Nickles Melissa A, Hasan Aliza, Shakhbazova Anastasia, Wright Sarah, Chambers Cynthia J, Sivamani Raja K
College of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
Department of Dermatology, University of California-Davis, Sacramento, CA, USA.
J Altern Complement Med. 2021 Feb;27(2):108-119. doi: 10.1089/acm.2020.0275. Epub 2020 Oct 19.
Broad-spectrum antibiotics are the first-line treatment for small intestinal bacterial overgrowth (SIBO). However, many antibiotics have a considerable side-effect profile and SIBO commonly reoccurs after successful eradication with antibiotics. Alternative therapies such as probiotics, therapeutic diets, and herbal medicines have been used to individualize SIBO management, particularly in recalcitrant cases. The objective of this review is to evaluate the role of alternative therapies in SIBO treatment. EMBASE, MEDLINE, and the Cochrane Central Register were systematically searched for clinical studies evaluating alternative therapies in the management of SIBO. Human studies in which an alternative intervention was used to treat SIBO were included. Alternative interventions were defined as an intervention that included a probiotic supplement, herbal preparation, or a dietary change. Randomized controlled trials (RCTs), nonrandomized clinical trials with or without a control, and crossover studies were included. The following information was extracted from the selected studies: study type, study participants, SIBO subtype, intervention, comparison, outcome measures, relevant results, relevant side effects, and Jadad score. Eight studies met inclusion criteria. The studies evaluated probiotics ( = 5), therapeutic diet ( = 1), and herbal medicines ( = 2). Among these studies, there were four RCTs, two open-label single-arm studies, one randomized, double-blind crossover study, and one two-arm open-label study with crossover. Main results are summarized. There may be studies not captured by the defined search criteria. Additionally, studies used different methodologies in both breath testing and measurement of clinical symptoms, making it difficult to draw conclusions on SIBO eradication and symptom improvement across studies. Our findings suggest preliminary evidence for a role of alternative therapies in the treatment of SIBO. However, robust clinical trials are generally lacking. Existing studies tend to be small and lack standardized formulations of treatment. Breath testing protocols and clinical symptom measurement greatly varied between studies. Large-scale, randomized, placebo-controlled trials are needed to further evaluate the best way to utilize alternative therapies in the treatment of SIBO.
广谱抗生素是小肠细菌过度生长（SIBO）的一线治疗方法。然而，许多抗生素有相当多的副作用，且SIBO在抗生素成功根除后通常会复发。益生菌、治疗性饮食和草药等替代疗法已被用于个性化管理SIBO，尤其是在难治性病例中。本综述的目的是评估替代疗法在SIBO治疗中的作用。我们系统检索了EMBASE、MEDLINE和Cochrane中央对照试验注册库，以查找评估替代疗法在SIBO管理中作用的临床研究。纳入了使用替代干预措施治疗SIBO的人体研究。替代干预措施被定义为包括益生菌补充剂、草药制剂或饮食改变的干预措施。纳入了随机对照试验（RCT）、有或无对照的非随机临床试验以及交叉研究。从所选研究中提取了以下信息：研究类型、研究参与者、SIBO亚型、干预措施、对照、结局指标、相关结果、相关副作用和Jadad评分。八项研究符合纳入标准。这些研究评估了益生菌（n = 5）、治疗性饮食（n = 1）和草药（n = 2）。在这些研究中，有四项RCT、两项开放标签单臂研究、一项随机双盲交叉研究和一项双臂开放标签交叉研究。主要结果进行了总结。可能存在未被既定检索标准涵盖的研究。此外，各研究在呼气测试和临床症状测量方面使用了不同的方法，这使得难以在各项研究中就SIBO的根除和症状改善得出结论。我们的研究结果表明，有初步证据支持替代疗法在SIBO治疗中发挥作用。然而，普遍缺乏有力的临床试验。现有研究往往规模较小，且缺乏标准化的治疗方案。各研究之间呼气测试方案和临床症状测量差异很大。需要大规模、随机、安慰剂对照试验来进一步评估在SIBO治疗中使用替代疗法的最佳方式。
