Notably, methane is produced mainly by Archaea-the domain of microorganisms, distinct from bacteria. Constipation accompanies SIBO when bacterial overgrowth is primarily due to methane-producing (methanogenic) microorganisms, such as Methanobrevibacter smithii. The patients may also complain of chronic fatigue and impaired concentration. The most common symptoms, reported by two-thirds of patients with SIBO, are abdominal distension, excessive gas accumulation and flatulence, the feeling of abdominal fullness, diffuse abdominal cramps, and altered bowel habits (predominantly diarrhea or alternating bowel habit, sometimes constipation) ( Figure 1). SIBO may cause various clinical manifestations as well as have an asymptomatic course. There are three types of protective mechanisms against SIBO : When these mechanisms are overwhelmed, insufficient, or absent, this may lead to SIBO. There are many protective mechanisms to ensure small intestinal microbiota homeostasis and prevent excessive bacterial colonization. Moreover, the clinical presentation of SIBO is a common epiphenomenon accompanying a number of systemic diseases (such as diabetes) or diseases of other organ systems (such as connective tissue disorders) and is not immediately considered in the differential diagnosis. The discrepancies in the reported prevalence rates result from the fact that SIBO syndrome may be asymptomatic or manifest with symptoms (such as abdominal bloating, pain, or altered bowel habits) that may be caused by other factors. Most authors report rates between 2.5 and 22% and emphasize that the prevalence increases with age and in populations with comorbidities. The exact prevalence of SIBO in the general population is unknown. The Prevalence, Pathophysiology, and Risk Factors of SIBO This review presents the most recent data on epidemiology, the pathological mechanism, clinical presentation, and recommended diagnostic and therapeutic management of SIBO.Ģ. However, controversies remain as to its diagnostics and management. The problem of SIBO has been steadily gaining attention since the first half of the 2000s. Despite the distinction between the two types, their importance in clinical practice is limited due to the similar symptoms and treatment. and Streptococcus viridans, whereas coliform SIBO is characterized predominantly by bacteria from the distal segments of the gastrointestinal tract, such as Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus sp., or Clostridioides sp. UAT SIBO is caused predominantly by oral cavity bacteria, including Prevotella sp. There are two well-established types: upper aerodigestive tract (UAT) SIBO and coliform SIBO. It is worth noting that the forms of SIBO differ depending on the predominant species of bacteria colonizing the small intestine, and these depend on their origin. Currently, the cut-off for SIBO diagnosis is above 10 3 CFU/mL of aspirate. This diagnostic technique helped establish a quantitative definition of SIBO, which-initially-was defined as the number of bacteria above 10 5 colony forming units (CFU) per milliliter of the aspirate collected from the third part of the duodenum on upper endoscopy. The number of bacteria can be accurately determined via cultures of the fluid endoscopically aspirated from the small intestinal lumen. The hallmark of SIBO is this excessive number of bacteria, both aerobic and anaerobic, within the small intestine, which is usually only sparsely colonized. Currently, SIBO is defined as a form of dysbiosis characterized by increased numbers of bacteria colonizing the small intestine, possibly with some characteristics of the colon microbiota. The medical phenomenon currently known as Small Intestinal Bacterial Overgrowth (SIBO) was identified several decades ago by Faber, who described it in 1897 in the form of a case report of ‘blind-loop syndrome’, with that term also used in some subsequent papers on this topic.
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