Literature and scientific sources SIBO IBS
SIBO (Small Intestinal Bacterial Overgrowth) Studies and Literature - what is Sibo?
Overview SIBO
Small intestinal bacterial overgrowth syndrome1
ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth2
The Spectrum of Small Intestinal Bacterial Overgrowth (SIBO)3
Small Intestinal Bacterial Overgrowth4
The Spectrum of Small Intestinal Bacterial Overgrowth (SIBO)5
Gastrointestinal bacterial overgrowth: pathogenesis and clinical significance6
Small Intestinal Bacterial Overgrowth A Comprehensive Review7
Small intestinal bacterial overgrowth in irritable bowel syndrome: are there any predictors?8
Order your SIBO Breath Test online
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1) Bures, Jan; Cyrany, Jiri; Kohoutova, Darina; Förstl, Miroslav; Rejchrt, Stanislav; Kvetina, Jaroslav et al. (2010): Small intestinal bacterial overgrowth syndrome. In: World Journal of Gastroenterology : WJG 16 (24), S. 2978–2990.
2) Pimentel, Mark; Saad, Richard J.; Long, Millie D.; Rao, Satish S. C. (2020): ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth. In: The American journal of gastroenterology 115 (2), S. 165–178.
3) Quigley, Eamonn M. M. (2019): The Spectrum of Small Intestinal Bacterial Overgrowth (SIBO). In: Current gastroenterology reports 21 (1), S. 3.
4) Rao, Satish S. C.; Bhagatwala, Jigar (2019): Small Intestinal Bacterial Overgrowth: Clinical Features and Therapeutic Management. In: Clinical and translational gastroenterology 10 (10), e00078.
5) Sorathia, Sufian J.; Rivas, John M. (2020): StatPearls. Small Intestinal Bacterial Overgrowth. Treasure Island (FL).
6) Sachdev, A. H., & Pimentel, M. (2013). Gastrointestinal bacterial overgrowth: Pathogenesis and clinical significance. Therapeutic Advances in Chronic Disease, 4(5), 223–231.
7) Dukowicz, A. C., Lacy, B. E., & Levine, G. M. (2007). Small intestinal bacterial overgrowth: A comprehensive review. Gastroenterology & Hepatology, 3(2), 112–122.
8) Reddymasu, S. C., Sostarich, S., & McCallum, R. W. (2010). Small intestinal bacterial overgrowth in irritable bowel syndrome: Are there any predictors? BMC Gastroenterology, 10, 23.
Methan-SIBO (IMO)
The importance of methane breath testing: a review2
Methanogens, Methane and Gastrointestinal Motility5
Bacterial overgrowth and methane production in children with encopresis8
Outcome of breath tests in adult patients with suspected small intestinal bacterial overgrowth10
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1) Ghoshal, U., Shukla, R., Srivastava, D., & Ghoshal, U. C. (2016). Irritable Bowel Syndrome, Particularly the Constipation-Predominant Form, Involves an Increase in Methanobrevibacter smithii, Which Is Associated with Higher Methane Production. Gut and Liver, 10(6), 932–938.
2) Lacy Costello, B. P. J. de, Ledochowski, M., & Ratcliffe, N. M. (2013). The importance of methane breath testing: A review. Journal of Breath Research, 7(2), 24001.
3) Pimentel, M., Kong, Y., & Park, S. (2004). Ibs subjects with methane on laktulose breath test have lower postprandial serotonin levels than subjects with hydrogen. Digestive Diseases and Sciences, 49(1), 84–87.
4) Suri, J., Kataria, R., Malik, Z., Parkman, H. P., & Schey, R. (2018). Elevated methane levels in small intestinal bacterial overgrowth suggests delayed small bowel and colonic transit. Medicine, 97(21), e10554.
5) Triantafyllou, K., Chang, C., & Pimentel, M. (2014). Methanogens, methane and gastrointestinal motility. Journal of Neurogastroenterology and Motility, 20(1), 31–40.
6) Bin Waqar, S. H., & Rehan, A. (2019). Methane and Constipation-predominant Irritable Bowel Syndrome: Entwining Pillars of Emerging Neurogastroenterology. Cureus, 11(5), e4764.
7) Ghoshal, U. C., Srivastava, D., & Misra, A. (2018). A randomized double-blind placebo-controlled trial showing rifaximin to improve constipation by reducing methane production and accelerating colon transit: A pilot study. Indian Journal of Gastroenterology : Official Journal of the Indian Society of Gastroenterology, 37(5), 416–423.
8) Leiby, A., Mehta, D., Gopalareddy, V., Jackson-Walker, S., & Horvath, K. (2010). Bacterial overgrowth and methane production in children with encopresis. The Journal of Pediatrics, 156(5), 766-70, 770.e1.
9) Mathur, R., Chua, K. S., Mamelak, M., Morales, W., Barlow, G. M., Thomas, R., Stefanovski, D., Weitsman, S., Marsh, Z., Bergman, R. N., & Pimentel, M. (2016). Metabolic effects of eradicating breath methane using antibiotics in prediabetic subjects with obesity. Obesity (Silver Spring, Md.), 24(3), 576–582.
10) Mattsson, J., Minaya, M. T., Monegro, M., Lebwohl, B., Lewis, S. K., Green, P. H., & Stenberg, R. (2017). Outcome of breath tests in adult patients with suspected small intestinal bacterial overgrowth. Gastroenterology and Hepatology from Bed to Bench, 10(3), 168–172.
Hydrogen sulfide SIBO (hydrogen sulfide)
Hydrogen sulfide in physiology and pathogenesis of bacteria and viruses2
Hydrogen Sulfide in Physiology and Diseases of the Digestive Tract3
A Mathematical Model for the Hydrogenotrophic Metabolism of Sulphate-Reducing Bacteria7
Alternative pathways for hydrogen disposal during fermentation in the human colon8
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1) Banik, G. D., De, A., Som, S., Jana, S., Daschakraborty, S. B., Chaudhuri, S., & Pradhan, M. (2016). Hydrogen sulphide in exhaled breath: A potential biomarker for small intestinal bacterial overgrowth in IBS. Journal of Breath Research, 10(2), 26010.
2) Pal, V. K., Bandyopadhyay, P., & Singh, A. (2018). Hydrogen sulfide in physiology and pathogenesis of bacteria and viruses. IUBMB Life, 70(5), 393–410.
3) Singh, S. B., & Lin, H. C. (2015). Hydrogen Sulfide in Physiology and Diseases of the Digestive Tract. Microorganisms, 3(4), 866–889.
4) Xu, G.‑Y., Winston, J. H., Shenoy, M., Zhou, S., Chen, J. D. Z., & Pasricha, P. J. (2009). The endogenous hydrogen sulfide producing enzyme cystathionine-beta synthase contributes to visceral hypersensitivity in a rat model of irritable bowel syndrome. Molecular Pain, 5, 44.
5) Fowler, H., Pichetshote, N., Hosseini, A., Takakura, W. R., Sedighi, R., Chang, C., Pimentel, M., Mathur, R., & Rezaie, A. (2020). Su1211 THE FIRST STUDY TO DETERMINE THE NORMAL RANGE OF EXHALED HYDROGEN SULFIDE (H2S) USING A NOVEL 4-GAS BREATH TEST DEVICE IN HEALTHY SUBJECTS. Gastroenterology, 158(6), S-545.
6) Ohge, H., Furne, J. K., Springfield, J., Sueda, T., Madoff, R. D., & Levitt, M. D. (2003). The effect of antibiotics and bismuth on fecal hydrogen sulfide and sulfate-reducing bacteria in the rat. FEMS Microbiology Letters, 228(1), 137–142.
7) Smith, N. W., Shorten, P. R., Altermann, E., Roy, N. C., & McNabb, W. C. (2019). A Mathematical Model for the Hydrogenotrophic Metabolism of Sulphate-Reducing Bacteria. Frontiers in Microbiology, 10, 1652.
8) Gibson, G. R., Cummings, J. H., Macfarlane, G. T., Allison, C., Segal, I., Vorster, H. H., & Walker, A. R. (1990). Alternative pathways for hydrogen disposal during fermentation in the human colon. Gut, 31(6), 679–683.
The link between irritable bowel syndrome (IBS) and SIBO.
Studies on the link between IBS and SIBO
American College of Gastroenterology Monograph on Management of Irritable Bowel Syndrome2
Post-infectious IBS, tropical sprue and small intestinal bacterial overgrowth: the missing link3
Update on Irritable Bowel Syndrome Diagnostics and Therapeutics5
Microbiome and Its Role in Irritable Bowel Syndrome6
Small Intestinal Bacterial Overgrowth Syndrome Prevalence in Romanian
Patients with Inflammatory Bowel Disease10
Small intestinal bacterial overgrowth in patients with irritable bowel syndrome11
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1) Chen, B., Kim, J. J.‑W., Zhang, Y., Du, L., & Dai, N. (2018). Prevalence and predictors of small intestinal bacterial overgrowth in irritable bowel syndrome: A systematic review and meta-analysis. Journal of Gastroenterology, 53(7), 807–818.
2) Ford, A. C., Moayyedi, P., Chey, W. D., Harris, L. A., Lacy, B. E., Saito, Y. A., & Quigley, E. M. M. (2018). American College of Gastroenterology Monograph on Management of Irritable Bowel Syndrome. The American Journal of Gastroenterology, 113(Suppl 2), 1–18.
