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We wish to thank Dr Pimentel for his interest in our recent article, as this gives us the opportunity to clarify some issues regarding the diagnosis of small intestinal bacterial overgrowth (SIBO) in patients fulfilling diagnostic criteria for irritable bowel syndrome (IBS).
First of all, we agree with Dr Pimentel that there is no perfect test for SIBO today. All of the tests used have disadvantages and important shortcomings, as pointed out in a recent leading article published in this journal.1 Culture of small bowel content, by many regarded as the gold standard to diagnose SIBO, is cumbersome, and the results of culturing are not always representative. The commonly used lactulose and glucose breath tests suffer from poor sensitivity and specificity, making them unsuitable for the diagnosis of SIBO, and far from perfect alternatives to small intestinal culturing. Therefore, …