Probiotics, prebiotics & synbiotics in small intestinal bacterial overgrowth: opening up a new therapeutic horizon!
Year: 2014
Type: article
Abstract: The human intestinal microbiota is a complex community comprised a myriad of bacterial species. Disruption of homeostasis in the small intestinal microbial community can lead to significant clinical consequences, most notably small intestinal bacterial overgrowth (SIBO); a situation where bacteria are present, not only in greater numbers, but also in a distribution more commonly associated with the colon. Classically, SIBO was recognized as an important cause of maldigestion and malabsorption; more recently, SIBO has been implicated in a variety of clinical scenarios ranging from non-alcoholic fatty liver disease to unexplained diarrhoea and the irritable bowel syndrome (IBS). Traditionally, SIBO was clinically defined on the basis of quantitative cultures of jejunal aspirates with the presence of more than 105 colony forming unit (cfu)/ml of proximal jejunal aspirate being regarded as diagnostic1. This approach, due to its invasive nature and resultant costs has fallen into abeyance and, in clinical practice, has been replaced either by cultures of duodenal aspirates obtained via an endoscope or, more commonly, by hydrogen breath tests (HBTs) performed using substrates such as lactulose or glucose. Despite their ease of performance and acceptability to patients, HBTs have been criticized on the basis of considerable variability in sensitivity and specificity, as well as their inability to detect bacterial overgrowth in the more distant reaches of the small intestine and their failure to detect overgrowth by non-H2-producing bacteria2,3. Currently, there is a lack of consensus on how to define an abnormal breath test with no agreement on either the optimal duration of sampling or the best cut-off level to define a positive test3. The lack of an accepted “gold standard” for the clinical definition of SIBO, especially, in a non-classical clinical scenario, represents a major challenge for the clinician.
Source: Europe PMC (PubMed Central)
Authors: Wei Chung Chen, Eamonn M M Quigley
Institution: Houston Methodist
Language: English
Topic: Gut microbiota and health
Subfield: Molecular Biology
Domain: Life Sciences
Open Access status: green
OpenAlex ID: W1895216807