3) Ghoshal, U. C., & Gwee, K.‑A. (2017). Post-infectious IBS, tropical sprue and small intestinal bacterial overgrowth: The missing link. Nature Reviews. Gastroenterology & Hepatology, 14(7), 435–441.
4) Ghoshal, U. C., Shukla, R., & Ghoshal, U. (2017). Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy. Gut and Liver, 11(2), 196–208.
5) Pimentel, M. (2016). Update on Irritable Bowel Syndrome Diagnostics and Therapeutics. Gastroenterology & Hepatology, 12(7), 442–445.
6) Pimentel, M., & Lembo, A. (2020). Microbiome and Its Role in Irritable Bowel Syndrome. Digestive Diseases and Sciences, 65(3), 829–839.
7) Shah, A., Talley, N. J., Jones, M., Kendall, B. J., Koloski, N., Walker, M. M., Morrison, M., & Holtmann, G. J. (2020). Small Intestinal Bacterial Overgrowth in Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of Case-Control Studies. The American Journal of Gastroenterology, 115(2), 190–201.
8) Wu, K.‑Q., Sun, W.‑J., Li, N., Chen, Y.‑Q., Wei, Y.‑L., & Chen, D.‑F. (2019). Small intestinal bacterial overgrowth is associated with Diarrhea-predominant irritable bowel syndrome by increasing mainly Prevotella abundance. Scandinavian Journal of Gastroenterology, 54(12), 1419–1425.
9) Ghoshal, U. C., & Srivastava, D. (2014). Irritable bowel syndrome and small intestinal bacterial overgrowth: Meaningful association or unnecessary hype. World Journal of Gastroenterology, 20(10), 2482–2491.
10) Andrei, M., Gologan, S., Stoicescu, A., Ionescu, M., Nicolaie, T., & Diculescu, M. (2016). Small Intestinal Bacterial Overgrowth Syndrome Prevalence in Romanian Patients with Inflammatory Bowel Disease. Current Health Sciences Journal, 42(2), 151–156.
11) Posserud, I., Stotzer, P.‑O., Björnsson, E. S., Abrahamsson, H., & Simrén, M. (2007). Small intestinal bacterial overgrowth in patients with irritable bowel syndrome. Gut, 56(6), 802–808.
Diagnostics - How can SIBO be detected?
Diagnostics - Overview
Diagnosis and management of small intestinal bacterial overgrowth1
Small intestinal bacterial overgrowth syndrome2
Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus3
Characterization of Proximal Small Intestinal Microbiota in Patients With Suspected Small Intestinal Bacterial Overgrowth: A Cross-Sectional Study4
Order your SIBO Breath Test online
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1) Bohm, M., Siwiec, R. M., & Wo, J. M. (2013). Diagnosis and management of small intestinal bacterial overgrowth. Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition, 28(3), 289–299.
2) Bures, J., Cyrany, J., Kohoutova, D., Förstl, M., Rejchrt, S., Kvetina, J., Vorisek, V., & Kopacova, M. (2010). Small intestinal bacterial overgrowth syndrome. World Journal of Gastroenterology, 16(24), 2978–2990.
3) Rezaie, A., Buresi, M., Lembo, A., Lin, H., McCallum, R., Rao, S., Schmulson, M., Valdovinos, M., Zakko, S., & Pimentel, M. (2017). Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus. The American Journal of Gastroenterology, 112(5), 775–784.
4) Shin, A. S., Gao, X., Bohm, M., Lin, H., Gupta, A., Nelson, D. E., Toh, E., Teagarden, S., Siwiec, R., Dong, Q., & Wo, J. M. (2019). Characterization of Proximal Small Intestinal Microbiota in Patients With Suspected Small Intestinal Bacterial Overgrowth: A Cross-Sectional Study. Clinical and Translational Gastroenterology, 10(8), e00073.
Diagnostik - Atemtest
How to Interpret Hydrogen Breath Tests1
Influencing Factors on Laktulose Breath Test Results2
Breath Tests for the Non-invasive Diagnosis of Small Intestinal Bacterial Overgrowth: A Systematic Review With Meta-analysis3
Outcome of breath tests in adult patients with suspected small intestinal bacterial overgrowth4
SIBO: The finer points of diagnosis, test interpretation, and treatment5
Normalization of laktulose breath testing correlates with symptom improvement in irritable bowel syndrome. a double-blind, randomized, placebo-controlled study6
How to Test and Treat Small Intestinal Bacterial Overgrowth: an Evidence-Based Approach7
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1) Ghoshal, U. C. (2011). How to interpret hydrogen breath tests. Journal of Neurogastroenterology and Motility, 17(3), 312–317.
2) Kim, J. W., Park, S.‑Y., Chung, J. O., Cho, H. A., Kim, D.‑H., Yoon, J. H., Park, C. H., Kim, H. S., Choi, S. K., & Rew, J. S. (2020). Influencing Factors on Laktulose Breath Test Results. The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi, 75(1), 23–28.
3) Losurdo, G., Leandro, G., Ierardi, E., Perri, F., Barone, M., Principi, M., & Di Leo, A. (2020). Breath Tests for the Non-invasive Diagnosis of Small Intestinal Bacterial Overgrowth: A Systematic Review With Meta-analysis. Journal of Neurogastroenterology and Motility, 26(1), 16–28.
4) Mattsson, J., Minaya, M. T., Monegro, M., Lebwohl, B., Lewis, S. K., Green, P. H., & Stenberg, R. (2017). Outcome of breath tests in adult patients with suspected small intestinal bacterial overgrowth. Gastroenterology and Hepatology from Bed to Bench, 10(3), 168–172.
5) SIBO: The Finer Points of Diagnosis, Test Interpretation, and Treatment. (2020, July 22).
6) Pimentel, M., Chow, E. J., & Lin, H. C. (2003). Normalization of laktulose breath testing correlates with symptom improvement in irritable bowel syndrome. A double-blind, randomized, placebo-controlled study. The American Journal of Gastroenterology, 98(2), 412–419.
7) Rezaie, A., Pimentel, M., & Rao, S. S. (2016). How to Test and Treat Small Intestinal Bacterial Overgrowth: An Evidence-Based Approach. Springer.
Diagnostik - Jejunumaspirat
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1) Rubio-Tapia, A., Barton, S. H., Rosenblatt, J. E., & Murray, J. A. (2009). Prevalence of small intestine bacterial overgrowth diagnosed by quantitative culture of intestinal aspirate in celiac disease. Journal of Clinical Gastroenterology, 43(2), 157–161.
Diagnostics - Biomarkers
Biomarkers of Irritable Bowel Syndrome1
Second-Generation Biomarker Testing for Irritable Bowel Syndrome Using Plasma Anti-CdtB and Anti-Vinculin Levels2
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1) Kim, J. H., Lin, E., & Pimentel, M. (2017). Biomarkers of Irritable Bowel Syndrome. Journal of Neurogastroenterology and Motility, 23(1), 20–26.
2) Morales, W., Rezaie, A., Barlow, G., & Pimentel, M. (2019). Second-Generation Biomarker Testing for Irritable Bowel Syndrome Using Plasma Anti-CdtB and Anti-Vinculin Levels. Digestive Diseases and Sciences, 64(11), 3115–3121.
Diagnostik - Elektronische Kapseln zur Gasmessung im Dünndarm
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1) Berean, K. J., Ha, N., Ou, J. Z., Chrimes, A. F., Grando, D., Yao, C. K., Muir, J. G., Ward, S. A., Burgell, R. E., Gibson, P. R., & Kalantar-Zadeh, K. (2018). The safety and sensitivity of a telemetric capsule to monitor gastrointestinal hydrogen production in vivo in healthy subjects: A pilot trial comparison to concurrent breath analysis. Alimentary Pharmacology & Therapeutics, 48(6), 646–654.
Triggers and risk factors
Hypochlorhydria (deficient gastric acid)
The effects of proton pump inhibitors on the microbiome in young children3
Intestinal Dysbiosis Secondary to Proton-Pump Inhibitor Use4
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1) Aerodigestive Tract or Coliform Bacterial Overgrowth of the Small Intestine in Symptomatic Patients. Journal of Clinical Gastroenterology, 54(2), 150–157.
2) Enko, D., & Kriegshäuser, G. (2017). Functional 13C-urea and glucose hydrogen/methane breath tests reveal significant association of small intestinal bacterial overgrowth in individuals with active Helicobacter pylori infection. Clinical Biochemistry, 50(1-2), 46–49.
3) Levy, E. I., Hoang, D. M., & Vandenplas, Y. (2020). The effects of proton pump inhibitors on the microbiome in young children. Acta Paediatrica (Oslo, Norway : 1992), 109(8), 1531–1538.
4) Naito, Y., Kashiwagi, K., Takagi, T., Andoh, A., & Inoue, R. (2018). Intestinal Dysbiosis Secondary to Proton-Pump Inhibitor Use. Digestion, 97(2), 195–204.
5) Schmulson, M. J., & Frati-Munari, A. C. (2019). Síntomas intestinales en pacientes que reciben inhibidores de bomba de protones (IBP). Resultados de una encuesta multicéntrica en México [Bowel symptoms in patients that receive proton pump inhibitors. Results of a multicenter survey in Mexico]. Revista De Gastroenterologia De Mexico, 84(1), 44–51.
