Bacterial Overgrowth Syndrome Differential Diagnoses

1. Hao WL, Lee YK. Microflora of the gastrointestinal tract: a review. Methods Mol Biol. 2004. 268:491-502. [QxMD MEDLINE Link].

2. Bures J, Cyrany J, Kohoutova D, et al. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010 Jun 28. 16(24):2978-90. [QxMD MEDLINE Link]. [Full Text].

3. Virally-Monod M, Tielmans D, Kevorkian JP, et al. Chronic diarrhoea and diabetes mellitus: prevalence of small intestinal bacterial overgrowth. Diabetes Metab. 1998 Dec. 24(6):530-6. [QxMD MEDLINE Link].

4. Quigley EM, Abu-Shanab A. Small intestinal bacterial overgrowth. Infect Dis Clin North Am. 2010 Dec. 24(4):943-59, viii-ix. [QxMD MEDLINE Link].

5. McEvoy A, Dutton J, James OF. Bacterial contamination of the small intestine is an important cause of occult malabsorption in the elderly. Br Med J (Clin Res Ed). 1983 Sep 17. 287(6395):789-93. [QxMD MEDLINE Link].

6. Parodi A, Paolino S, Greco A, Drago F, Mansi C, Rebora A. Small intestinal bacterial overgrowth in rosacea: clinical effectiveness of its eradication. Clin Gastroenterol Hepatol. 2008 Jul. 6(7):759-64. [QxMD MEDLINE Link].

7. Castiglione F, Rispo A, Di Girolamo E, Cozzolino A, Manguso F, Grassia R, et al. Antibiotic treatment of small bowel bacterial overgrowth in patients with Crohn's disease. Aliment Pharmacol Ther. 2003 Dec. 18(11-12):1107-12. [QxMD MEDLINE Link].

8. Rubio-Tapia A, Barton SH, Rosenblatt JE, Murray JA. Prevalence of small intestine bacterial overgrowth diagnosed by quantitative culture of intestinal aspirate in celiac disease. J Clin Gastroenterol. 2009 Feb. 43(2):157-61. [QxMD MEDLINE Link].

9. Ghoshal UC, Ghoshal U, Misra A, Choudhuri G. Partially responsive celiac disease resulting from small intestinal bacterial overgrowth and lactose intolerance. BMC Gastroenterol. 2004 May 22. 4:10. [QxMD MEDLINE Link].

10. Lewis SJ, Franco S, Young G, O'Keefe SJ. Altered bowel function and duodenal bacterial overgrowth in patients treated with omeprazole. Aliment Pharmacol Ther. 1996 Aug. 10(4):557-61. [QxMD MEDLINE Link].

11. Elphick DA, Chew TS, Higham SE, Bird N, Ahmad A, Sanders DS. Small bowel bacterial overgrowth in symptomatic older people: can it be diagnosed earlier?. Gerontology. 2005 Nov-Dec. 51(6):396-401. [QxMD MEDLINE Link].

12. Hoverstad T, Bjorneklett A, Fausa O, Midtvedt T. Short-chain fatty acids in the small-bowel bacterial overgrowth syndrome. Scand J Gastroenterol. 1985 May. 20(4):492-9. [QxMD MEDLINE Link].

13. Kocoshis SA, Schletewitz K, Lovelace G, Laine RA. Duodenal bile acids among children: keto derivatives and aerobic small bowel bacterial overgrowth [published erratum appears in J Pediatr Gastroenterol Nutr 1988 Jan-Feb;7(1):155]. J Pediatr Gastroenterol Nutr. 1987 Sep-Oct. 6(5):686-96. [QxMD MEDLINE Link].

14. Chalmers RA, Valman HB, Liberman MM. Measurement of 4-hydroxyphenylacetic aciduria as a screening test for small-bowel disease. Clin Chem. 1979 Oct. 25(10):1791-4. [QxMD MEDLINE Link].

15. Sherr HP, Sasaki Y, Newman A, et al. Detection of bacterial deconjugation of bile salts by a convenient breath-analysis technic. N Engl J Med. 1971 Sep 16. 285(12):656-61. [QxMD MEDLINE Link].

16. Saad RJ, Chey WD. Breath testing for small intestinal bacterial overgrowth: maximizing test accuracy. Clin Gastroenterol Hepatol. 2014 Dec. 12 (12):1964-72; quiz e119-20. [QxMD MEDLINE Link].

17. Gasbarrini A, Corazza GR, Gasbarrini G, Montalto M, Di Stefano M, Basilisco G. Methodology and indications of H2-breath testing in gastrointestinal diseases: the Rome Consensus Conference. Aliment Pharmacol Ther. 2009 Mar 30. 29 Suppl 1:1-49. [QxMD MEDLINE Link].

18. Hofmann AF. evaluation of bacterial overgrowth in the small intestine: how, when and why. In: Perri F, Andriulli A,editors. Clinical Application of Breath Tests in Gastroenterology and Hepatology. 1998.

