Modern approaches to diagnosis of small intestinal bacterial overgrowth (SIBO) syndrome
SIBO develops due to strictly determined causes among which the major role is played by age peculiarities, endocrine and metabolic disorders, irritable bowel syndrome (IBS), taking proton-pump inhibitors (PPIs) for a long time, disorders of the small intestine, especially those accompanied with its decreased motility, dysfunction of inner organs, immune disorders. As SIBO is important from clinical point of view, its timely diagnosis is of great practical value. There is still a need to find out a gold standard for diagnosis of SIBO. Using quantitative culture of intestinal aspirate for this purpose is doubtful because of invasive character of the test, no standardization, sampling error, special equipment required and its high cost. Hydrogen breath tests provide solution to a set of practical issues. A choice of an appropriate patient, proper preparation for the test, standardized methods of carrying out the test and checking for methane levels improves accuracy of diagnosis with hydrogen breath tests. Taking into account that modern investigations are imperfect, great efforts should be taken to understand better the role of microbiota in the development of gastrointestinal symptom. Using complex methods of molecular genetics to determine microflora of an individual in normal and pathological conditions will make it possible to speed up solution of this problem. An important issue which is still to be solved is whether viruses and fungi have an effect on the development of SIBO. Widening horizons of science will help us to understand which of existing and future methods of investigation must be concentrated on studying quantitative and/or qualitative changes of microflora in the intestinal lumen or on the mucous membrane of the intestines.