The potential role of small intestinal bacterial overgrowth (SIBO) in irritable bowel syndrome (IBS) has been strongly debated in the recent literature. Much of the controversy surrounding SIBO as a potential factor in IBS is due to the methods used in diagnosing SIBO. In a recent systematic literature review,1 we evaluated all diagnostic tests for the determination of SIBO. In this review, no test was found to be accurate. In fact, even culture was not a valid gold standard.

Culture of the small bowel for the identification of SIBO suffers from a number of flaws. Some challenges include: (1) maintaining an …