SIBO (Small Intestinal Bacterial Overgrowth): A Complete Guide to Diagnosis, Treatment, and Recovery

What Is SIBO?

Your small intestine is supposed to be relatively clean. Unlike the large intestine, which houses trillions of bacteria in a thriving ecosystem, the small intestine normally contains far fewer microorganisms. When bacteria from the colon (or other sources) colonize the small intestine in excessive numbers, you get SIBO.

These misplaced bacteria ferment carbohydrates that arrive in the small intestine, producing gases that cause a cascade of symptoms. The bacteria also damage the intestinal lining over time, interfere with nutrient absorption, and trigger systemic inflammation that can affect nearly every organ system.

SIBO is not a fringe diagnosis. Research estimates that SIBO affects up to 15% of the general population and is present in 30-85% of patients diagnosed with irritable bowel syndrome [1]. It is increasingly recognized as one of the most common and most overlooked causes of chronic digestive problems.

What makes SIBO particularly frustrating for patients is that it often goes undiagnosed for years. Many people bounce between doctors hearing that their labs are normal, that it is “just stress,” or that they simply have IBS without anyone looking deeper. Understanding what SIBO is and how it works is the first step toward getting proper help.

The Three Types of SIBO

Not all SIBO is the same. The type of gas the overgrown organisms produce determines your dominant symptoms and shapes your entire treatment plan.

Hydrogen-Dominant SIBO

In this form, bacteria produce excess hydrogen gas during fermentation of carbohydrates. Hydrogen-dominant SIBO tends to present with diarrhea, urgency, bloating, and abdominal cramping. Many patients report that symptoms flare within 30-90 minutes of eating, particularly after meals containing fermentable carbohydrates.

This is generally the most straightforward type to treat. It typically responds well to a single course of rifaximin or a well-chosen herbal antimicrobial protocol. Eradication rates tend to be higher than with the other subtypes.

Methane-Dominant SIBO (Intestinal Methanogen Overgrowth / IMO)

Methane is produced not by bacteria, but by archaea, a completely different domain of life. The primary culprit is Methanobrevibacter smithii. Because the organisms responsible are not bacteria at all, researchers have reclassified methane-dominant SIBO as Intestinal Methanogen Overgrowth (IMO) [2]. This also means IMO can occur in the large intestine, not just the small intestine.

Methane gas directly slows intestinal transit time by acting on the smooth muscle of the gut wall. This is why constipation is the hallmark symptom. Patients with IMO often experience hard stools, significant straining, bloating that worsens progressively throughout the day, and visible abdominal distension. Some patients report gaining a full pant size by evening.

IMO is harder to eradicate than hydrogen-dominant SIBO and typically requires dual antimicrobial therapy targeting both the archaea and the hydrogen-producing bacteria that feed them.

Hydrogen Sulfide SIBO

This is the newest recognized subtype. Certain sulfate-reducing bacteria, particularly Desulfovibrio and Fusobacterium species, consume hydrogen and produce hydrogen sulfide gas instead. Symptoms can include diarrhea (sometimes alternating with constipation), especially foul-smelling gas, bladder irritation, brain fog, weight gain, and sensitivity to sulfur-containing foods like eggs, garlic, onions, and cruciferous vegetables.

Until recently, hydrogen sulfide SIBO was nearly impossible to detect on standard breath tests. A flat-line pattern on both hydrogen and methane was sometimes the only clue. The trio-smart breath test, developed by Dr. Mark Pimentel’s team at Cedars-Sinai, now measures all three gases simultaneously, making diagnosis much more reliable [3].

Symptoms of SIBO

SIBO symptoms range from mild digestive discomfort to severe, life-disrupting problems. Importantly, they extend well beyond the gut. This is because the intestinal inflammation and permeability changes caused by SIBO allow bacterial byproducts, endotoxins, and partially digested food proteins to enter the bloodstream, triggering immune responses throughout the body.

