What are the guideline sources, guidelines and references for Small intestinal bacterial overgrowth ?
Guideline sources The following summarized guidelines for the evaluation and management of small intestinal bacterial overgrowth are prepared by our editorial team based on guidelines from the American College of Gastroenterology (ACG 2020), the British Society of Gastroenterology (BSG 2018), and the North American Consensus (NAC 2017). 1 2 3 Guidelines 1. Diagnostic investigations Breath testing, indications: As per ACG 2020 guidelines, consider obtaining glucose hydrogen or lactulose hydrogen breath testing for the diagnosis of SIBO in patients with: irritable bowel disease suspected motility disorders abdominal pain, gas, bloating, and/or diarrhea with previous luminal abdominal surgery. C Show 2 more As per NAC 2017 guidelines, consider obtaining breath testing for the diagnosis of SIBO. C Show 3 more https://web.pathway.md/diseases/recVxAQZiQCzPjLMr 1/3 6/24/23, 3:13 PM Small intestinal bacterial overgrowth Pathway Breath testing (preparation): avoid using antibiotics for 4 weeks before breath testing. D Show 5 more Breath testing, technical considerations: As per ACG 2020 guidelines, use the following carbohydrate substrates during breath testing for standardization purposes: glucose: 75 g lactulose: 10 g. B As per NAC 2017 guidelines: Consider using the following carbohydrate substrates with or followed by one cup of water for breath testing: glucose: 75 g C lactulose: 10 g. C Measure hydrogen, methane and CO simultaneously during breath testing. A Breath testing, interpretation: As per ACG 2020 guidelines, recognize that the presence of excessive methane on breath testing does not indicate SIBO, since methanogens are not bacteria (they are archea). Use the term intestinal methanogen overgrowth. B As per NAC 2017 guidelines, consider interpreting a rise of hydrogen 20 ppm from baseline by 90 min as positive for SIBO. C Show 3 more 2. Diagnostic procedures Duodenal aspiration and culture: As per ACG 2020 guidelines, use a colony count of 10 CFU/mL as most suggestive of SIBO when obtaining duodenal culture. B As per NAC 2017 guidelines: Recognize that current small bowel culture techniques are not satisfactory for the assessment of SIBO. B Consider using a threshold of > 10 CFU/mL for the definition of SIBO, if culture is obtained for the diagnosis of SIBO. C 3. Medical management Antibiotics: As per ACG 2020 guidelines, consider administering antibiotics in symptomatic patients with SIBO to eradicate overgrowth and resolve symptoms. C https://web.pathway.md/diseases/recVxAQZiQCzPjLMr 2/3 6/24/23, 3:13 PM Small intestinal bacterial overgrowth Pathway As per BSG 2018 guidelines, offer an empirical trial of antibiotics in patients with chronic diarrhea if small bowel bacterial overgrowth is suspected. B Probiotics: insufficient evidence to support the use of specific probiotics for the treatment of patients with SIBO. I 4. Therapeutic procedures Fecal microbiota transplantation: insufficient evidence to recommend fecal microbiota transplantation for the treatment of patients with SIBO. I 5. Preventative measures Prevention of recurrence: Determine and treat the underlying cause of SIBO as the primary mode of prevention of recurrences. B Focus on prevention of SIBO to avoid the need for repeated courses of antibiotics. B 6. Follow-up and surveillance Retesting: consider obtaining retesting after treatment in patients with abnormal breath test, as it may correlate with symptom improvement and may be confirmed by normalization of hydrogen or methane levels. C References 1. Ali Rezaie, Michelle Buresi, Anthony Lembo et al. Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus. Am J Gastroenterol. 2017 May;112 5 775 784. Open 2. Mark Pimentel, Richard J Saad, Millie D Long et al. ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth. Am J Gastroenterol. 2020 Feb;115 2 165 178. Open 3. Arasaradnam RP, Brown S, Forbes A et al. Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition. Gut. 2018 Aug;67 8 1380 1399. Open https://web.pathway.md/diseases/recVxAQZiQCzPjLMr 3/3