6) Su, T., Lai, S., Lee, A., He, X., & Chen, S. (2018). Meta-analysis: Proton pump inhibitors moderately increase the risk of small intestinal bacterial overgrowth. Journal of Gastroenterology, 53(1), 27–36.
Surgeries
Systematic review: the effect of right hemicolectomy for cancer on postoperative bowel function1
Positive Glucose Breath Tests in Patients with Hysterectomy, Gastrectomy, and Cholecystectomy3
Does colectomy predispose to small intestinal bacterial (SIBO) and fungal overgrowth (SIFO)?5
Diagnostic and Therapeutic Management of Post-Gastric Bypass Chronic Diarrhea: a Systematic Review6
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1) Hope, C., Reilly, J., Lund, J., & Andreyev, H. (2020). Systematic review: The effect of right hemicolectomy for cancer on postoperative bowel function. Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer. Advance online publication
2) Jirapinyo, P., Makuvire, T. T., Dong, W. Y., Chan, W. W., & Thompson, C. C. (2019). Impact of Oral-Cecal Transit Time on the Interpretation of Laktulose Breath Tests After RYGB: A Personalized Approach to the Diagnosis of SIBO. Obesity Surgery, 29(3), 771–775.
3) Kim, D. B., Paik, C.‑N., Kim, Y. J., Lee, J. M., Jun, K.‑H., Chung, W. C., Lee, K.‑M., Yang, J.‑M., & Choi, M.‑G. (2017). Positive Glucose Breath Tests in Patients with Hysterectomy, Gastrectomy, and Cholecystectomy. Gut and Liver, 11(2), 237–242.
4) Mouillot, T., Rhyman, N., Gauthier, C., Paris, J., Lang, A.‑S., Lepers-Tassy, S., Manfredi, S., Lepage, C., Leloup, C., Jacquin-Piques, A., Brindisi, M.‑C., & Brondel, L. (2020). Study of Small Intestinal Bacterial Overgrowth in a Cohort of Patients with Abdominal Symptoms Who Underwent Bariatric Surgery. Obesity Surgery, 30(6), 2331–2337.
5) Rao, S. S. C., Tan, G., Abdulla, H., Yu, S., Larion, S., & Leelasinjaroen, P. (2018). Does colectomy predispose to small intestinal bacterial (SIBO) and fungal overgrowth (SIFO)? Clinical and Translational Gastroenterology, 9(4), 146.
6) Sollier, C., Barsamian, C., Bretault, M., Poghosyan, T., Rahmi, G., Chevallier, J.‑M., Bouillot, J.‑L., Carette, C., Czernichow, S., & Rives-Lange, C. (2020). Diagnostic and Therapeutic Management of Post-Gastric Bypass Chronic Diarrhea: A Systematic Review. Obesity Surgery, 30(3), 1102–1111.
7) Sung, H. J., Paik, C.‑N., Chung, W. C., Lee, K.‑M., Yang, J.‑M., & Choi, M.‑G. (2015). Small Intestinal Bacterial Overgrowth Diagnosed by Glucose Hydrogen Breath Test in Post-cholecystectomy Patients. Journal of Neurogastroenterology and Motility, 21(4), 545–551.
8) Sung, H. J., Paik, C.‑N., Chung, W. C., Lee, K.‑M., Yang, J.‑M., & Choi, M.‑G. (2015). Small Intestinal Bacterial Overgrowth Diagnosed by Glucose Hydrogen Breath Test in Post-cholecystectomy Patients. Journal of Neurogastroenterology and Motility, 21(4), 545–551.
Ileocecal valve dysfunction
Motility of the ileocolonic junction2
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1) Roland, B. C., Ciarleglio, M. M., Clarke, J. O., Semler, J. R., Tomakin, E., Mullin, G. E., & Pasricha, P. J. (2014). Low ileocecal valve pressure is significantly associated with small intestinal bacterial overgrowth (SIBO). Digestive Diseases and Sciences, 59(6), 1269–1277.
2) Phillips, S. F., Quigley, E. M., Kumar, D., & Kamath, P. S. (1988). Motility of the ileocolonic junction. Gut, 29(3), 390–406.
Motility disorders (mobility disorders of the intestine)
Association between interstitial cells of Cajal and anti-vinculin antibody in human stomach2
Bacterial overgrowth, dysbiosis, inflammation, and dysmotility in the Cystic Fibrosis intestine5
Gastrointestinal motility disorder assessment in systemic sclerosis8
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1) Grover, M., Kanazawa, M., Palsson, O. S., Chitkara, D. K., Gangarosa, L. M., Drossman, D. A., & Whitehead, W. E. (2008). Small intestinal bacterial overgrowth in irritable bowel syndrome: Association with colon motility, bowel symptoms, and psychological distress. Neurogastroenterology and Motility : The Official Journal of the European Gastrointestinal Motility Society, 20(9), 998–1008.
2) Kim, J. H., Nam, S.‑J., Park, S. C., Lee, S. H., Kim, T. S., Lee, M., Park, J. M., Choi, D. H., Kang, C. D., Lee, S. J., Ryu, Y. J., Lee, K., & Park, S. Y. (2020). Association between interstitial cells of Cajal and anti-vinculin antibody in human stomach. The Korean Journal of Physiology & Pharmacology : Official Journal of the Korean Physiological Society and the Korean Society of Pharmacology, 24(2), 185–191.
3) Vantrappen, G., Janssens, J., Hellemans, J., & Ghoos, Y. (1977). The interdigestive motor complex of normal subjects and patients with bacterial overgrowth of the small intestine. The Journal of Clinical Investigation, 59(6), 1158–1166.
4) Barboza, J. L., Okun, M. S., & Moshiree, B. (2015). The treatment of gastroparesis, constipation and small intestinal bacterial overgrowth syndrome in patients with Parkinson's disease. Expert Opinion on Pharmacotherapy, 16(16), 2449–2464.
5) Dorsey, J., & Gonska, T. (2017). Bacterial overgrowth, dysbiosis, inflammation, and dysmotility in the Cystic Fibrosis intestine. Journal of Cystic Fibrosis : Official Journal of the European Cystic Fibrosis Society, 16 Suppl 2, S14-S23.
6) Malik, A., Morya, R. K., Bhadada, S. K., & Rana, S. (2018). Type 1 diabetes mellitus: Complex interplay of oxidative stress, cytokines, gastrointestinal motility and small intestinal bacterial overgrowth. European Journal of Clinical Investigation, 48(11), e13021.
7) Rana, S. V., Malik, A., Bhadada, S. K., Sachdeva, N., Morya, R. K., & Sharma, G. (2017). Malabsorption, Orocecal Transit Time and Small Intestinal Bacterial Overgrowth in Type 2 Diabetic Patients: A Connection. Indian Journal of Clinical Biochemistry : IJCB, 32(1), 84–89.
8) Savarino, E., Mei, F., Parodi, A., Ghio, M., Furnari, M., Gentile, A., Berdini, M., Di Sario, A., Bendia, E., Bonazzi, P., Scarpellini, E., Laterza, L., Savarino, V., & Gasbarrini, A. (2013). Gastrointestinal motility disorder assessment in systemic sclerosis. Rheumatology (Oxford, England), 52(6), 1095–1100.
9) Lee, A. A., Baker, J. R., Wamsteker, E. J., Saad, R., & DiMagno, M. J. (2019). Small Intestinal Bacterial Overgrowth Is Common in Chronic Pancreatitis and Associates With Diabetes, Chronic Pancreatitis Severity, Low Zinc Levels, and Opiate Use. The American Journal of Gastroenterology, 114(7), 1163–1171.
Food poisonings
ICC density predicts bacterial overgrowth in a rat model of post-infectious IBS2
Infection-Induced Intestinal Dysbiosis Is Mediated by Macrophage Activation and Nitrate Production7
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1) Chen, B., Zhu, S., Du, L., He, H., Kim, J. J., & Dai, N. (2017). Reduced interstitial cells of Cajal and increased intraepithelial lymphocytes are associated with development of small intestinal bacterial overgrowth in post-infectious IBS mouse model. Scandinavian Journal of Gastroenterology, 52(10), 1065–1071.
2) Jee, S.‑R., Morales, W., Low, K., Chang, C., Zhu, A., Pokkunuri, V., Chatterjee, S., Soffer, E., Conklin, J. L., & Pimentel, M. (2010). Icc density predicts bacterial overgrowth in a rat model of post-infectious IBS. World Journal of Gastroenterology, 16(29), 3680–3686.
3) Morales, W., Triantafyllou, K., Parodi, G., Weitsman, S., Park, S. C., Rezaie, A., Pichetshote, N., Lin, E., & Pimentel, M. (2020). Immunization with cytolethal distending toxin B produces autoantibodies to vinculin and small bowel bacterial changes in a rat model of postinfectious irritable bowel syndrome. Neurogastroenterology and Motility : The Official Journal of the European Gastrointestinal Motility Society, e13875.
4) Pimentel, M., Morales, W., Pokkunuri, V., Brikos, C., Kim, S. M., Kim, S. E., Triantafyllou, K., Weitsman, S., Marsh, Z., Marsh, E., Chua, K. S., Srinivasan, S., Barlow, G. M., & Chang, C. (2015). Autoimmunity Links Vinculin to the Pathophysiology of Chronic Functional Bowel Changes Following Campylobacter jejuni Infection in a Rat Model. Digestive Diseases and Sciences, 60(5), 1195–1205.