Digestive Symptoms

• Bloating and visible abdominal distension (often the most prominent complaint)
• Excessive gas, belching, and flatulence
• Diarrhea, constipation, or alternating between the two (depending on SIBO type)
• Abdominal pain and cramping, often worse after eating
• Nausea, particularly in the morning or after meals
• Acid reflux or heartburn
• Feeling uncomfortably full after eating only small amounts
• Food intolerances that seem to multiply over time

Systemic Symptoms

• Fatigue and low energy that does not improve with rest
• Brain fog and difficulty concentrating
• Joint pain and muscle aches
• Skin problems (rosacea, eczema, acne, unexplained rashes)
• Mood changes, anxiety, or depression
• Restless legs syndrome
• Histamine intolerance (flushing, headaches, hives after certain foods)
• Weight changes (either unexplained weight loss or stubborn weight gain)

Nutrient Deficiencies

Because the overgrown bacteria consume nutrients before your body can absorb them, and because they damage the absorptive surface of the intestinal lining, SIBO frequently leads to deficiencies. Common ones include iron, vitamin B12, fat-soluble vitamins (A, D, E, K), magnesium, and zinc [4].

Unexplained anemia, persistently low ferritin despite supplementation, or low B12 in someone who eats animal products should always raise suspicion for SIBO. Fat malabsorption may cause pale, floating, greasy stools and deficiencies in fat-soluble vitamins.

What Causes SIBO?

SIBO is rarely a standalone problem. It almost always develops because one or more of the body’s natural defense mechanisms against bacterial overgrowth have broken down. Understanding these root causes is critical, because if you treat the overgrowth without addressing why it developed, it will come back.

Impaired Motility and the Migrating Motor Complex

The migrating motor complex (MMC) is a sweeping wave of muscle contractions that moves through the small intestine between meals. Think of it as a built-in housekeeper that pushes bacteria, debris, and undigested food particles toward the colon every 90-120 minutes during fasting. When the MMC is impaired, bacteria accumulate in the small intestine because nothing is clearing them out.

Dr. Mark Pimentel’s landmark research demonstrated that many cases of SIBO begin after an episode of acute food poisoning. The infection triggers an autoimmune response that damages vinculin, a protein critical for MMC function. This creates a self-perpetuating cycle: the damaged MMC allows bacterial overgrowth, which triggers more inflammation, which further impairs motility [5].

Ileocecal Valve Dysfunction

The ileocecal valve sits at the junction between the small and large intestines. It acts as a one-way gate, allowing digested material to pass from the small intestine into the colon while preventing the bacteria-rich contents of the colon from flowing backward. When this valve becomes incompetent due to inflammation, surgery, or structural issues, colonic bacteria migrate upstream into the small intestine. This backwash mechanism is a significant and often-overlooked driver of recurrent SIBO.

Post-Infectious IBS/SIBO

Food poisoning caused by organisms like Campylobacter jejuni, Salmonella, pathogenic E. coli, and Shigella can trigger a cascade of autoimmune damage to gut nerve cells. The toxin cytolethal distending toxin B (CdtB) produced by these pathogens triggers antibodies that cross-react with vinculin in the gut wall. The IBS Smart blood test can measure these anti-CdtB and anti-vinculin antibodies, providing objective laboratory evidence for this mechanism [5].

Structural Causes

• Abdominal adhesions from previous surgery (especially gynecological or appendectomy)
• Strictures from Crohn’s disease or radiation
• Small bowel diverticula (outpouchings where bacteria can hide and multiply)
• Blind loops created by surgical bypass procedures
• Anatomical variations that slow transit

Medications That Increase SIBO Risk

Proton pump inhibitors (PPIs) like omeprazole and pantoprazole reduce stomach acid, which is one of the body’s primary defenses against bacterial overgrowth. A meta-analysis found that long-term PPI use is associated with a significantly increased risk of developing SIBO [6]. Opioid medications slow gut motility substantially and are another major risk factor. Frequent or prolonged antibiotic courses can disrupt the gut ecosystem in ways that paradoxically promote overgrowth.