19. Stotzer PO, Kilander AF. Comparison of the 1-gram (14)C-D-xylose breath test and the 50-gram hydrogen glucose breath test for diagnosis of small intestinal bacterial overgrowth. Digestion. 2000. 61(3):165-71. [QxMD MEDLINE Link].

20. Pyleris E, Giamarellos-Bourboulis EJ, Tzivras D, Koussoulas V, Barbatzas C, Pimentel M. The prevalence of overgrowth by aerobic bacteria in the small intestine by small bowel culture: relationship with irritable bowel syndrome. Dig Dis Sci. 2012 May. 57 (5):1321-9. [QxMD MEDLINE Link].

21. Pimentel M, Saad RJ, Long MD, Rao SSC. ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth. Am J Gastroenterol. 2020 Feb. 115 (2):165-178. [QxMD MEDLINE Link].

22. Peralta S, Cottone C, Doveri T, Almasio PL, Craxi A. Small intestine bacterial overgrowth and irritable bowel syndrome-related symptoms: experience with Rifaximin. World J Gastroenterol. 2009 Jun 7. 15(21):2628-31. [QxMD MEDLINE Link].

23. Pimentel M. Review of rifaximin as treatment for SIBO and IBS. Expert Opin Investig Drugs. 2009 Mar. 18(3):349-58. [QxMD MEDLINE Link].

24. Scarpellini E, Gabrielli M, Lauritano CE, Lupascu A, Merra G, Cammarota G. High dosage rifaximin for the treatment of small intestinal bacterial overgrowth. Aliment Pharmacol Ther. 2007 Apr 1. 25(7):781-6. [QxMD MEDLINE Link].

25. Frissora CL, Cash BD. Review article: the role of antibiotics vs. conventional pharmacotherapy in treating symptoms of irritable bowel syndrome. Aliment Pharmacol Ther. 2007 Jun 1. 25(11):1271-81. [QxMD MEDLINE Link].

26. Tamer MA, Santora TR, Sandberg DH. Cholestyramine therapy for intractable diarrhea. Pediatrics. 1974 Feb. 53(2):217-20. [QxMD MEDLINE Link].

27. Vanderhoof JA, Young RJ. Etiology and pathogenesis of bacterial overgrowth. Clinical manifestations and diagnosis of bacterial overgrowth. Treatment of bacterial overgrowth UpToDate online, vol 18.1; Wellesley, 2010. http://www.uptodate.com. Available at http://www.uptodate.com.

28. Banwell JG, Sherr H. Effect of bacterial enterotoxins on the gastrointestinal tract. Gastroenterology. 1973 Sep. 65(3):467-97. [QxMD MEDLINE Link].

29. Quigley EM, Quera R. Small intestinal bacterial overgrowth: roles of antibiotics, prebiotics, and probiotics. Gastroenterology. 2006 Feb. 130(2 Suppl 1):S78-90. [QxMD MEDLINE Link].

30. Ong DK, Mitchell SB, Barrett JS, Shepherd SJ, Irving PM, Biesiekierski JR, et al. Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome. J Gastroenterol Hepatol. 2010 Aug. 25 (8):1366-73. [QxMD MEDLINE Link].

31. McIntosh K, Reed DE, Schneider T, Dang F, Keshteli AH, De Palma G, et al. FODMAPs alter symptoms and the metabolome of patients with IBS: a randomised controlled trial. Gut. 2017 Jul. 66 (7):1241-1251. [QxMD MEDLINE Link].

32. Marie I, Ducrotté P, Denis P, Menard JF, Levesque H. Small intestinal bacterial overgrowth in systemic sclerosis. Rheumatology (Oxford). 2009 Oct. 48 (10):1314-9. [QxMD MEDLINE Link].

33. Zhong C, Qu C, Wang B, Liang S, Zeng B. Probiotics for Preventing and Treating Small Intestinal Bacterial Overgrowth: A Meta-Analysis and Systematic Review of Current Evidence. J Clin Gastroenterol. 2017 Apr. 51 (4):300-311. [QxMD MEDLINE Link].

34. [Guideline] Pimentel M, Saad RJ, Long MD, Rao SSC. ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth. Am J Gastroenterol. 2020 Feb. 115 (2):165-178. [QxMD MEDLINE Link].

35. [Guideline] Rezaie A, Buresi M, Lembo A, Lin H, McCallum R, Rao S, et al. Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus. Am J Gastroenterol. 2017 May. 112 (5):775-784. [QxMD MEDLINE Link].

36. Hill ID, Mann MD, Househam KC, Bowie MD. Use of oral gentamicin, metronidazole, and cholestyramine in the treatment of severe persistent diarrhea in infants. Pediatrics. 1986 Apr. 77(4):477-81. [QxMD MEDLINE Link].

37. Abraczinskas D, Goldfinger SE. Intestinal gas and bloating. UpToDate on line, 18.1. Wellesley, 2010. http://www.uptodate.com. Available at http://www.uptodate.com.