5) Rezaie, A., Park, S. C., Morales, W., Marsh, E., Lembo, A., Kim, J. H., Weitsman, S., Chua, K. S., Barlow, G. M., & Pimentel, M. (2017). Assessment of Anti-vinculin and Anti-cytolethal Distending Toxin B Antibodies in Subtypes of Irritable Bowel Syndrome. Digestive Diseases and Sciences, 62(6), 1480–1485.
6) Sung, J., Morales, W., Kim, G., Pokkunuri, V., Weitsman, S., Rooks, E., Marsh, Z., Barlow, G. M., Chang, C., & Pimentel, M. (2013). Effect of repeated Campylobacter jejuni infection on gut flora and mucosal defense in a rat model of post infectious functional and microbial bowel changes. Neurogastroenterology and Motility : The Official Journal of the European Gastrointestinal Motility Society, 25(6), 529–537.
7) Wang, S., El-Fahmawi, A., Christian, D. A., Fang, Q., Radaelli, E., Chen, L., Sullivan, M. C., Misic, A. M., Ellringer, J. A., Zhu, X.‑Q., Winter, S. E., Hunter, C. A., & Beiting, D. P. (2019). Infection-Induced Intestinal Dysbiosis Is Mediated by Macrophage Activation and Nitrate Production. MBio, 10(3).
Therapy
Small Intestinal Bacterial Overgrowth: How to Diagnose and Treat (and Then Treat Again)1
Management of Small Intestinal Bacterial Overgrowth in Adult Patients2
Systematic review: the efficacy of treatments for irritable bowel syndrome--a European perspective3
Pharmacologic and complementary and alternative medicine therapies for irritable bowel syndrome6
Predicting a Response to Antibiotics in Patients with the Irritable Bowel Syndrome7
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1) Ginnebaugh, B., Chey, W. D., & Saad, R. (2020). Small Intestinal Bacterial Overgrowth. Gastroenterology Clinics of North America. Advance online publication.
2) Rasmussen, J., & Duriancik, D. M. (2019). Management of Small Intestinal Bacterial Overgrowth in Adult Patients. Gastroenterology Nursing : The Official Journal of the Society of Gastroenterology Nurses and Associates, 42(3), 269–276.
3) Tack, J., Fried, M., Houghton, L. A., Spicak, J., & Fisher, G. (2006). Systematic review: The efficacy of treatments for irritable bowel syndrome--a European perspective. Alimentary Pharmacology & Therapeutics, 24(2), 183–205.
4) Black, C. J., Burr, N. E., Camilleri, M., Earnest, D. L., Quigley, E. M., Moayyedi, P., Houghton, L. A., & Ford, A. C. (2020). Efficacy of pharmacological therapies in patients with IBS with diarrhoea or mixed stool pattern: Systematic review and network meta-anal Brenner, D. M., & Sayuk, G. S. (2020). Current US Food and Drug Administration-Approved Pharmacologic Therapies for the Treatment of Irritable Bowel Syndrome with Diarrhea. Advances in Therapy, 37(1), 83–96. ysis. Gut, 69(1), 74–82.
5) Brenner, D. M., & Sayuk, G. S. (2020). Current US Food and Drug Administration-Approved Pharmacologic Therapies for the Treatment of Irritable Bowel Syndrome with Diarrhea. Advances in Therapy, 37(1), 83–96.
6) Chey, W. D., Maneerattaporn, M., & Saad, R. (2011). Pharmacologic and complementary and alternative medicine therapies for irritable bowel syndrome. Gut and Liver, 5(3), 253–266.
7) Kasir, R., Zakko, S., Zakko, P., Adler, M., Lee, A., Dhingra, S., & Guttermuth, C. (2016). Predicting a Response to Antibiotics in Patients with the Irritable Bowel Syndrome. Digestive Diseases and Sciences, 61(3), 846–851.
Antibiotics
Review of rifaximin as treatment for SIBO and IBS2
Meta-analysis: antibiotic therapy for small intestinal bacterial overgrowth4
Preferential usage of rifaximin for the treatment of hydrogen-positive smallintestinal bacterial overgrowth7
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1) Chey, W. D., Shah, E. D., & DuPont, H. L. (2020). Mechanism of action and therapeutic benefit of rifaximin in patients with irritable bowel syndrome: A narrative review. Therapeutic Advances in Gastroenterology, 13, 1756284819897531.
2) Pimentel, M. (2009). Review of rifaximin as treatment for SIBO and IBS. Expert Opinion on Investigational Drugs, 18(3), 349–358.
3) Pimentel, M. (2016). Review article: Potential mechanisms of action of rifaximin in the management of irritable bowel syndrome with diarrhoea. Alimentary Pharmacology & Therapeutics, 43 Suppl 1, 37–49.
4) Shah, S. C., Day, L. W., Somsouk, M., & Sewell, J. L. (2013). Meta-analysis: Antibiotic therapy for small intestinal bacterial overgrowth. Alimentary Pharmacology & Therapeutics, 38(8), 925–934.
5) Zhuang, X., Tian, Z., Luo, M., & Xiong, L. (2020). Short-course Rifaximin therapy efficacy and laktulose hydrogen breath test in Chinese patients with diarrhea-predominant irritable bowel syndrome. BMC Gastroenterology, 20(1), 187.
6) García-Collinot, G., Madrigal-Santillán, E. O., Martínez-Bencomo, M. A., Carranza-Muleiro, R. A., Jara, L. J., Vera-Lastra, O., Montes-Cortes, D. H., Medina, G., & Cruz-Domínguez, M. P. (2020). Effectiveness of Saccharomyces boulardii and Metronidazole for Small Intestinal Bacterial Overgrowth in Systemic Sclerosis. Digestive Diseases and Sciences, 65(4), 1134–1143.
7) Barkin, J. A., Keihanian, T., Barkin, J. S., Antequera, C. M., & Moshiree, B. (2019). Preferential usage of rifaximin for the treatment of hydrogen-positive smallintestinal bacterial overgrowth [Preferential usage of rifaximin for the treatment of hydrogen-positive smallintestinal bacterial overgrowth]. Revista De Gastroenterologia Del Peru : Organo Oficial De La Sociedad De Gastroenterologia Del Peru, 39(2), 111–115.
Herbal antibiotics
Antimicrobial properties of allicin from garlic1
Allicin: chemistry and biological properties2
Herbal Therapy Is Equivalent to Rifaximin for the Treatment of Small Intestinal Bacterial Overgrowth3
Berberis Vulgaris and Berberine: An Update Review5
Naturopathic Approaches to Irritable Bowel Syndrome—A Delphi Study9
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1) Ankri, S., & Mirelman, D. (1999). Antimicrobial properties of allicin from garlic. Microbes and Infection, 1(2), 125–129.
2) Borlinghaus, J., Albrecht, F., Gruhlke, M. C. H., Nwachukwu, I. D., & Slusarenko, A. J. (2014). Allicin: Chemistry and biological properties. Molecules (Basel, Switzerland), 19(8), 12591–12618.
3) Chedid, V., Dhalla, S., Clarke, J. O., Roland, B. C., Dunbar, K. B., Koh, J., Justino, E., Tomakin, E., & Mullin, G. E. (2014). Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth. Global Advances in Health and Medicine, 3(3), 16–24.
4) Brown, K., Scott-Hoy, B., & Jennings, L. W. (2016). Response of irritable bowel syndrome with constipation patients administered a combined quebracho/conker tree/M. Balsamea Willd extract. World Journal of Gastrointestinal Pharmacology and Therapeutics, 7(3), 463–468.
5) Imenshahidi, M., & Hosseinzadeh, H. (2016). Berberis Vulgaris and Berberine: An Update Review. Phytotherapy Research : PTR, 30(11), 1745–1764.
6) Thompson, A., Meah, D., Ahmed, N., Conniff-Jenkins, R., Chileshe, E., Phillips, C. O., Claypole, T. C., Forman, D. W., & Row, P. E. (2013). Comparison of the antibacterial activity of essential oils and extracts of medicinal and culinary herbs to investigate potential new treatments for irritable bowel syndrome. BMC Complementary and Alternative Medicine, 13, 338.
7) Wüllner, D., Haupt, A., Prochnow, P., Leontiev, R., Slusarenko, A. J., & Bandow, J. E. (2019). Interspecies Comparison of the Bacterial Response to Allicin Reveals Species-Specific Defense Strategies. Proteomics, 19(24), e1900064.
8) Zhang, J., Duan, L.‑p., Zhu, S., Wang, B., Jia, Q., Song, L., & Fang, Y. (2020). Sa1908 BERBERINE RESTORES MICROGLIA ACTIVATION INDUCED BY FECAL MICROBIOTA FROM IBS PATIENT IN GERM-FREE RATS WITH A DISTINCT EFFECT ON MICROBIOTA COMPARED WITH RIFAXIMIN. Gastroenterology, 158(6), S-475-S-476.
9) Goldenberg, J. Z., Ward, L., Day, A., & Cooley, K. (2019). Naturopathic Approaches to Irritable Bowel Syndrome-A Delphi Study. Journal of Alternative and Complementary Medicine (New York, N.Y.), 25(2), 227–233.