Other Conditions That Predispose to SIBO

• Hypothyroidism (slows motility throughout the GI tract)
• Diabetes (autonomic neuropathy affecting gut nerve function)
• Ehlers-Danlos syndrome (connective tissue laxity affects gut wall structure and motility)
• Scleroderma (fibrosis of the gut wall impairs motility)
• Chronic pancreatitis (reduced digestive enzyme output)
• Immunodeficiency states (particularly IgA deficiency)
• Celiac disease
• Endometriosis (pelvic adhesions and inflammation)

How Is SIBO Diagnosed?

Breath Testing

The most widely used diagnostic tool for SIBO is the breath test. After an overnight fast and a 24-hour preparatory diet (avoiding high-fiber foods, fermented foods, and certain starches), you drink a sugar solution and then breathe into collection tubes at regular intervals over 2-3 hours.

The principle is straightforward: bacteria in the small intestine ferment the sugar substrate and produce gases. These gases are absorbed into the bloodstream, travel to the lungs, and appear in your breath where they can be measured. An early rise in hydrogen (within the first 90 minutes for lactulose) suggests bacterial overgrowth in the small intestine. Elevated methane at any point during the test (10 ppm or above) suggests IMO [7].

Lactulose breath test: Lactulose is a synthetic sugar that cannot be absorbed by the human body, so it travels the full length of the small intestine. This makes it better at detecting distal SIBO (overgrowth in the lower portions of the small intestine). The trade-off is that it can occasionally produce false positives in patients with very fast intestinal transit, because the lactulose may reach the colon bacteria sooner than expected.

Glucose breath test: Glucose is absorbed quickly in the upper small intestine. This makes the glucose breath test more specific (fewer false positives) but less sensitive, as it can miss overgrowth occurring in the mid or lower small intestine.

Limitations of Breath Testing

Breath tests are useful but imperfect. Published sensitivity ranges from 55-85% depending on the substrate used and the diagnostic criteria applied [7]. False negatives occur regularly, particularly with hydrogen sulfide SIBO (unless a trio-smart test is used that measures all three gases). Preparation errors, recent antibiotic use, and fast or slow transit can all skew results.

A negative breath test does not definitively rule out SIBO if your symptoms and clinical picture are strongly suggestive. Experienced clinicians treat based on the overall picture, not just a single test result.

Jejunal Aspirate: The Gold Standard

Direct sampling of small intestinal fluid via upper endoscopy, with subsequent bacterial culture, remains the technical gold standard for SIBO diagnosis. A bacterial count exceeding 10^3 colony-forming units per milliliter is now considered diagnostic (this threshold was lowered from the older 10^5 standard) [2].

However, this method is invasive, expensive, and subject to contamination during the procedure. It also only samples one location in the small intestine and may miss patchy overgrowth elsewhere. For these reasons, it is rarely used in routine clinical practice and remains primarily a research tool.

Conventional Treatment for SIBO

Rifaximin (Xifaxan)

Rifaximin is the most well-studied antibiotic for SIBO. It works locally in the gut with minimal systemic absorption, which gives it a favorable safety profile compared to systemic antibiotics. It is FDA-approved for IBS with diarrhea. The standard dosing protocol is 550 mg three times daily for 14 days.

For hydrogen-dominant SIBO, rifaximin alone produces eradication rates of approximately 50-70% [8]. Some patients require two or more rounds. One practical tip: eating normally (not restricting carbohydrates) during rifaximin treatment may actually improve its effectiveness, because the bacteria need to be metabolically active to be killed by the antibiotic.

Combination Therapy for Methane/IMO

Methane-producing archaea are resistant to rifaximin alone. The standard approach for IMO combines rifaximin (550 mg three times daily) with neomycin (500 mg twice daily) for 14 days. Some practitioners substitute metronidazole (250 mg three times daily) for neomycin when it is better tolerated. This dual-therapy approach significantly improves methane clearance compared to monotherapy [9].

