Small Intestinal Bacterial Overgrowth and Rifaximin: An Update

Excessive bacteria and nutrient malabsorption are the two major events need to clarify small intestinal bacterial overgrowth (SIBO). Clinically, SIBO is defined as a condition with the existence of > 106 colony-forming units (CFU) bacteria in the human intestine. It is the only generally accepted criteria to diagnose the SIBO in clinical practice. The main problem is that several clinical disorders are happening in patients with SIBO; thus actual discrimination will be relatively difficult. Exploration of the current status of SIBO management and suggesting rifaximin as a main clinical target is our optimal goal. Although the quality of performed randomized clinical trials needs to be re-evaluated, rifaximin seems the only suitable option for treatment of SIBO. Undoubtedly, new treatment should include the correction of ongoing small intestinal microflora with proper antibiotic therapy. Personalized medicine is another option that should be studied thoroughly before entering the area of SIBO treating using proton pump inhibitors. Finally, we have to focus on the available option to have better management of patients with SIBO.