SIBO, Dysbiosis & Organic Acids Test (OAT) - References

SIBO, Dysbiosis & Organic Acids Test (OAT) — Literature Dossier

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Landmark Peer-Reviewed Studies

1. Rezaie et al. (2017) — Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus

• Citation: Rezaie, A., Buresi, M., Lembo, A., Lin, H., McCallum, R., Rao, S., … & Pimentel, M. (2017). Hydrogen and methane-based breath testing in gastrointestinal disorders: the North American Consensus. The American Journal of Gastroenterology, 112(5), 775–784.
• Identifiers: DOI: 10.1038/ajg.2017.46 (DOI · SciDB · Scholar) | PMID: 28323273 (PubMed · Europe PMC) | PMCID: PMC5418558 (PMC Full Text)
• Study Design & Cohort: Systematic evidence synthesis and consensus guideline establishing standardized preparation, substrate dosing ($75\text{ g}$ glucose or $10\text{ g}$ lactulose), and quantitative diagnostic thresholds for SIBO and IMO.
• Quantitative Findings & Diagnostic Thresholds:
  • Hydrogen (${\text{H}}_2$) SIBO Cutoff: A rise of $\ge 20\text{ ppm}$ from baseline within 90 minutes of substrate ingestion is diagnostic of small intestinal bacterial overgrowth (avoiding false-positive colonic fermentation seen at 120–180 min).
  • Methane (${\text{CH}}_4$) IMO Cutoff: A concentration of $\ge 10\text{ ppm}$ at any point during breath testing is diagnostic of intestinal methanogen colonization (Methanobrevibacter smithii), which directly slows small-bowel transit time by 59%.

2. Pimentel et al. (2015) — Development and Validation of a Biomarker for Diarrhea-Predominant IBS (Anti-CdtB and Anti-Vinculin Antibodies)

• Citation: Pimentel, M., Morales, W., Rezaie, A., Marsh, E., Lembo, A., Mirocha, J., … & Chang, C. (2015). Development and validation of a biomarker for diarrhea-predominant irritable bowel syndrome in human subjects. PLoS ONE, 10(5), e0126438.
• Identifiers: DOI: 10.1371/journal.pone.0126438 (DOI · SciDB · Scholar) | PMID: 25970536 (PubMed · Europe PMC) | PMCID: PMC4430492 (PMC Full Text)
• Study Design & Cohort: Large multicenter validation study ($N=2,681$ subjects: $2,375$ IBS-D, $142$ IBD, $121$ celiac disease, $43$ healthy controls).
• Quantitative Findings & Diagnostic Thresholds:
  • At optical density cutoffs of $\ge 2.80$ for anti-CdtB and $\ge 1.68$ for anti-vinculin, specificity for post-infectious enteric autoimmunity (vs. IBD) was 91.6% for anti-CdtB (Likelihood Ratio 5.2) and 83.8% for anti-vinculin, confirming autoimmune damage to interstitial cells of Cajal and the Migrating Motor Complex as a primary root cause of recurrent SIBO.

3. Chedid et al. (2014) — Herbal Therapy Is Equivalent to Rifaximin for the Treatment of Small Intestinal Bacterial Overgrowth

• Citation: Chedid, V., Dhalla, S., Clarke, J. O., Roland, B. C., Milbrandt, K. B., Francis, M. Y., … & Mullin, G. E. (2014). Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth. Global Advances in Health and Medicine, 3(3), 16–24.
• Identifiers: DOI: 10.7453/gahmj.2014.019 (DOI · SciDB · Scholar) | PMID: 24891990 (PubMed · Europe PMC) | PMCID: PMC4030608 (PMC Full Text)
• Study Design & Cohort: Multicenter clinical cohort trial at Johns Hopkins and University of Pittsburgh ($N=104$ patients with newly diagnosed lactulose-breath-test-positive SIBO treated for 4 weeks with either Rifaximin $1,200\text{ mg/day}$ or standardized botanical antimicrobials [Oregano oil, Berberine, Wormwood, Thyme]).
• Quantitative Findings & Diagnostic Thresholds:
  • Repeat lactulose breath testing became negative in 46% of patients treated with herbal therapy vs. 34% treated with Rifaximin ($\text{OR }1.85$, $95\%\text{ CI }0.77–4.41$, $p=0.24$).
  • Among Rifaximin non-responders who subsequently crossed over to rescue herbal therapy, 57.1% achieved complete breath-test eradication (similar to triple antibiotic rescue at 60%), with significantly fewer adverse events ($1\text{ case}$ of mild diarrhea vs. $C.\text{ difficile}$ and anaphylaxis in the antibiotic arm).

4. Furnari et al. (2010) — Clinical Trial: The Combination of Rifaximin with Partially Hydrolysed Guar Gum Is More Effective Than Rifaximin Alone in Eradicating SIBO

• Citation: Furnari, M., Parodi, A., Gemignani, L., Giannini, E. G., Marabotto, E., Savarino, E., … & Savarino, V. (2010). Clinical trial: the combination of rifaximin with partially hydrolysed guar gum is more effective than rifaximin alone in eradicating small intestinal bacterial overgrowth. Alimentary Pharmacology & Therapeutics, 32(8), 1000–1006.
• Identifiers: DOI: 10.1111/j.1365-2036.2010.04436.x (DOI · SciDB · Scholar) | PMID: 20937045 (PubMed · Europe PMC)
• Study Design & Cohort: Prospective randomized controlled clinical trial ($N=77$ SIBO-positive patients randomized to 10 days of Rifaximin $1,200\text{ mg/day}$ alone vs. Rifaximin $1,200\text{ mg/day}$ + Partially Hydrolyzed Guar Gum [PHGG] $5\text{ g/day}$).
• Quantitative Findings & Diagnostic Thresholds:
  • Co-administration of PHGG ($5\text{ g/day}$) increased SIBO eradication rate from 62.1% to 87.1% ($p=0.017$ per-protocol; $85.0\%$ vs. $62.1\%$ intention-to-treat, $p=0.036$) and significantly improved clinical symptom resolution ($91\%$ vs. $69\%$).