Herbal Antimicrobials

A pivotal 2014 study from Johns Hopkins found that herbal antimicrobial protocols were at least as effective as rifaximin for SIBO eradication [10]. This study gave credibility to what many integrative practitioners had been observing clinically for years. Commonly used herbal agents include:

• Allicin (stabilized garlic extract): Particularly effective against methanogens and often used as the herbal equivalent of neomycin in IMO protocols
• Berberine-containing herbs: Oregon grape, goldenseal, barberry, and coptis all contain berberine, which has broad-spectrum antimicrobial activity
• Oregano oil (carvacrol): A potent antimicrobial with activity against many gut pathogens
• Neem: An Ayurvedic herb with antimicrobial and biofilm-disrupting properties
• Atrantil: A proprietary blend of peppermint leaf, quebracho, and horse chestnut designed specifically for methane-producing organisms

Herbal protocols typically run 4-6 weeks, longer than pharmaceutical antibiotics. Many practitioners prefer them for patients who need multiple treatment rounds, as they appear less likely to drive antibiotic resistance or cause significant collateral damage to the beneficial bacteria in the large intestine.

Dietary Approaches for SIBO

Diet alone will not eradicate SIBO. However, the right dietary strategy can dramatically reduce symptoms during treatment, improve the effectiveness of antimicrobials, and play a central role in preventing relapse.

The Low FODMAP Diet

FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) are short-chain carbohydrates that are poorly absorbed and readily fermented by bacteria. Reducing FODMAP intake essentially starves the overgrown bacteria of their preferred fuel source and typically provides significant symptom relief. Research from Monash University has shown that a low FODMAP diet reduces symptoms in about 75% of IBS patients [11].

A critical point: the low FODMAP diet is meant to be temporary. Prolonged restriction can reduce beneficial bacterial diversity in the colon, potentially creating new problems. Work with a knowledgeable dietitian to reintroduce FODMAPs systematically after your SIBO treatment is complete.

The Elemental Diet

An elemental diet consists of pre-digested nutrients: amino acids, simple sugars, and fats that are absorbed in the very first section of the small intestine. This leaves nothing for bacteria further down the intestine to ferment. A two-week elemental diet has shown SIBO eradication rates of up to 80-85% in published research [12].

The elemental diet is effective but demanding. It means consuming nothing but the elemental formula (and water) for the entire treatment period, typically 14-21 days. Most patients find it psychologically and socially challenging, though the results can be remarkable for treatment-resistant cases that have failed multiple rounds of antimicrobials.

The SIBO Biphasic Diet

Developed by Dr. Nirala Jacobi, the Biphasic Diet is a structured approach that draws from low FODMAP, SCD, and other therapeutic diets. Phase 1 is highly restrictive to reduce the bacterial load and calm symptoms. Phase 2 gradually reintroduces more foods while antimicrobial treatment is underway. This step-by-step approach gives patients a clear roadmap rather than leaving them to figure out food choices on their own.

The Specific Carbohydrate Diet (SCD)

The SCD removes all complex carbohydrates, grains, and most starches. It allows simple sugars (including honey), fruits, vegetables, nuts, and unprocessed meats. Some patients with SIBO respond well to SCD, particularly those who also have inflammatory bowel disease. However, it is quite restrictive and may be unnecessarily limiting for many SIBO patients. The low FODMAP or Biphasic approach tends to be more practical for most people.

Prokinetics: The Critical Step Most People Skip

This is arguably the most important and most frequently overlooked part of SIBO treatment. After clearing the overgrowth with antimicrobials, you need to restore healthy migrating motor complex function to keep bacteria from accumulating again. This is what prokinetic agents do.

Without prokinetic support after treatment, SIBO recurrence rates are discouragingly high. Studies suggest relapse rates of approximately 45% within one year [13]. Prokinetics are typically taken at bedtime on an empty stomach and continued for a minimum of 3 months, though many patients benefit from 6-12 months or longer.

