Small Intestinal Bacterial Overgrowth

Despite the current increase in interest in the role of the microbiota in health and disease and the recognition, for over 50 years, that an excess of "colonic" type flora in the small intestine could lead to a malabsorption syndrome, small intestinal overgrowth remains poorly defined. This lack of clarity owes much to the difficulties that arise in attempting to arrive at consensus with regard to the diagnosis of this condition: there is currently no gold standard and the commonly available methodologies, the culture of jejunal aspirates and a variety of breath tests, suffer from considerable variations in their performance and interpretation, thereby leading to wild variations in the prevalence of overgrowth in a variety of clinical contexts. Treatment is similarly supported by a scanty evidence base and the most commonly employed antibiotic regimes owe more to custom than clinical trials.