ReviewNeurogastroenterology and motility2024
Critical appraisal of the SIBO hypothesis and breath testing: A clinical practice update endorsed by the European society of neurogastroenterology and motility (ESNM) and the American neurogastroenterology and motility society (ANMS).
Review in Neurogastroenterology and motility, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it.
- European Consensus on Malabsorption-UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN. Part 1: Definitions, Clinical Phenotypes, and Diagnostic Testing for Malabsorption.United European gastroenterology journal · 2025Guideline
- Effect of microencapsulated sodium butyrate on abdominal symptoms and carbohydrate metabolism in patients with type 2 diabetes: a randomized placebo-controlled trial.Scientific reports · 2026Trial
- Clinical and cost effectiveness of nurse led-structured management of diarrhoea predominant irritable bowel syndrome in primary care (Lincolnshire POACHER study); a randomised control trial.BMC primary care · 2026Trial
- Constipation with bloating: a clinical approach to evaluation and management.Annals of medicine · 2026Review
- Irritable bowel syndrome.Nature reviews. Disease primers · 2026Review
- Targeted antibiotic and dietary approaches in managing small intestinal bacterial overgrowth across irritable bowel syndrome subtypes.Internal and emergency medicine · 2026Review
- Beyond Malabsorption: The Need for Symptom-Based Assessment in Suspected Lactose Intolerance. Lessons From a Test-Specific Symptom Assessment.Neurogastroenterology and motility · 2026Article
- Critical Review: The Past, Present, and Future of Small Intestinal Bacterial Overgrowth (SIBO).JGH open : an open access journal of gastroenterology and hepatology · 2026Review
- The Gut-Brain Axis-From Science to Clinical Practice.Gastro hep advances · 2026Review
- Delayed orocecal transit in pediatric gut-brain interaction disorders: A comparative study using the lactulose breath test.World journal of gastrointestinal pathophysiology · 2025Article
- Diagnostic Evaluation of Small Intestinal Microbial Overgrowth: A Cross-Sectional Comparison of Glucose and Lactulose Breath Tests.Journal of clinical medicine · 2025Article
- Ileal Biofilms Confirm SIBO-IBS Hypothesis: Comment on PMID 38798120.Neurogastroenterology and motility · 2025Article
- Hydrogen Sulfide and Methane on Breath Test Correlate with Human Small Intestinal Hydrogen Sulfide Producers and Methanogens.Digestive diseases and sciences · 2025Article
- Can Symptoms and Medical History Predict Outcomes for Hydrogen and Methane Breath Testing?The American journal of gastroenterology · 2025Article
- Common misconceptions and controversies in the management of irritable bowel syndrome.Nature reviews. Gastroenterology & hepatology · 2025Review
- Anxiety and small intestinal bacterial overgrowth: associations with recurrent aphthous ulcers.BMC oral health · 2025Article
- Gas-tly Interpretations: A Case-Based Approach to the Nuances of SIBO Breath Testing.Current gastroenterology reports · 2025Review
- Should We Treat SIBO Patients? Impact on Quality of Life and Response to Comprehensive Treatment: A Real-World Clinical Practice Study.Nutrients · 2025Article
- Impact of Microbiota on Irritable Bowel Syndrome Pathogenesis and Management: A Narrative Review.Medicina (Kaunas, Lithuania) · 2025Review
- Role of the Small Intestinal Microbiota in Gastrointestinal Disorders.The Korean journal of helicobacter and upper gastrointestinal research · 2024Review
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
backgroundThere is compelling evidence that microbe-host interactions in the intestinal tract underlie many human disorders, including disorders of gut-brain interactions (previously termed functional bowel disorders), such as irritable bowel syndrome (IBS). Small intestinal bacterial overgrowth (SIBO) has been recognized for over a century in patients with predisposing conditions causing intestinal stasis, such as surgical alteration of the small bowel or chronic diseases, including scleroderma and is associated with diarrhea and signs of malabsorption. Over 20 years ago, it was hypothesized that increased numbers of small intestine bacteria might also account for symptoms in the absence of malabsorption in IBS and related disorders. This SIBO-IBS hypothesis stimulated significant research and helped focus the profession's attention on the importance of microbe-host interactions as a potential pathophysiological mechanism in IBS. PURPOSE: However, after two decades, this hypothesis remains unproven. Moreover, it has led to serious unintended consequences, namely the widespread use of unreliable and unvalidated breath tests as a diagnostic test for SIBO and a resultant injudicious use of antibiotics. In this review, we examine why the SIBO hypothesis remains unproven and, given the unintended consequences, discuss why it is time to reject this hypothesis and its reliance on breath testing. We also examine recent IBS studies of bacterial communities in the GI tract, their composition and functions, and their interactions with the host. While these studies provide important insights to guide future research, they highlight the need for further mechanistic studies of microbe-host interactions in IBS patients before we can understand their possible role in diagnosis and treatment of patient with IBS and related disorders.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.