Common Prokinetic Options

• Low-dose erythromycin (50 mg at bedtime): Used at sub-antibiotic doses specifically for its prokinetic effect on the MMC. Well-studied and effective.
• Low-dose naltrexone (LDN, 2.5-5 mg): Modulates the immune system, reduces inflammation, and improves motility. Increasingly popular among integrative practitioners.
• Prucalopride (Motegrity): A selective 5-HT4 receptor agonist with strong evidence for improving intestinal motility.
• Ginger-based formulas: Products like Iberogast and MotilPro contain ginger and other botanicals with evidence supporting their use for functional dyspepsia and motility support.
• Meal spacing: Not a supplement, but critically important. The MMC only activates during fasting periods. Eating every 2-3 hours suppresses it entirely. Space meals 4-5 hours apart to give the MMC time to do its job.

The SIBO and IBS Connection

For decades, IBS was considered a diagnosis of exclusion: a label given when no “real” organic cause could be identified. Ongoing research has fundamentally challenged that view. Studies now demonstrate that SIBO is present in a large percentage of patients carrying an IBS diagnosis, and that treating the underlying bacterial overgrowth often resolves their IBS symptoms [1].

Dr. Pimentel’s research group at Cedars-Sinai has been central to this shift in understanding. Their work shows that post-infectious changes to gut motility create a clear, measurable, organic basis for what was previously dismissed as a stress-related or psychosomatic condition. This matters because it changes the treatment approach entirely: instead of simply managing symptoms with fiber and antispasmodics, you can address the root cause.

If you carry an IBS diagnosis, particularly IBS-D (diarrhea-predominant) or IBS-M (mixed type), it is worth discussing SIBO testing with your doctor. Even IBS-C (constipation-predominant) may be driven by intestinal methanogen overgrowth.

SIBO and Other Conditions

SIBO and Hypothyroidism

Thyroid hormone plays a direct role in gut motility. Hypothyroid patients have slower intestinal transit across the board, which creates favorable conditions for bacterial overgrowth. Research has found a significantly higher prevalence of SIBO in hypothyroid patients compared to matched controls. Treating SIBO in these patients can sometimes improve GI symptoms that were not responding fully to thyroid hormone replacement alone.

SIBO and Ehlers-Danlos Syndrome (EDS)

Ehlers-Danlos syndrome affects connective tissue throughout the body, including the walls of the gastrointestinal tract. Patients with hypermobile EDS (hEDS) frequently experience significant GI dysmotility, and SIBO rates are notably elevated in this population. Treatment can be more challenging because the underlying connective tissue disorder creates a persistent structural predisposition to recurrence, making long-term prokinetic use particularly important.

SIBO and Endometriosis

Endometriosis and SIBO share many overlapping symptoms: bloating (the “endo belly”), abdominal pain, altered bowel habits, and fatigue. Research suggests that women with endometriosis have higher rates of SIBO [14], and that some of the GI symptoms attributed to endometriosis may actually be caused by concurrent bacterial overgrowth. Addressing both conditions together typically produces better outcomes than treating either in isolation.

Relapse Prevention: A Long-Term Strategy

Clearing SIBO is only half the battle. Keeping it from returning requires a sustained, multi-pronged approach. This is where many treatment plans fall short: the antimicrobials work, symptoms improve, and then everything comes back within a few months because no one addressed prevention.

1. Take prokinetics consistently. At minimum, continue prokinetic therapy for 3 months after successful treatment. Many practitioners recommend 6-12 months, and some patients with significant motility impairment benefit from ongoing use.
2. Space your meals. Eat 3 meals per day with 4-5 hours between them. Eliminate snacking and grazing. The MMC cannot activate while you are digesting food.
3. Address the root cause. If hypothyroidism, low stomach acid, adhesions, ileocecal valve dysfunction, or another underlying condition contributed to your SIBO, that condition needs ongoing management. Treat the overgrowth without fixing the cause and you are setting yourself up for a cycle of recurrence.
4. Manage stress actively. Chronic stress impairs gut motility through the vagus nerve and the gut-brain axis. Vagus nerve stimulation exercises, meditation, adequate sleep, and regular physical activity all support healthy gut motility.
5. Reintroduce foods strategically. Staying on a highly restrictive diet for months after treatment backfires. Gradual, structured reintroduction of diverse foods feeds beneficial bacteria in the colon while allowing you to monitor for symptom recurrence.
6. Support digestion. Digestive enzymes, adequate stomach acid production (betaine HCl if clinically appropriate), and bile acid support can all help prevent food from sitting in the small intestine longer than it should.

