DIAGNOSIS AND TREATMENT OF SMALL INTESTINAL BACTERIAL OVERGROWTH: AN OFFICIAL POSITION PAPER FROM THE BRAZILIAN FEDERATION OF GASTROENTEROLOGY.

Abstract

Background: Small intestinal bacterial overgrowth (SIBO) is a condition characterized by an abnormal increase in bacterial population in the small intestine, leading to symptoms such as bloating, abdominal pain, distension, diarrhea, and eventually malabsorption. The diagnosis and management of SIBO remain challenging due to overlapping symptoms with other gastrointestinal disorders such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), and coeliac disease.

Objective: This article aims to review current evidence on the diagnosis and treatment of SIBO, with a focus on strategies suitable for the Brazilian healthcare system.

Methods: A comprehensive literature review was performed, focusing on clinical guidelines, randomized controlled trials, and cohort studies concerning SIBO. Diagnostic methods, including breath tests and direct aspiration techniques, were critically analyzed. Treatment approaches, including antibiotics, dietary modifications, and probiotics, were reviewed. The recommendations were formulated based on a panel of gastroenterologists, members of the Brazilian Federation of Gastroenterology (FBG), with approval from the majority of the members.

Results: Breath tests using glucose and lactulose remain the most commonly used non-invasive diagnostic tools, though they are subject to limitations such as false positives and false negatives. Treatment with rifaximin is effective in most cases of SIBO, while systemic antibiotics like metronidazole and ciprofloxacin are alternatives. Probiotics and dietary interventions, particularly low FODMAP diets, can complement antibiotic therapy. Long-term follow-up is essential due to the recurrence rate, which is common in SIBO patients.

Conclusion: Standardizing SIBO diagnosis and treatment in Brazil is essential to reduce diagnostic delays and optimize care, especially given the disparities and heterogeneity in clinical practice across the country. This article provides evidence-based recommendations to guide clinical practice. Further research is needed to refine diagnostic methods, explore novel treatment strategies, and better understand the specific characteristics of the Brazilian population.