Global perspectives on dietary management of small intestinal bacterial overgrowth (SIBO): a systematic review of clinical guidelines, consensus statements and expert recommendations.

Introduction: Small intestinal bacterial overgrowth (SIBO) is a disorder associated with gastrointestinal symptoms, alterations in gut microbiota composition, and a high rate of recurrence. Although antibiotic therapy remains the cornerstone of treatment, dietary interventions are increasingly used as adjunctive strategies to improve symptom control and support long-term management. However, international recommendations regarding dietary management remain heterogeneous and lack standardization. Therefore, the aim of this systematic review was to analyze and compare dietary recommendations for the treatment of SIBO presented by international scientific organizations and recent expert reviews. Methods: This guidelines review was conducted in accordance with PRISMA 2020 recommendations. PubMed and Cochrane Library were searched for publications published between January 2016 and January 2026. Eligible documents included clinical guidelines, consensus statements, official position papers, and supplementary expert review articles addressing dietary management in SIBO. Data were extracted on the role of dietary therapy, low-FODMAP recommendations, dietary fiber, probiotics, prebiotics, treatment priorities, and the reported impact of dietary interventions on the gut microbiota. A qualitative synthesis of recommendations from different geographic regions was performed. Results: Five key documents from North America, South America, Europe, and the Asia-Pacific region met the inclusion criteria. Dietary therapy was consistently regarded as supportive rather than curative, although its perceived importance varied across regions. The low-FODMAP diet was the most frequently discussed dietary intervention and was generally recommended for symptom relief, particularly for bloating, abdominal pain, and altered bowel habits. Nevertheless, evidence supporting its role in eradicating SIBO remains insufficient. Recommendations regarding dietary fiber, probiotics, and prebiotics were heterogeneous and largely emphasized individualized use. Antibiotic therapy and management of underlying predisposing factors remained the central therapeutic strategy in all analyzed regions. Conclusion: Despite increasing interest in nutritional approaches, substantial international variability exists in dietary recommendations for SIBO. Current evidence supports dietary therapy primarily as an adjunct to medical treatment and a tool for symptom management. High-quality prospective studies are needed to establish standardized, evidence-based dietary recommendations and to clarify the long-term effects of dietary interventions on the gut microbiota and disease recurrence.