Finding a SIBO-Literate Practitioner

Not all healthcare providers are familiar with SIBO or current treatment approaches. Many gastroenterologists recognize the condition but may not be up to date on the latest testing methods, the nuances of herbal treatment, or the critical importance of prokinetics. If your current provider dismisses your symptoms or is unfamiliar with breath testing, consider seeking a practitioner with specific expertise.

Good resources for finding SIBO-knowledgeable clinicians include:

• The SIBO Doctor website (sibodoctor.com), where Dr. Nirala Jacobi maintains a practitioner directory
• Integrative and functional medicine practitioners certified through the Institute for Functional Medicine (IFM)
• Naturopathic doctors (NDs) with a gastrointestinal specialization
• GI-focused registered dietitians who are trained in SIBO testing and treatment protocols

When evaluating a potential practitioner, ask about their experience interpreting breath tests, their approach to treatment-resistant cases, and whether they routinely prescribe prokinetics after antimicrobial treatment. A clinician who understands the full treatment arc, from testing through treatment to relapse prevention, will give you the best chance of lasting recovery.

Related Reading

• Hashimoto’s Thyroiditis: A Complete Guide – Hypothyroidism is a common underlying driver of SIBO and slowed gut motility.
• Gut Health Fundamentals – Understanding the microbiome, intestinal permeability, and digestive function.
• The Low FODMAP Diet Explained – A detailed look at implementing this dietary strategy for SIBO and IBS symptom management.

Frequently Asked Questions

How is SIBO diagnosed?

The most common test is a breath test using a lactulose or glucose substrate, which measures hydrogen and methane (and hydrogen sulfide with the trio-smart test) over a 2 to 3 hour collection period. Published sensitivity ranges from 55 to 85 percent depending on the substrate used, and elevated methane at any point of 10 ppm or above suggests IMO. The gold standard is a jejunal aspirate showing a bacterial count above 10 to the third colony-forming units per milliliter, but it is invasive and rarely used clinically.

What are the main treatment options for SIBO?

The guide covers pharmaceutical antimicrobials such as rifaximin (550 mg three times daily for 14 days), herbal antimicrobials like allicin, berberine, oregano oil, neem, and Atrantil run over 4 to 6 weeks, and dietary approaches including low FODMAP, the SIBO biphasic diet, and an elemental diet. Prokinetics such as low-dose erythromycin, low-dose naltrexone, prucalopride, and ginger formulas are used to help prevent relapse. The guide notes that diet alone will not eradicate SIBO.

How effective is treatment, and how likely is relapse?

Rifaximin alone achieves roughly 50 to 70 percent eradication for hydrogen-dominant SIBO, while an elemental diet over 14 to 21 days shows up to 80 to 85 percent eradication in published research. A 2014 Johns Hopkins study found herbal antimicrobials at least as effective as rifaximin. Relapse is common, occurring in approximately 45 percent of people within one year when prokinetics are not used.

Are herbal antimicrobials as good as antibiotics?

A 2014 Johns Hopkins study found herbal protocols at least as effective as rifaximin, and they appear less likely to drive antibiotic resistance. However, the guide notes that this evidence remains limited. Herbal protocols typically run 4 to 6 weeks compared with a 14-day rifaximin course.

Is rifaximin safe?

The guide states that rifaximin has minimal systemic absorption, which gives it a favorable safety profile compared with systemic antibiotics. No specific adverse effects are detailed for rifaximin or the other treatments discussed. For methane-dominant SIBO (IMO), rifaximin is often combined with neomycin or metronidazole.

