Small intestinal bacterial overgrowth (SIBO) is an underrecognized cause of malabsorption in the geriatric population, characterized by the excessive growth of bacteria in the small bowel, sometimes bearing resemblance to colonic flora. Age is a predisposing factor; however additional comorbidity such as diabetes, systemic sclerosis, Parkinson's disease, irritable bowel syndrome, and a variety of stasis syndromes such as blind loops, diverticulae, and fistulae are likely to be the basis. Medications that affect immune function and excessive use of PPIs are recognized causes. Diagnosis is based on demonstration of positive duodenal or jejunal aspirate cultures and breath tests. Management typically involves a short course of antibiotics; however recurrences often follow months following antibiotic therapy necessitating repeat courses.
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