38. Bouhnik Y, Alain S, Attar A, et al. Bacterial populations contaminating the upper gut in patients with small intestinal bacterial overgrowth syndrome. Am J Gastroenterol. 1999 May. 94(5):1327-31. [QxMD MEDLINE Link].

39. Donald IP, Kitchingmam G, Donald F, Kupfer RM. The diagnosis of small bowel bacterial overgrowth in elderly patients. J Am Geriatr Soc. 1992 Jul. 40(7):692-6. [QxMD MEDLINE Link].

40. Elphick DA, Chew TS, Higham SE, Bird N, Ahmad A, Sanders DS. Small bowel bacterial overgrowth in symptomatic older people: can it be diagnosed earlier?. Gerontology. 2005 Nov-Dec. 51(6):396-401. [QxMD MEDLINE Link].

41. Gracey M, Burke V, Oshin A, et al. Bacteria, bile salts, and intestinal monosaccharide malabsorption. Gut. 1971 Sep. 12(9):683-92. [QxMD MEDLINE Link].

42. Gregg CR. Enteric bacterial flora and bacterial overgrowth syndrome. Semin Gastrointest Dis. 2002 Oct. 13(4):200-9. [QxMD MEDLINE Link].

43. Haboubi NY, Lee GS, Montgomery RD. Duodenal mucosal morphometry of elderly patients with small intestinal bacterial overgrowth: response to antibiotic treatment. Age Ageing. 1991 Jan. 20(1):29-32. [QxMD MEDLINE Link].

44. Kilby AM, Dolby JM, Honour P, Walker-Smith JA. Duodenal bacterial flora in early stages of transient monosaccharide intolerance in infants. Arch Dis Child. 1977 Mar. 52(3):228-34. [QxMD MEDLINE Link].

45. King CE, Toskes PP. Small intestine bacterial overgrowth. Gastroenterology. 1979 May. 76(5 Pt 1):1035-55. [QxMD MEDLINE Link].

46. Klish WJ, Udall JN, Rodriguez JT, et al. Intestinal surface area in infants with acquired monosaccharide intolerance. J Pediatr. 1978 Apr. 92(4):566-71. [QxMD MEDLINE Link].

47. Lin HC. Small intestinal bacterial overgrowth: a framework for understanding irritable bowel syndrome. JAMA. 2004 Aug 18. 292(7):852-8. [QxMD MEDLINE Link].

48. Mathias JR, Clench MH. Review: pathophysiology of diarrhea caused by bacterial overgrowth of the small intestine. Am J Med Sci. 1985 Jun. 289(6):243-8. [QxMD MEDLINE Link].

49. Meyers JS, Ehrenpreis ED, Craig RM. Small Intestinal Bacterial Overgrowth Syndrome. Curr Treat Options Gastroenterol. 2001 Feb. 4(1):7-14. [QxMD MEDLINE Link].

50. Nichols VN, Fraley JK, Evans KD, Nichols BL Jr. Acquired monosaccharide intolerance in infants. J Pediatr Gastroenterol Nutr. 1989 Jan. 8(1):51-7. [QxMD MEDLINE Link].

51. Saltzman JR, Russell RM. Nutritional consequences of intestinal bacterial overgrowth. Compr Ther. 1994. 20(9):523-30. [QxMD MEDLINE Link].

52. Tahan S, Melli LC, Mello CS, Rodrigues MS, Bezerra Filho H, de Morais MB. Effectiveness of trimethoprim-sulfamethoxazole and metronidazole in the treatment of small intestinal bacterial overgrowth in children living in a slum. J Pediatr Gastroenterol Nutr. 2013 Sep. 57 (3):316-8. [QxMD MEDLINE Link].

Chinelo N Animalu, MD, MPH, FIDSA Associate Professor, Division of Infectious Diseases, Department of Internal Medicine, University of Tennessee Health Science Center College of Medicine; Physician, Department of Infectious Disease, University of Tennessee Methodist Physicians (UTMP), Methodist University Hospital

Chinelo N Animalu, MD, MPH, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, Infectious Diseases Society of America, Memphis Medical Society, Tennessee Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Joseph F John, Jr, MD, FACP, FIDSA, FSHEA Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Joseph F John, Jr, MD, FACP, FIDSA, FSHEA is a member of the following medical societies: Charleston County Medical Association, Infectious Diseases Society of America, South Carolina Infectious Diseases Society

Disclosure: Nothing to disclose.

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Mark R Wallace, MD, FACP, FIDSA Infectious Disease Physician, Skagit Valley Hospital, Skagit Regional Health

Disclosure: Nothing to disclose.

Saqib Zaheer Syed, MBBS Nephrologist, South Texas Renal Care Group

Disclosure: Nothing to disclose.

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Pedro A Manibusan Jr, DO; Joshua S Hawley, MD; Richard E Frye, MD, PhD; M Akram Tamer, MD; and Burke A Cunha, MD, to the development and writing of this article.

• Print this section
• Print the entire contents of
• Print the entire contents of article