Can a negative breath test rule out SIBO?

No. The guide states that a negative breath test does not definitively rule out SIBO if your symptoms and clinical picture are strongly suggestive. False negatives occur regularly, particularly with hydrogen sulfide SIBO, and published sensitivity for breath testing runs from 55 to 85 percent.

References

1. Ghoshal UC, Shukla R, Ghoshal U. Small intestinal bacterial overgrowth and irritable bowel syndrome: a bridge between functional organic dichotomy. Gut Liver. 2017;11(2):196-208. doi:10.5009/gnl16126
2. Pimentel M, Saad RJ, Long MD, Rao SSC. ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth. Am J Gastroenterol. 2020;115(2):165-178. doi:10.14309/ajg.0000000000000501
3. Singer-Englar T, Rezaie A, Englar R, Pimentel M. Competitive hydrogen gas utilization by hydrogen sulfide and methane producing microorganisms and associated clinical implications. Gastroenterology. 2019;156(6):S-521. doi:10.1016/S0016-5085(19)38208-X
4. Dukowicz AC, Lacy BE, Levine GM. Small intestinal bacterial overgrowth: a review. Gastroenterol Hepatol (N Y). 2007;3(2):112-122. PMC3099351
5. Pimentel M, Morales W, Rezaie A, et al. Development and validation of a biomarker for diarrhea-predominant irritable bowel syndrome in human subjects. PLoS One. 2015;10(5):e0126438. doi:10.1371/journal.pone.0126438
6. Lo WK, Chan WW. Proton pump inhibitor use and the risk of small intestinal bacterial overgrowth: a meta-analysis. Clin Gastroenterol Hepatol. 2013;11(5):483-490. doi:10.1016/j.cgh.2012.12.011
7. Rezaie A, Buresi M, Lembo A, et al. Hydrogen and methane-based breath testing in gastrointestinal disorders: the North American Consensus. Am J Gastroenterol. 2017;112(5):775-784. doi:10.1038/ajg.2017.46
8. Pimentel M, Lembo A, Chey WD, et al. Rifaximin therapy for patients with irritable bowel syndrome without constipation. N Engl J Med. 2011;364(1):22-32. doi:10.1056/NEJMoa1004409
9. Rezaie A, Pimentel M, Rao SS. How to test and treat small intestinal bacterial overgrowth: an evidence-based approach. Curr Gastroenterol Rep. 2016;18(2):8. doi:10.1007/s11894-015-0482-9
10. Chedid V, Dhalla S, Clarke JO, et al. Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth. Glob Adv Health Med. 2014;3(3):16-24. doi:10.7453/gahmj.2014.019
11. Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology. 2014;146(1):67-75.e5. doi:10.1053/j.gastro.2013.09.046
12. Pimentel M, Constantino T, Kong Y, Bajwa M, Rezaei A, Park S. A 14-day elemental diet is highly effective in normalizing the lactulose breath test. Dig Dis Sci. 2004;49(1):73-77. doi:10.1023/B:DDAS.0000011605.43979.e1
13. Lauritano EC, Gabrielli M, Scarpellini E, et al. Small intestinal bacterial overgrowth recurrence after antibiotic therapy. Am J Gastroenterol. 2008;103(8):2031-2035. doi:10.1111/j.1572-0241.2008.02030.x
14. Ek M, Roth B, Nilsson PM, Ohlsson B. Characteristics of SIBO in women with endometriosis. Arch Gynecol Obstet. 2019;300(6):1653-1660. doi:10.1007/s00404-019-05300-0
15. Pimentel M, Morales W, Chua K, et al. Effects of rifaximin treatment and retreatment in nonconstipated IBS subjects. Dig Dis Sci. 2011;56(7):2067-2072. doi:10.1007/s10620-011-1728-5
16. Shah SC, Day LW, Somsouk M, Sewell JL. Meta-analysis: antibiotic therapy for small intestinal bacterial overgrowth. Aliment Pharmacol Ther. 2013;38(8):925-934. doi:10.1111/apt.12479