Biofilm disrupters
Synthesis and activity of biomimetic biofilm disruptors1
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1) Böttcher, T., Kolodkin-Gal, I., Kolter, R., Losick, R., & Clardy, J. (2013). Synthesis and activity of biomimetic biofilm disruptors. Journal of the American Chemical Society, 135(8), 2927–2930.
2) Das, T., Paino, D., Manoharan, A., Farrell, J., Whiteley, G., Kriel, F. H., Glasbey, T., & Manos, J. (2019). Conditions Under Which Glutathione Disrupts the Biofilms and Improves Antibiotic Efficacy of Both ESKAPE and Non-ESKAPE Species. Frontiers in Microbiology, 10, 2000.
Prokinetics
Prucalopride for the treatment of constipation: a view from 2015 and beyond1
Clinical Efficacy and Safety Profile of Prucalopride in Chronic Idiopathic Constipation4
Use of prucalopride in adults with chronic idiopathic constipation5
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1) Bassotti, G., Usai Satta, P., & Bellini, M. (2019). Prucalopride for the treatment of constipation: A view from 2015 and beyond. Expert Review of Gastroenterology & Hepatology, 13(3), 257–262.
2) Mahajan, R. (2019). Prucalopride: A Recently Approved Drug by the Food and Drug Administration for Chronic Idiopathic Constipation. International Journal of Applied and Basic Medical Research, 9(1), 1–2.
3) Revaiah, P. C., Kochhar, R., Rana, S. V., Berry, N., Ashat, M., Dhaka, N., Rami Reddy, Y., & Sinha, S. K. (2018). Risk of small intestinal bacterial overgrowth in patients receiving proton pump inhibitors versus proton pump inhibitors plus prokinetics. JGH Open, 2(2), 47–53.
4) Tameez Ud Din, A., Khan, A. H., Bajwa, H., Maqsood, M. H., & Malik, M. N. (2019). Clinical Efficacy and Safety Profile of Prucalopride in Chronic Idiopathic Constipation. Cureus, 11(4), e4382.
5) Vijayvargiya, P., & Camilleri, M. (2019). Use of prucalopride in adults with chronic idiopathic constipation. Expert Review of Clinical Pharmacology, 12(7), 579–589.
Dietary fiber
Fiber and Prebiotics: Mechanisms and Health Benefits1
Role of PHGG as a dietary fiber: a review article2
:::
1) Slavin, J. (2013). Fiber and prebiotics: Mechanisms and health benefits. Nutrients, 5(4), 1417–1435.
2) Quartarone, G. (2013). Role of PHGG as a dietary fiber: A review article. Minerva Gastroenterologica E Dietologica, 59(4), 329–340.
Probiotics
Poor predictive value of breath hydrogen response for probiotic effects in IBS6
Brain fogginess, gas and bloating: a link between SIBO, probiotics and metabolic acidosis7
_________________________________________
1) Khalighi, A. R., Khalighi, M. R., Behdani, R., Jamali, J., Khosravi, A., Kouhestani, S., Radmanesh, H., Esmaeelzadeh, S., & Khalighi, N. (2014). Evaluating the efficacy of probiotic on treatment in patients with small intestinal bacterial overgrowth (SIBO)--a pilot study. The Indian Journal of Medical Research, 140(5), 604–608.
2) Leventogiannis, K., Gkolfakis, P., Spithakis, G., Tsatali, A., Pistiki, A., Sioulas, A., Giamarellos-Bourboulis, E. J., & Triantafyllou, K. (2019). Correction to: Effect of a Preparation of Four Probiotics on Symptoms of Patients with Irritable Bowel Syndrome: Association with Intestinal Bacterial Overgrowth. Probiotics and Antimicrobial Proteins, 11(2), 635–637.
3) Liang, S., Xu, L., Zhang, D., & Wu, Z. (2016). Effect of probiotics on small intestinal bacterial overgrowth in patients with gastric and colorectal cancer. The Turkish Journal of Gastroenterology : The Official Journal of Turkish Society of Gastroenterology, 27(3), 227–232.
4) Zhong, C., Qu, C., Wang, B., Liang, S., & Zeng, B. (2017). Probiotics for Preventing and Treating Small Intestinal Bacterial Overgrowth: A Meta-Analysis and Systematic Review of Current Evidence. Journal of Clinical Gastroenterology, 51(4), 300–311.
5) Kaźmierczak-Siedlecka, K., Ruszkowski, J., Fic, M., Folwarski, M., & Makarewicz, W. (2020). Saccharomyces boulardii CNCM I-745: A Non-bacterial Microorganism Used as Probiotic Agent in Supporting Treatment of Selected Diseases. Current Microbiology. Advance online publication.
6) Yao, C. K., Barrett, J. S., Philpott, H., Chung, A. R. T., van Langenberg, D., Garg, M., & Gibson, P. R. (2015). Poor predictive value of breath hydrogen response for probiotic effects in IBS. Journal of Gastroenterology and Hepatology, 30(12), 1731–1739.
7) Rao, S. S. C., Rehman, A., Yu, S., & Andino, N. M. de (2018). Brain fogginess, gas and bloating: A link between SIBO, probiotics and metabolic acidosis. Clinical and Translational Gastroenterology, 9(6), 162.
Komplementäre und alternative Therapien
Aspects of the non-pharmacological treatment of irritable bowel syndrome1
Intestinal Microbiome in Irritable Bowel Syndrome before and after Gut-Directed Hypnotherapy2
Cognitive Behavioral Therapy for IBS: How Useful, How Often, and How Does It Work?3
Randomised clinical trial: yoga vs a low-FODMAP diet in patients with irritable bowel syndrome4
Psychological Interventions for Irritable Bowel Syndrome5
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1) Eriksson, E. M., Andr&, K. I., Eacute, N, G&, Ouml, Kurlberg, r. K., & Eriksson, H. T. (2015). Aspects of the non-pharmacological treatment of irritable bowel syndrome. Baishideng Publishing Group Inc.
2) Peter, J., Fournier, C., Keip, B., Rittershaus, N., Stephanou-Rieser, N., Durdevic, M., Dejaco, C., Michalski, M., & Moser, G. (2018). Intestinal Microbiome in Irritable Bowel Syndrome before and after Gut-Directed Hypnotherapy. International Journal of Molecular Sciences, 19(11).
3) Radziwon, C. D., & Lackner, J. M. (2017). Cognitive Behavioral Therapy for IBS: How Useful, How Often, and How Does It Work? Current Gastroenterology Reports, 19(10), 49.
4) Schumann, D., Langhorst, J., Dobos, G., & Cramer, H. (2018). Randomised clinical trial: Yoga vs a low-FODMAP diet in patients with irritable bowel syndrome. Alimentary Pharmacology & Therapeutics, 47(2), 203–211.
5) Surdea-Blaga, T., Baban, A., Nedelcu, L., & Dumitrascu, D. L. (2016). Psychological Interventions for Irritable Bowel Syndrome. Journal of Gastrointestinal and Liver Diseases : JGLD, 25(3), 359–366.
Diets and dietary changes at SIBO
Overview diets
Specific foods can reduce symptoms of irritable bowel syndrome and functional constipation: a review2
The role of dietary diversity in the formation of syndrome intestinal bacterial overgrowth3
The role of diet in irritable bowel syndrome: implications for dietary advice4
Diet in irritable bowel syndrome: What to recommend, not what to forbid to patients!5
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1) Algera, J., Colomier, E., & Simrén, M. (2019). The Dietary Management of Patients with Irritable Bowel Syndrome: A Narrative Review of the Existing and Emerging Evidence. Nutrients, 11(9).
2) Okawa, Y., Fukudo, S., & Sanada, H. (2019). Specific foods can reduce symptoms of irritable bowel syndrome and functional constipation: A review. BioPsychoSocial Medicine, 13, 10.
3) Pilipenko, V. I., Isakov, V. A., Vlasova, A. V., Naidenova, M. A., & Morozov, S. V. (2020). The role of dietary diversity in the formation of syndrome intestinal bacterial overgrowth. Voprosy pitaniia, 89(1), 54–63.
4) Rej, A., Aziz, I., Tornblom, H., Sanders, D. S., & Simrén, M. (2019). The role of diet in irritable bowel syndrome: Implications for dietary advice. Journal of Internal Medicine, 286(5), 490–502.
5) Cozma-Petruţ, A., Loghin, F., Miere, D., & Dumitraşcu, D. L. (2017). Diet in irritable bowel syndrome: What to recommend, not what to forbid to patients! World Journal of Gastroenterology, 23(21), 3771–3783.
6) Suskind, D. L., Wahbeh, G., Cohen, S. A., Damman, C. J., Klein, J., Braly, K., Shaffer, M., & Lee, D. (2016). Patients Perceive Clinical Benefit with the Specific Carbohydrate Diet for Inflammatory Bowel Disease. Digestive Diseases and Sciences, 61(11), 3255–3260.
Elemental Diet
A 14-day elemental diet is highly effective in normalizing the laktulose breath test1
Effectiveness of postoperative elemental diet (Elental®) in elderly patients after gastrectomy3
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1) normalizing the laktulose breath test. Digestive Diseases and Sciences, 49(1), 73–77.
2) McLaughlin, S. D., Culkin, A., Cole, J., Clark, S. K., Tekkis, P. P., Ciclitira, P. J., Nicholls, R. J., & Whelan, K. (2013). Exclusive elemental diet impacts on the gastrointestinal microbiota and improves symptoms in patients with chronic pouchitis. Journal of Crohn's & Colitis, 7(6), 460–466.
