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Aetiology, diagnosis and management of small intestinal bacterial overgrowth
  1. Jabed Foyez Ahmed,
  2. Pritpal Padam,
  3. Aruchuna Ruban
  1. Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Jabed Foyez Ahmed, Department of Gastroenterology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London W2 1NY, UK; jabedahmed{at}


Small intestinal bacterial overgrowth is a small bowel disorder characterised by excessive amounts of bacteria populating the small intestine leading to symptoms of abdominal pain, bloating and change in bowel habit. This creates some degree of diagnostic uncertainty due to the overlap of these symptoms with numerous other gastrointestinal conditions. Quantitative culture of jejunal aspirates is the gold standard diagnostic test but has largely been replaced by glucose and lactulose breath tests due to their relative ease and accessibility. The approach to treatment centres around reducing bacterial numbers through antibiotic therapy and managing any predisposing factors. Further research is required in order to define the optimum antibiotic choice and duration of therapy as well as the potential diagnostic utility of home breath testing and capsule-based technology.


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  • Contributors JFA and PP co-wrote the article. AR conceptualised and provided oversight and overall supervision of this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.