Division of Gastroenterology and Hepatology, Houston Methodist Hospital, Houston, Texas, USA.
Curr Opin Gastroenterol. 2014 Mar;30(2):141-6. doi: 10.1097/MOG.0000000000000040.
To critically review recent literature on small intestinal bacterial overgrowth (SIBO).
When originally described, SIBO was added to the list of causes of the malabsorption syndrome and the pathophysiology of its consequences for the digestion and absorption of various nutrients was gradually revealed. More recently, SIBO was incriminated as a cause of diarrhea, especially in the elderly. However, the suggestion that SIBO may be a causative factor in irritable bowel syndrome and of its constituent symptoms has sparked debate and controversy on the very definition of SIBO. This debate revolves around the tests employed and the diagnostic cut-off values (for bacterial numbers) used to diagnose SIBO in clinical practice.
A fundamental problem with SIBO, and one that allows controversy to simmer, is the lack of a universally accepted and applied gold standard for the diagnosis of SIBO. Hopefully, the application of molecular microbiological methods to the characterization of the small intestinal microbiome will tell us, once and for all, what is normal and when 'abnormality' is truly responsible for symptoms and disease. Meanwhile, therapy remains, for the most part, empirical and is based on the correction, wherever possible, of any underlying cause, attention to nutritional deficiencies, and the use of antibiotics.
批判性地回顾近期有关小肠细菌过度生长（SIBO）的文献。
最初描述 SIBO 时，它被添加到吸收不良综合征的病因列表中，其对各种营养物质消化和吸收的病理生理学逐渐被揭示。最近，SIBO 被认为是腹泻的一个原因，特别是在老年人中。然而，SIBO 可能是肠易激综合征及其组成症状的致病因素的说法引发了关于 SIBO 的定义的争论和争议。这种争论围绕着用于诊断 SIBO 的检测方法和诊断截断值（细菌数量）展开。
SIBO 的一个根本问题，也是引起争议的根源，是缺乏普遍接受和应用的诊断 SIBO 的金标准。希望将分子微生物学方法应用于小肠微生物组的特征描述，将一劳永逸地告诉我们什么是正常的，以及何时“异常”真正对症状和疾病负责。同时，治疗在很大程度上仍然是经验性的，并且基于尽可能纠正任何潜在原因、注意营养缺乏以及使用抗生素。