3) Ohkura, Y., Haruta, S., Tanaka, T., Ueno, M., & Udagawa, H. (2016). Effectiveness of postoperative elemental diet (Elental®) in elderly patients after gastrectomy. World Journal of Surgical Oncology, 14(1), 268.
4) Tanaka, Y., Ueno, T., Yoshida, N., Akutsu, Y., Takeuchi, H., Baba, H., Matsubara, H., Kitagawa, Y., & Yoshida, K. (2018). The effect of an elemental diet on oral mucositis of esophageal cancer patients treated with DCF chemotherapy: A multi-center prospective feasibility study (EPOC study). Esophagus : Official Journal of the Japan Esophageal Society, 15(4), 239–248.
Low-Fodmap Diet
Low FODMAP Diet: Evidence, Doubts, and Hopes1
Review article: FODMAPS, prebiotics and gut health-the FODMAP hypothesis revisited4
Evidence‐based dietary management of functional gastrointestinal symptoms: The FODMAP approach8
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1) Bellini, M., Tonarelli, S., Nagy, A. G., Pancetti, A., Costa, F., Ricchiuti, A., Bortoli, N. de, Mosca, M., Marchi, S., & Rossi, A. (2020). Low FODMAP Diet: Evidence, Doubts, and Hopes. Nutrients, 12(1).
2) Fisher, K., Hutcheon, D., & Ziegler, J. (2020). Elimination of Fermentable Carbohydrates to Reduce Gastrointestinal Symptoms in Pediatric Patients With Irritable Bowel Syndrome: A Narrative Review. Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition, 35(2), 231–245.
3) Frieling, T., Heise, J., Krummen, B., Hundorf, C., & Kalde, S. (2019). Toleranz einer FODMAP – reduzierten Diät beim Reizdarmsyndrom – Effektivität, Adhärenz und Gewichtsentwicklung [Tolerability of FODMAP - reduced diet in irritable bowel syndrome - efficacy, adherence, and body weight course]. Zeitschrift Fur Gastroenterologie, 57(6), 740–744.
4) Gibson, P. R., Halmos, E. P., & Muir, J. G. (2020). Review article: Fodmaps, prebiotics and gut health-the FODMAP hypothesis revisited. Alimentary Pharmacology & Therapeutics, 52(2), 233–246.
5) Kortlever, T. L., Bokkel Huinink, S. ten, Offereins, M., Hebblethwaite, C., O'Brien, L., Leeper, J., Mulder, C. J. J., Barrett, J. S., & Gearry, R. B. (2019). Low-FODMAP Diet Is Associated With Improved Quality of Life in IBS Patients-A Prospective Observational Study. Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition, 34(4), 623–630.
6) Tuck, C. J., Reed, D. E., Muir, J. G., & Vanner, S. J. (2020). Implementation of the low FODMAP diet in functional gastrointestinal symptoms: A real-world experience. Neurogastroenterology and Motility : The Official Journal of the European Gastrointestinal Motility Society, 32(1), e13730.
7) Wilson, B., Cox, S. R., & Whelan, K. (2020). Challenges of the low FODMAP diet for managing irritable bowel syndrome and approaches to their minimisation and mitigation. The Proceedings of the Nutrition Society, 1–10.
8) Gibson, P. R., & Shepherd, S. J. (2010). Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. Journal of Gastroenterology and Hepatology, 25(2), 252–258.
Gluten free diet
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1) Lis, D. M. (2019). Exit Gluten-Free and Enter Low FODMAPs: A Novel Dietary Strategy to Reduce Gastrointestinal Symptoms in Athletes. Sports Medicine (Auckland, N.Z.), 49(Suppl 1), 87–97.
2) Reddel, S., Putignani, L., & Del Chierico, F. (2019). The Impact of Low-FODMAPs, Gluten-Free, and Ketogenic Diets on Gut Microbiota Modulation in Pathological Conditions. Nutrients, 11(2).
Associated diseases with IBS and SIBO
Acne vulgaris
The relationship between acne vulgaris and irritable bowel syndrome: A preliminary study1
Potential Role of the Microbiome in Acne: A Comprehensive Review. Journal of Clinical Medicine2
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1) Demirbaş, A., & Elmas, Ö. F. (2020). The relationship between acne vulgaris and irritable bowel syndrome: A preliminary study. Journal of Cosmetic Dermatology. Advance online publication
2) Lee, Byun, & Kim (2019). Potential Role of the Microbiome in Acne: A Comprehensive Review. Journal of Clinical Medicine, 8(7), 987.
Angsttörungen
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1) Addolorato, G., Mirijello, A., D’Angelo, C., Leggio, L., Ferrulli, A., Abenavoli, L., Vonghia, L., Cardone, S., Leso, V., Cossari, A., Capristo, E., & Gasbarrini, G. (2008). State and trait anxiety and depression in patients affected by gastrointestinal diseases: psychometric evaluation of 1641 patients referred to an internal medicine outpatient setting. International Journal of Clinical Practice, 62(7), 1063–1069.
2) Chu, H., Fox, M., Zheng, X., Deng, Y., Long, Y., Huang, Z., Du, L., Xu, F., & Dai, N. (2016). Small Intestinal Bacterial Overgrowth in Patients with Irritable Bowel Syndrome: Clinical Characteristics, Psychological Factors, and Peripheral Cytokines. Gastroenterology Research and Practice, 2016, 1–8.
Cholelithiasis (gallstones)
The characteristics of small intestinal bacterial overgrowth in patients with gallstone diseases1
:::
1) Kim, D. B., Paik, C.‑N., Song, D. S., Kim, Y. J., & Lee, J. M. (2018). The characteristics of small intestinal bacterial overgrowth in patients with gallstone diseases. Journal of Gastroenterology and Hepatology, 33(8), 1477–1484.
2) Vakhrushev, Y. M., & Lukashevich, A. P. (2017). Osobennosti narushenii pishchevareniya, vsasyvaniya i mikrobiotsenoza v kishechnike u bol'nykh zhelchnokamennoi bolezn'yu [Specific features of impaired intestinal digestion, absorption, and microbiocenosis in patients with cholelithiasis]. Terapevticheskii arkhiv, 89(2), 28–32.
Chronic fatigue syndrome
Gut inflammation in chronic fatigue syndrome2
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1) Pimentel, M., Hallegua, D., Chow, E. J., Wallace, D., Bonorris, G., & Lin, H. C. (2000). Eradication of small intestinal bacterial overgrowth decreases symptoms in chronic fatigue syndrome: A double blind, randomized study. Gastroenterology, 118(4), A414.
2) Shaheen E Lakhan, & Kirchgessner, A. (2010). Gut inflammation in chronic fatigue syndrome. BioMed Central.
Clostridium difficile
Clostridium difficile, the Difficult “Kloster” Fuelled by Antibiotics1
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1) Dicks, L. M. T., Mikkelsen, L. S., Brandsborg, E., & Marcotte, H. (2019). Clostridium difficile, the Difficult “Kloster” Fuelled by Antibiotics. Current Microbiology, 76(6), 774–782.
Colitis ulcerosa
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1) Rana, S. V., Sharma, S., Kaur, J., Prasad, K. K., Sinha, S. K., Kochhar, R., Malik, A., & Morya, R. K. (2014). Relationship of cytokines, oxidative stress and GI motility with bacterial overgrowth in ulcerative colitis patients. Journal of Crohn's & Colitis, 8(8), 859–865.
2) Yang, C., Guo, X., Wang, J., Fan, H., Huo, X., Dong, L., & Duan, Z. (2020). Relationship between Small Intestinal Bacterial Overgrowth and Peripheral Blood ET, TLR2 and TLR4 in Ulcerative Colitis. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 30(3), 245–249
Diabetes mellitus (diabetes)
Small bowel bacterial overgrowth and type 1 diabetes2
:::
1) Adamska, A., Nowak, M., Piłaciński, S., Araszkiewicz, A., Litwinowicz, M., Tomaszewska, M., Wierusz-Wysocka, B., Grzymisławski, M., & Zozulińska-Ziółkiewicz, D. (2016). Small intestinal bacterial overgrowth in adult patients with type 1 diabetes: Its prevalence and relationship with metabolic control and the presence of chronic complications of the disease. Polskie Archiwum Medycyny Wewnetrznej, 126(9), 628–634.
2) Ojetti, V., Pitocco, D., Scarpellini, E., Zaccardi, F., Scaldaferri, F., Gigante, G., Gasbarrini, G., Ghirlanda, G., & Gasbarrini, A. (2009). Small bowel bacterial overgrowth and type 1 diabetes. European Review for Medical and Pharmacological Sciences, 13(6), 419–423.
Diverticulosis (diverticular disease)
:::
1) Tursi, A., Brandimarte, G., Giorgetti, G. M., & Elisei, W. (2005). Assessment of small intestinal bacterial overgrowth in uncomplicated acute diverticulitis of the colon. World Journal of Gastroenterology, 11(18), 2773–2776.
2) Tursi, A., Brandimarte, G., Giorgetti, G. M., & Elisei, W. (2006). Transient lactose malabsorption in patients affected by symptomatic uncomplicated diverticular disease of the colon. Digestive Diseases and Sciences, 51(3), 461–465.
