![]() 2 At present, the prevalence of SIBO in the community or in a tertiary-care gastroenterology referral practice remains unknown. 1 Although the overall prevalence of SIBO in the general public is unknown, a metaanalysis has shown that the prevalence of SIBO is approximately 56% among patients with irritable bowel syndrome (IBS). Small intestinal bacterial overgrowth (SIBO) is defined as an increase in the concentration of bacteria of more than 100 000 colony-forming units per mL of proximal jejunal fluid. Only one case of diarrhea was reported in the herbal therapy arm, which did not reach statistical significance (P=.22). Adverse effects were reported among the rifaximin treated arm including 1 case of anaphylaxis, 2 cases of hives, 2 cases of diarrhea and 1 case of Clostridium difficile. Fourteen of the 44 (31.8%) rifaximin non-responders were offered herbal rescue therapy, with 8 of the 14 (57.1%) having a negative LBT after completing the rescue herbal therapy, while 10 non-responders were offered triple antibiotics with 6 responding (60%, P=.89). The odds ratio of having a negative LBT after taking herbal therapy as compared to rifaximin was 1.85 (CI=0.77-4.41, P=.17) once adjusted for age, gender, SIBO risk factors and IBS status. Of the 37 patients who received herbal therapy, 17 (46%) had a negative follow-up LBT compared to 23/67 (34%) of rifaximin users (P=.24). ![]() Three hundred ninety-six patients underwent LBT for suspected SIBO, of which 251 (63.4%) were positive 165 underwent treatment and 104 had a follow-up LBT.
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