Management of small intestinal bacterial overgrowth

1. Pimentel M, Soffer EE, Chow EJ, Lin HC: Lower frequency of MMC is found in IBS subjects with abnormal lactulose breath test, suggesting bacterial overgrowth. Dig Dis Sci 2002, 47:2639–2643. This paper describes reduced frequency of intestinal housekeeper waves in patients with IBS who have confirmed SIBO.

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2. Pimentel M, Chow EJ, Lin HC: Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol 2000, 95:3503–3506.

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3. Pimentel M, Chow EJ, Lin HC: Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome a double-blind, randomized, placebocontrolled study. Am J Gastroenterol 2003, 98:412–419. This double-blind, placebo-controlled study of IBS sufferers compared treatment with neomycin to placebo. LBT was performed before and after treatment. Neomycin treatment resulted in normalization of LBT and decreased symptoms nearly three times more than placebo. Methane production was related to severity of constipation. Rapid transit was not a factor in producing elevated breath gas or symptoms because both diarrhea-predominant and constipation-predominant IBS sufferers had similar LBT profiles.

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13. O’Mahony L, McCarthy J, Kelly P, et al.: Lactobacillus and Bifidobacterium in irritable bowel syndrome: symptom responses and relationship to cytokine profiles. Gastroenterology 2005, 128:541–551. This randomized, double-blind, placebo-controlled study of the utility of probiotic formulations in alleviating the symptoms of IBS demonstrated that Bifidobacterium infantis 35624 but not Lactobacillus salivarius UCC4331 was effective. Reduction of symptoms was associated with normalization of ratio of interleukin-10 to interleukin-12.

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14. Pimentel M, Constantino T, Kong Y, et al.: A 14-day elemental diet is highly effective in normalizing the lactulose breath test. Dig Dis Sc 2004, 49:73–77. This is the first demonstration that an exclusively elemental diet given for 14 days could normalize the LBT in IBS patients. In this retrospective study, LBT profile was normalized in 80% of patients on the diet, irrespective of IBS subgroup.

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