However, some studies showed increased prevalence of positive breath tests in fibromyalgia patients which may indicate an association between psychological distress factors like somatization and SIBO( 11). No study has looked at psychological distress as a moderating variable in SIBO patients. predominant methane producers remains to be determined. Whether antibiotic choices should differ for patients who are predominant hydrogen vs. However, treatment with antibiotic is not completely safe: antibiotics may worsen symptoms of IBS by altering the delicate balance of “good” and “bad” (e.g., probiotic vs. Pimentel et al and others recommend that IBS be treated with broad spectrum antibiotics( 9). Further work is needed to evaluate methane’s effect on colonic motility and its association with constipation. Pimentel et al showed in animal studies that exogenous methane slows transit and augments non-propagating contractions in the small bowel( 8). However, recent studies also test for elevated methane and find that this gas, which is liberated by anaerobic bacteria, is more often associated with constipation. Critics have suggested that differences in how SIBO is diagnosed, and especially differences in which substrate is used, may account for inconsistencies between studies.Įarly studies of SIBO tested only for excess hydrogen in breath following ingestion of sugar, and those studies usually reported diarrhea to be the primary symptom. However, these assertions are controversial( 7). However, Pimentel et al reported a prevalence of 80% among IBS patients, and suggested (a) that SIBO may be the etiology for all or most IBS, and (b) that antibiotics are an effective treatment for IBS( 5). Galatola et al( 6) showed that 29% of IBS patients without diarrhea, and 56% of those with diarrhea of obscure origin had an abnormal 1g-14C Xylose breath test. SIBO has been proposed to be common in IBS with reported prevalence figures ranging from 10-70%( 4 5). The usual symptoms are diarrhea, flatulence, abdominal pain and bloating( 3). SIBO may be associated with a broad range of predisposing conditions including decreased peristaltic motility in the small intestine or surgical procedures that encourage stasis( 1 2). Small Intestinal bacterial overgrowth (SIBO) is characterized by the presence of an abnormally high number of bacteria in the small bowel.
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