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November 10, 2004

Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(18):2213-2214. doi:10.1001/jama.292.18.2213-b

In Reply: I am grateful to Dr King for his clarifications regarding my recent review on IBS. I agree that the lactulose breath test provides an indirect demonstration of SIBO and that measurement of breath hydrogen alone is inadequate. Currently, direct confirmation of SIBO is severely limited by difficult access to the full length of the small intestine and inadequate culturing and identification methods for the vast majority of the more than 500 species of bacteria in the gut.