Diminished acid production (hypochlorhydria) is a risk factor for SIBO, and can develop after colonization with Helicobacter pylori or as a consequence of aging. Gastric acid suppresses the growth of ingested bacteria, thereby limiting bacterial counts in the upper small intestine. 9 In summary, although data are limited, the prevalence rates of SIBO in young and middle-aged adults appear to be low, whereas prevalence rates appear to be consistently higher in the older patient (14.5–15.6%) these rates, however, are dependent upon the diagnostic test used (see below). 8 Finally, in a study of 111 patients with irritable bowel syndrome (IBS), 20% of healthy age- and sex-matched controls were found to have an abnormal lactulose breath test suggestive of SIBO. 7 Healthy elderly volunteers from the United Kingdom had a 14.5% prevalence rate for SIBO based on a positive glucose breath test.
5 A study of healthy older adults from Japan (mean age 74.7 years) found no patient with SIBO using a glucose breath test 6 an Australian study detected SIBO from duodenal aspirates in 0% of healthy controls (mean age 59), although 13% were positive for SIBO using a lactulose breath test. In a study of 294 nonhospitalized older adults in which 34 younger adults (mean age 33.6 years) served as healthy controls, the prevalence of SIBO, as determined by glucose breath test, was 5.9% in the control group versus 15.6% in the older group. Only limited data are available regarding the prevalence of SIBO in healthy populations. Only published manuscripts are included in this review abstracts are not included.Īn extensive literature search was unable to identify a study evaluating the incidence of SIBO in healthy volunteers.
All identified articles were then manually searched for other relevant studies. For PubMed (no time limit), a similar search process was followed.
For Ovid MEDLINE (1966 to December 2006, English language only) three primary search terms (bacterial overgrowth, small intestine overgrowth, and small intestine bacterial overgrowth) were individually coupled with a larger number of secondary search terms (epidemiology, incidence, prevalence, populations at risk, symptoms, pathogenesis, pathophysiology, inflammation, malabsorption, complications, vitamin deficiency, motility disorders, scleroderma, gastroparesis, chronic intestinal pseudo-obstruction, celiac disease, irritable bowel syndrome, renal failure, cirrhosis, alcohol abuse, elderly, aging, diabetes, hypochlorhydria, surgery, malnutrition, diarrhea, evaluation, diagnosis, breath testing, duodenum, jejunum, aspirates, breath tests, lactulose, treatment, antibiotics, rifaximin, tetracycline, metronidazole, ciprofloxacin, amoxicillin/clavulanate, probiotics, duration, resistance). Ovid MEDLINE and PubMed databases were used to search the published literature.
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