered the gold standard for diagnosing small intestinal bacterial overgrowth, have not demonstrated an increased prevalence of the condition in suspected IBS, 143 and the lactulose breath test correlates poorly with small intestinal aspiration.144”
From British Society of Gastroenterology guidelines on the management of irritable bowel syndrome (2021) · cites this paper as [143]
In the citing paper
“Preliminary studies suggest that more IBS patients have SIBO when a lower cut-off of >103 cfu/ml is used but well-designed studies are needed.82 85”
From Intestinal microbiota in functional bowel disorders: a Rome foundation report (2013) · cites this paper as [82]
In the citing paper
“However, when a lower cutoff concentration of ≥104 cfu/ml was used, significant differences were observed, suggesting increased numbers of bacteria in the small intestine of patients with IBS.”
From Intestinal microbiota and immune function in the pathogenesis of irritable bowel syndrome (2013) · cites this paper as [141]
In the citing paper
“Using this definition, a study of bacterial cultures of aspirates from patients with IBS compared with cultures from healthy volunteers showed no statistically significant differences in the incidence of SIBO (141).”
From Intestinal microbiota and immune function in the pathogenesis of irritable bowel syndrome (2013) · cites this paper as [141]
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“Preliminary studies suggest that more IBS patients have SIBO when a lower cut-off of >10(3) cfu/ml is used but well-designed studies are needed.(82) 85 Available molecular studies are not adequately designed to establish whether SIBO is involved in IBS but have significant potential.”
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Self-citation
Metadata
- Authors
- Posserud, I., Stotzer, P.-O., Björnsson, E. S., Abrahamsson, H., & Simrén, M.
- Affiliations
- Sahlgrenska University Hospital (SE)
- ORCID
- Simrén, Magnus
- Venue
- Gut
- Publisher
- BMJ
- Published
- 2006-12-05
- Volume
- 56
- Issue
- 6
- Pages
- 802-808
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- PMC
- PMC1954873
- OpenAlex
- W2120896017
- Cited by
- 499
- References
- 53
- Citations by year
- 2026: 8 · 2025: 13 · 2024: 7 · 2023: 15 · 2022: 10 · 2021: 18 · 2020: 22 · 2019: 17 · 2018: 22 · 2017: 29 · 2016: 26 · 2015: 34 · 2014: 35 · 2013: 31 · 2012: 31
- FWCI
- 28.64
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gut (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Medical Research Council
- 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 › Gastroenterology › Microscopic Colitis
- Keywords
- small intestinal bacterial overgrowth, irritable bowel syndrome, small intestine motility, SIBO prevalence
- MeSH terms
- Adult, Aged, Anti-Bacterial Agents, Bacteria, Bacterial Infections, Breath Tests, Constipation, Diarrhea, Female, Gastrointestinal Motility, Humans, Intestine, Small, Jejunum, Male, Manometry, Middle Aged, Treatment Outcome, Irritable Bowel Syndrome
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