Ehlers-Danlos and Marfan syndrome
Gastrointestinal Symptoms in Marfan Syndrome and Hypermobile Ehlers-Danlos Syndrome1
Higher prevalence of joint hypermobility in constipation predominant irritable bowel syndrome2
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1) Inayet, N., Hayat, J. O., Kaul, A., Tome, M., Child, A., & Poullis, A. (2018). Gastrointestinal Symptoms in Marfan Syndrome and Hypermobile Ehlers-Danlos Syndrome. Gastroenterology Research and Practice, 2018, 4854701.
2) Zweig, A., Schindler, V., Becker, A. S., van Maren, A., & Pohl, D. (2018). Higher prevalence of joint hypermobility in constipation predominant irritable bowel syndrome. Neurogastroenterology and Motility : The Official Journal of the European Gastrointestinal Motility Society, 30(9), e13353.
Fibromyalgie
Small Intestinal Bacterial Overgrowth: A Possible Association with Fibromyalgia3
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1) Erdrich, S., Hawrelak, J. A., Myers, S. P., & Harnett, J. E. (2020). Determining the association between fibromyalgia, the gut microbiome and its biomarkers: A systematic review. BMC Musculoskeletal Disorders, 21(1), 181.
2) Pimentel, M., Wallace, D., Hallegua, D., Chow, E., Kong, Y., Park, S., & Lin, H. C. (2004). A link between irritable bowel syndrome and fibromyalgia may be related to findings on laktulose breath testing. Annals of the Rheumatic Diseases, 63(4), 450–452.
3) Pimentel, M., Chow, E. J., Hallegua, D., Wallace, D., & Lin, H. C. (2001). Small Intestinal Bacterial Overgrowth: A Possible Association with Fibromyalgia. Journal of Musculoskeletal Pain, 9(3), 105–113.
Functional dyspepsia
High Prevalence of Pathological Hydrogen Breath Tests in Patients with Functional Dyspepsia1
::::
1) Petzold, G., Amanzada, A., Gress, T. M., Ellenrieder, V., Neesse, A., & Kunsch, S. (2019). High Prevalence of Pathological Hydrogen Breath Tests in Patients with Functional Dyspepsia. Digestion, 100(3), 186–191.
2) Kim, B.‑T., Kim, K.‑M., & Kim, K.‑N. (2020). The Effect of Ursodeoxycholic Acid on Small Intestinal Bacterial Overgrowth in Patients with Functional Dyspepsia: A Pilot Randomized Controlled Trial. Nutrients, 12(5).
Gastroparesis
Small intestinal bacterial overgrowth in gastroparesis: Are there any predictors?1
:::
1) Reddymasu, S. C., & McCallum, R. W. (2010). Small intestinal bacterial overgrowth in gastroparesis: Are there any predictors? Journal of Clinical Gastroenterology, 44(1), e8-13.
Helicobacter pylori Gastritis
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1) Enko, D., & Kriegshäuser, G. (2017). Functional 13C-urea and glucose hydrogen/methane breath tests reveal significant association of small intestinal bacterial overgrowth in individuals with active Helicobacter pylori infection. Clinical Biochemistry, 50(1-2), 46–49.
2) Konrad, P., Chojnacki, J., Gąsiorowska, A., Rudnicki, C., Kaczka, A., & Chojnacki, C. (2018). Therapeutic efficacy of amoxicillin and rifaximin in patients with small intestinal bacterial overgrowth and Helicobacter pylori infection. Przeglad Gastroenterologiczny, 13(3), 213–217.
Hypochlorhydria (decreased gastric acidity)
Bacterial overgrowth as a consequence of reduced gastric acidity1
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1) Stockbruegger, R. W. (1985). Bacterial overgrowth as a consequence of reduced gastric acidity. Scandinavian Journal of Gastroenterology, 20(sup111), 7–15.
2) Sarker, S. A., Ahmed, T., & Brüssow, H. (2017). Hunger and microbiology: Is a low gastric acid-induced bacterial overgrowth in the small intestine a contributor to malnutrition in developing countries? Microbial Biotechnology, 10(5), 1025–1030.
Coronary heart disease (CHD)
Small Intestinal Bacterial Overgrowth and Coronary Artery Disease: What Is in the CArDs?1
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1) Adkins, C., & Rezaie, A. (2018). Small Intestinal Bacterial Overgrowth and Coronary Artery Disease: What Is in the CArDs? Digestive Diseases and Sciences, 63(2), 271–272.
2) Fialho, A., Fialho, A., Kochhar, G., Schenone, A. L., Thota, P., McCullough, A. J., & Shen, B. (2018). Association Between Small Intestinal Bacterial Overgrowth by Glucose Breath Test and Coronary Artery Disease. Digestive Diseases and Sciences, 63(2), 412–421.
3) He, Z., Ding, R., Wu, F., Wu, Z., & Liang, C. (2018). Excess Alcohol Consumption: A Potential Mechanism Behind the Association Between Small Intestinal Bacterial Overgrowth and Coronary Artery Disease. Digestive Diseases and Sciences, 63(12), 3516–3517.
Carbohydrate malabsorption
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1) Perets, T. T., Hamouda, D., Layfer, O., Ashorov, O., Boltin, D., Levy, S., Niv, Y., & Dickman, R. (2017). Small Intestinal Bacterial Overgrowth May Increase the Likelihood of Lactose and Sorbitol but not Fructose Intolerance False Positive Diagnosis. Annals of Clinical and Laboratory Science, 47(4), 447–451.
Leaky gut
Luminal bacteria and small-intestinal permeability2
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1) Simeonova, D., Ivanovska, M., Murdjeva, M., Carvalho, A. F., & Maes, M. (2018). Recognizing the Leaky Gut as a Trans-diagnostic Target for Neuroimmune Disorders Using Clinical Chemistry and Molecular Immunology Assays. Current Topics in Medicinal Chemistry, 18(19), 1641–1655.
2) Riordan, S. M., McIver, C. J., Thomas, D. H., Duncombe, V. M., Bolin, T. D., & Thomas, M. C. (1997). Luminal bacteria and small-intestinal permeability. Scandinavian Journal of Gastroenterology, 32(6), 556–563.
Food poisonings
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1) Chen, B., Zhu, S., Du, L., He, H., Kim, J. J., & Dai, N. (2017). Reduced interstitial cells of Cajal and increased intraepithelial lymphocytes are associated with development of small intestinal bacterial overgrowth in post-infectious IBS mouse model. Scandinavian Journal of Gastroenterology, 52(10), 1065–1071.
2) Pimentel, M., Morales, W., Pokkunuri, V., Brikos, C., Kim, S. M., Kim, S. E., Triantafyllou, K., Weitsman, S., Marsh, Z., Marsh, E., Chua, K. S., Srinivasan, S., Barlow, G. M., & Chang, C. (2015). Autoimmunity Links Vinculin to the Pathophysiology of Chronic Functional Bowel Changes Following Campylobacter jejuni Infection in a Rat Model. Digestive Diseases and Sciences, 60(5), 1195–1205.
Liver cirrhosis
Small intestinal bacterial overgrowth in cirrhosis: Systematic review and meta-analysis1
Is small intestinal bacterial overgrowth a cause of hyperdynamic circulation in cirrhosis?2
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1) Maslennikov, R., Pavlov, C., & Ivashkin, V. (2018). Small intestinal bacterial overgrowth in cirrhosis: Systematic review and meta-analysis. Hepatology International, 12(6), 567–576.
2) Maslennikov, R., Pavlov, C., & Ivashkin, V. (2019). Is small intestinal bacterial overgrowth a cause of hyperdynamic circulation in cirrhosis? The Turkish Journal of Gastroenterology : The Official Journal of Turkish Society of Gastroenterology, 30(11), 964–975.
3) Zhang, Y., Feng, Y., Cao, B., & Tian, Q. (2016). The effect of small intestinal bacterial overgrowth on minimal hepatic encephalopathy in patients with cirrhosis. Archives of Medical Science : AMS, 12(3), 592–596.
Malignant diseases (cancer)
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1) Ma, X., Wang, H., Zhang, P., Xu, L., & Tian, Z. (2019). Association between small intestinal bacterial overgrowth and toll-like receptor 4 in patients with pancreatic carcinoma and cholangiocarcinoma. The Turkish Journal of Gastroenterology : The Official Journal of Turkish Society of Gastroenterology, 30(2), 177–183.
2) Zhou, D. X., Ma, Y. J., Chen, G. Y., Gao, X., & Yang, L. (2019). Relationship of TLR2 and TLR4 expressions on the surface of peripheral blood mononuclear cells to small intestinal bacteria overgrowth in patients with hepatocellular carcinoma. Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology, 27(4), 286–290.
Metabolic syndrome and obesity
Small intestinal bacterial overgrowth and nonalcoholic fatty liver disease1
Obesity increases the risk of small intestinal bacterial overgrowth (SIBO)2
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1) Augustyn, M., Grys, I., & Kukla, M. (2019). Small intestinal bacterial overgrowth and nonalcoholic fatty liver disease. Clinical and Experimental Hepatology, 5(1), 1–10.
2) Roland, B. C., Lee, D., Miller, L. S., Vegesna, A., Yolken, R., Severance, E., Prandovszky, E., Zheng, X. E., & Mullin, G. E. (2018). Obesity increases the risk of small intestinal bacterial overgrowth (SIBO). Neurogastroenterology and Motility : The Official Journal of the European Gastrointestinal Motility Society, 30(3).
