4, 5 In contrast to the earlier belief, SIBO is known to occur in absence of anatomical factors predisposing to it. 2, 3 Patients with small intestinal bacterial overgrowth (SIBO), in which there is increase in bacteria equal to or greater than 10 5 colony forming unit per mL of upper gut aspirate, 2 also experience abdominal pain or discomfort, bloating, flatulence and loose motion. 2 Bloating is another common symptom of IBS. 1 IBS is manifested by abdominal pain and/or discomfort, irregular stool form and passage. Irritable bowel syndrome (IBS) is one of the commonest disorders encountered in Gastroenterology practice. Keywords: Bacterial overgrowth, Dysbiosis, Breath tests, Gastrointestinal microbiota, Probiotics, Rifaximin A recent proof-of-concept study showing the high frequency of symptom improvement in patients with IBS with SIBO further supports this hypothesis. Several therapeutic trials targeting gut microbes using antibiotics and probiotics have further demonstrated that not all symptoms in patients with IBS originate in the brain but rather in the gut, providing support for the micro-organic basis of IBS. Female gender, older age, diarrhea-predominant IBS, bloating and flatulence, proton pump inhibitor and narcotic intake, and low hemoglobin are associated with SIBO among IBS patients. Although the glucose hydrogen breath test is highly specific, its sensitivity is low in contrast, the early-peak criteria in the lactulose hydrogen breath test are highly nonspecific. Although quantitative jejunal aspirate culture is considered the gold standard for the diagnosis of SIBO, noninvasive hydrogen breath tests have been popular. Between 4% and 78% of patients with IBS and 1% and 40% of controls have SIBO such wide variations in prevalence might result from population differences, IBS diagnostic criteria, and, most importantly, methods to diagnose SIBO. One of the reasons for this paradigm shift is the realization that gut dysbiosis, including small intestinal bacterial overgrowth (SIBO), causes IBS symptoms. The pathogenesis of irritable bowel syndrome (IBS), once thought to be largely psychogenic in origin, is now understood to be multifactorial. The editor retains the right to determine publication priorities, the style of the paper, and to request, if necessary, that the material submitted be shortened for publication. In many cases, papers may be rejected despite favorable reviews because of editorial policy or a lack of space. The final responsibility for the decision to accept or reject lies with the editors. We reserve the right to return manuscripts in which no reviewers are suggested.
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