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Management of Small Intestinal Bacterial Overgrowth in Adult Patients

Rasmussen, Jamie MS; Duriancik, David M. PhD

doi: 10.1097/SGA.0000000000000369

The human gastrointestinal tract is a complex system of digestive pathways aided by mechanical processes, enzymes, transport molecules, and colonic bacteria. Occasionally, these bacterial components transplant to atypical locations due to various gastrointestinal imbalances or anatomical structural issues. This may lead to bacterial overgrowth of the small intestine, where minimal or no bacteria are normally found. Symptoms of small intestinal bacterial overgrowth may mimic those of various functional gastrointestinal diseases. Small intestinal bacterial overgrowth is typically diagnosed through hydrogen breath tests or jejunal aspirate culture. Current recommendations indicate antibiotics as the first-line treatment to eradicate or modify the bacterial overgrowth to a more favorable state. Nutritional support is also indicated to correct deficiencies and aid in symptom alleviation. As small intestinal bacterial overgrowth is common in other conditions, much of the research for this area is based on findings in codisease states rather than independent disease research. To provide accurate recommendations for small intestinal bacterial overgrowth, more targeted research is needed.

Jamie Rasmussen, MS, is Registered Dietitian, Department of HEV, Central Michigan University, Mt Pleasant.

David M. Duriancik, PhD, is Associate Professor, Department of HEV, Central Michigan University, Mt Pleasant, and Department of Biology, University of Michigan-Flint, Flint.

Correspondence to: Jamie Rasmussen, MS, Department of HEV, Central Michigan University, 106A Wightman Hall, Mt Pleasant, MI 48859 (,

The authors declare no conflicts of interest.

Received March 20, 2017

Accepted May 18, 2017

© 2019 by the Society of Gastroenterology Nurses and Associates, Inc.