Authors
Potoskueva P.A.1, Podgorbunskikh V.A.1, Gusarov A.A.2, Bazarbaev Sh.Sh.3, Malysheva A.A.1, Lebedeva L.N.4
1 Tyumen state medical university, Tyumen
2 I.M. Sechenov First Moscow state medical university, Moscow
3 Novosibirsk state medical university, Novosibirsk
4 Tsiolkovsky Kaluga state university, Kaluga
Abstract
Rationale. Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders. One of the potentially significant pathophysiological factors in IBS is small intestinal bacterial overgrowth (SIBO), characterized by microbial imbalance in the small intestine.
Objective. To review current data on therapeutic approaches to SIBO in patients with IBS.
Methods. The review includes publications from PubMed, Scopus, Web of Science, Cochrane Library, and eLIBRARY.RU databases from 2019 to 2025. The selection included randomized clinical trials, meta-analyses, and systematic reviews focusing on the diagnosis and treatment of SIBO in the context of IBS. Studies with low levels of evidence or small sample sizes were excluded.
Results. Analysis of the included sources showed that the prevalence of SIBO in IBS patients ranges from 30% to 85%, with the highest rates observed in the diarrheal subtype. Rifaximin is the most extensively studied antibacterial agent and is associated with a significant reduction in bloating, abdominal pain, and stool irregularities. A carbohydrate-restricted diet has demonstrated positive effects on stool frequency, consistency, and abdominal pain. Probiotics containing Bacillus subtilis and Bacillus coagulans have shown efficacy in alleviating abdominal pain and improving quality of life.
Conclusion. The coexistence of IBS and SIBO requires a comprehensive diagnostic and therapeutic approach. Rifaximin remains the treatment of choice for antibacterial therapy. Dietary interventions and probiotics serve as effective adjunctive measures. Further research is needed to standardize diagnostics, stratify patients, and assess the long-term efficacy of combined treatment strategies.
Keywords: irritable bowel syndrome, small intestinal bacterial overgrowth, rifaximin, probiotics, FODMAP diet, breath test, microbiota, intestinal dysfunction.
References
1. Ivashkin VT, Shelygin YA, Baranskaya EK, et al. Irritable bowel syndrome. Koloproktologia. 2022; 21(1): 10-25. (In Russ.) doi: 10.33878/2073-7556-2022-21-1-10-25.
2. Arif TB, Ali SH, Bhojwani KD, et al. Global prevalence and risk factors of irritable bowel syndrome from 2006 to 2024 using the Rome III and IV criteria: a meta-analysis. Eur J Gastroenterol Hepatol. 2025. doi: 10.1097/MEG.0000000000002994.
3. IvashkinVT, Fomin VV, Tkacheva ON, et al. Small Intestinal Bacterial Overgrowth in Various Specialties of Medical Practice (Literature Review and Expert Council Resolution). Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2024; 34(2): 14-34. (In Russ.) doi: 10.22416/1382-4376-2024-954.
4. Sharabi E, Rezaie A. Small Intestinal Bacterial Overgrowth. Curr Infect Dis Rep. 2024; 26: 227-233. doi: 10.1007/s11908-024-00847-7.
5. Kazyulin AN, Goncharenko AYu, Pavleeva EE, et al. Understanding similarities and differences of irritable bowel syndrome and conditions with IBS-like symptoms. Russian Journal of Evidence-Based Gastroenterology. 2024; 13(1): 66‑78. (In Russ.) doi: 10.17116/dokgastro20241301166.
6. Nalyotov AV, Guz NP. Prevalence of Small Intestinal Bacterial Overgrowth Syndrome in Patients with Irritable Bowel Syndrome who Have Suffered COVID-19. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2022; 32(3): 35-39. (In Russ.) doi: 10.22416/1382-4376-2022-32-3-35-39.
7. Bushyhead D, Quigley EMM. Small intestinal bacterial overgrowth -Pathophysiology and its implications for definition and management. Gastroenterology. 2022; 163(3): 593-607. doi: 10.1053/j.gastro.2022.05.042.
8. Tang HY, Jiang AJ, Wang XY, et al. Uncovering the pathophysiology of irritable bowel syndrome by exploring the gut-brain axis: a narrative review. Annals of Translational Medicine. 2021; 9(14): 4304-4313. doi: 10.21037/apm-21-1427.
9. Efremova I, Maslennikov R, Poluektova E, et al. Epidemiology of small intestinal bacterial overgrowth. World J Gastroenterol. 2023; 29(22): 3400-3421. doi: 10.3748/wjg.v29.i22.3400.
10. Kulygina YuA, Osipenko MF. Course of irritable bowel syndrome associated with small intestinal bacterial overgrowth. Russian Medical Inquiry. 2022; 6(5): 232-236. (In Russ.) doi: 10.32364/ 2587-6821-2022-6-5-232-236.
11. Liébana-Castillo AR, Redondo-Cuevas L, Nicolás Á, et al. Should We Treat SIBO Patients? Impact on Quality of Life and Response to Comprehensive Treatment: A Real-World Clinical Practice Study. Nutrients. 2025; 17(7): 1251. doi: 10.3390/nu17071251.
12. Ghoshal UC. Antibiotic treatment for small intestinal bacterial overgrowth: Is a cocktail better than a single? United European Gastroenterol J. 2021; 9(6): 643-644. doi: 10.1002/ueg2.12075.
13. Takakura W, Rezaie A, Chey WD, et al. Symptomatic Response to Antibiotics in Patients With Small Intestinal Bacterial Overgrowth: A Systematic Review and Meta-analysis. J Neurogastroenterol Motil. 2024; 30(1): 7-16. doi: 10.5056/jnm22187.
14. Wielgosz-Grochowska JP, Domanski N, Drywień ME. Efficacy of an Irritable Bowel Syndrome Diet in the Treatment of Small Intestinal Bacterial Overgrowth: A Narrative Review. Nutrients. 2022; 14(16): 3382. doi: 10.3390/nu14163382.
15. Kwon H, Nam EH, Kim H, et al. Effect of Lacticaseibacillus rhamnosus IDCC 3201 on irritable bowel syndrome with constipation: a randomized, double-blind, and placebo-controlled trial. Sci Rep. 2024; 14: 22384. doi: 10.1038/s41598-024-72887-x.
16. Wielgosz-Grochowska JP, Domanski N, Drywień ME. Efficacy of an Irritable Bowel Syndrome Diet in the Treatment of Small Intestinal Bacterial Overgrowth: A Narrative Review. Nutrients. 2022; 14(16): 3382. doi: 10.3390/nu14163382.