3) Sabaté, J.‑M., Jouët, P., Harnois, F., Mechler, C., Msika, S., Grossin, M., & Coffin, B. (2008). High prevalence of small intestinal bacterial overgrowth in patients with morbid obesity: A contributor to severe hepatic steatosis. Obesity Surgery, 18(4), 371–377.
4) Stepanov, Y. M., Zavhorodnia, N. Y., Yagmur, V. B., Lukianenko, O. Y., & Zygalo, E. V. (2019). Association of nonalcoholic fatty liver disease with small intestine bacterial overgrowth in obese children. Wiadomosci Lekarskie (Warsaw, Poland : 1960), 72(3), 350–356.
Morbus Crohn
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1) Greco, A., Caviglia, G. P., Brignolo, P., Ribaldone, D. G., Reggiani, S., Sguazzini, C., Smedile, A., Pellicano, R., Resegotti, A., Astegiano, M., & Bresso, F. (2015). Glucose breath test and Crohn's disease: Diagnosis of small intestinal bacterial overgrowth and evaluation of therapeutic response. Scandinavian Journal of Gastroenterology, 50(11), 1376–1381.
2) Klaus, J., Spaniol, U., Adler, G., Mason, R. A., Reinshagen, M., & Tirpitz C, C. von (2009). Small intestinal bacterial overgrowth mimicking acute flare as a pitfall in patients with Crohn's Disease. BMC Gastroenterology, 9, 61.
Morbus Parkinson
The role of small intestinal bacterial overgrowth in Parkinson's disease1
Prevalence of small intestinal bacterial overgrowth in Chinese patients with Parkinson's disease2
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1) Fasano, A., Bove, F., Gabrielli, M., Petracca, M., Zocco, M. A., Ragazzoni, E., Barbaro, F., Piano, C., Fortuna, S., Tortora, A., Di Giacopo, R., Campanale, M., Gigante, G., Lauritano, E. C., Navarra, P., Marconi, S., Gasbarrini, A., & Bentivoglio, A. R. (2013). The role of small intestinal bacterial overgrowth in Parkinson's disease. Movement Disorders : Official Journal of the Movement Disorder Society, 28(9), 1241–1249.
2) Niu, X.‑L., Liu, L., Song, Z.‑X., Li, Q., Wang, Z.‑H., Zhang, J.‑L., & Li, H.‑H. (2016). Prevalence of small intestinal bacterial overgrowth in Chinese patients with Parkinson's disease. Journal of Neural Transmission (Vienna, Austria : 1996), 123(12), 1381–1386.
Cystic Fibrosis (Cystic Fibrosis, CF)
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1) Furnari, M., Alessandri, A. de, Cresta, F., Haupt, M., Bassi, M., Calvi, A., Haupt, R., Bodini, G., Ahmed, I., Bagnasco, F., Giannini, E. G., & Casciaro, R. (2019). The role of small intestinal bacterial overgrowth in cystic fibrosis: A randomized case-controlled clinical trial with rifaximin. Journal of Gastroenterology, 54(3), 261–270.
2) Lisowska, A., Pogorzelski, A., Oracz, G., Siuda, K., Skorupa, W., Rachel, M., Cofta, S., Piorunek, T., & Walkowiak, J. (2011). Oral antibiotic therapy improves fat absorption in cystic fibrosis patients with small intestine bacterial overgrowth. Journal of Cystic Fibrosis : Official Journal of the European Cystic Fibrosis Society, 10(6), 418–421. )
Pancreatitis (inflammation of the pancreas)
Systematic review and meta-analysis: Small intestinal bacterial overgrowth in chronic pancreatitis1
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1) Capurso, G., Signoretti, M., Archibugi, L., Stigliano, S., & Delle Fave, G. (2016). Systematic review and meta-analysis: Small intestinal bacterial overgrowth in chronic pancreatitis. United European Gastroenterology Journal, 4(5), 697–705.
2) Kim, D. B., Paik, C.‑N., Sung, H. J., Chung, W. C., Lee, K.‑M., Yang, J.‑M., & Choi, M.‑G. (2015). Breath hydrogen and methane are associated with intestinal symptoms in patients with chronic pancreatitis. Pancreatology : Official Journal of the International Association of Pancreatology (IAP) … [Et Al.], 15(5), 514–518.
Parasites
Giardia Alters Commensal Microbial Diversity throughout the Murine Gut1
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1) Barash, N. R., Maloney, J. G., Singer, S. M., & Dawson, S. C. (2017). Giardia Alters Commensal Microbial Diversity throughout the Murine Gut. Infection and Immunity, 85(6).
Psoriasis (psoriasis)
Oral psoriasis and SIBO: Is there a link?1
Malabsorption in psoriatic patients: Cause or consequence?2
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1) Drago, F., Ciccarese, G., Cordara, V., Paudice, M., Herzum, A., & Parodi, A. (2018). Oral psoriasis and SIBO: Is there a link? Journal of the European Academy of Dermatology and Venereology : JEADV, 32(9), e368-e369.
2) Ojetti, V., Simone, C. de, Aguilar Sanchez, J., Capizzi, R., Migneco, A., Guerriero, C., Cazzato, A., Gasbarrini, G., Amerio, P., & Gasbarrini, A. (2006). Malabsorption in psoriatic patients: Cause or consequence? Scandinavian Journal of Gastroenterology, 41(11), 1267–1271.
Restless legs syndrome
Restless Leg Syndrome: Does It Start With A Gut Feeling?1
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1) Blum, D. J., During, E., Barwick, F., Davidenko, P., & Zeitzer, J. M. (2019). 0009 Restless Leg Syndrome: Does It Start With A Gut Feeling? Sleep, 42(Supplement_1), A4-A4.
2) Weinstock, L. B., & Walters, A. S. (2011). Restless legs syndrome is associated with irritable bowel syndrome and small intestinal bacterial overgrowth. Sleep Medicine, 12(6), 610–613.
Rheumatoid arthritis
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1) Lichtman, S. N., Wang, J., Sartor, R. B., Zhang, C., Bender, D., Dalldorf, F. G., & Schwab, J. H. (1995). Reactivation of arthritis induced by small bowel bacterial overgrowth in rats: Role of cytokines, bacteria, and bacterial polymers. Infection and Immunity, 63(6), 2295–2301.
Rosacea
Small intestinal bacterial overgrowth in rosacea: Clinical effectiveness of its eradication1
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1) Parodi, A., Paolino, S., Greco, A., Drago, F., Mansi, C., Rebora, A., Parodi, A., & Savarino, V. (2008). Small intestinal bacterial overgrowth in rosacea: Clinical effectiveness of its eradication. Clinical Gastroenterology and Hepatology : The Official Clinical Practice Journal of the American Gastroenterological Association, 6(7), 759–764.
Hypothyroidism (underactive thyroid gland)
Thyroid dysfunction in patients with small intestinal bacterial overgrowth1
Link between hypothyroidism and small intestinal bacterial overgrowth2
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1) Konrad, P., Chojnacki, J., Kaczka, A., Pawłowicz, M., Rudnicki, C., & Chojnacki, C. (2018). Ocena czynności tarczycy u osób z zespołem przerostu bakteryjnego jelita cienkiego [Thyroid dysfunction in patients with small intestinal bacterial overgrowth]. Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego, 44(259), 15–18.
2) Patil, A. D. (2014). Link between hypothyroidism and small intestinal bacterial overgrowth. Indian Journal of Endocrinology and Metabolism, 18(3), 307–309.
Scleroderma (Systemic Sclerosis)
Intestinal Involvement in Systemic Sclerosis: A Clinical Review2
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1) intestinal bacterial overgrowth in patients suffering from scleroderma: Clinical effectiveness of its eradication. The American Journal of Gastroenterology, 103(5), 1257–1262.
2) Sakkas, L. I., Simopoulou, T., Daoussis, D., Liossis, S.‑N., & Potamianos, S. (2018). Intestinal Involvement in Systemic Sclerosis: A Clinical Review. Digestive Diseases and Sciences, 63(4), 834–844.
SIFO (Small intestinal fungal overgrowth)
Small intestinal fungal overgrowth1
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1) Erdogan, A., & Rao, S. S. C. (2015). Small intestinal fungal overgrowth. Current Gastroenterology Reports, 17(4), 16.
2) Jacobs, C., Coss Adame, E., Attaluri, A., Valestin, J., & Rao, S. S. C. (2013). Dysmotility and proton pump inhibitor use are independent risk factors for small intestinal bacterial and/or fungal overgrowth. Alimentary Pharmacology & Therapeutics, 37(11), 1103–1111.
Celiac disease (gluten-sensitive enteropathy)
Small intestinal bacterial overgrowth and Celiac disease - coincidence or causation?1
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1) Charlesworth, R. P. G., & Winter, G. (2020). Small intestinal bacterial overgrowth and Celiac disease - coincidence or causation? Expert Review of Gastroenterology & Hepatology, 14(5), 305–306.
2) Losurdo, G., Marra, A., Shahini, E., Girardi, B., Giorgio, F., Amoruso, A., Pisani, A., Piscitelli, D., Barone, M., Principi, M., Di Leo, A., & Ierardi, E. (2017). Small intestinal bacterial overgrowth and celiac disease: A systematic review with pooled-data analysis. Neurogastroenterology and Motility : The Official Journal of the European Gastrointestinal Motility Society, 29(6).