(Governing Council Member) and Association of Physicians of India. He is a founder member and the Secretary General of Asian Neurogastroenterology and Motility Association and Honorary Secretary of Indian Motility and Functional Bowel Disease Association. He is currently an associate editor of J Neurogastroenterology and Motility, editorial board member of J Gastroenterol Hepatol, World J Gastroenterol and American J Robotic Surgery. He is also a peer reviewer to 35 international journals. He is in the advisory board of Nature Reviews Gastroenterology and Hepatology. He is the National Coordinator of Indian Society of Gastroenterology Task Force on IBS. He is also the Chair of Epidemiology and Infection section of Asian IBS Consensus and Asian Dyspepsia Consensus Teams and member of Asian Barrett's Consortium. He has received 33 awards and orations including 8 gold medals during MBBS study. He was a visiting clinician to Mayo Clinic, Scottsdale, USA, Hamad Medical Corporation, Doha, Qatar, and WHO Fellow in Prince of Songkhla Univeristy, Hat Yai, Thailand.

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"Small Intestinal Bacterial Overgrowth in Digestive Diseases"

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Small intestinal bacterial overgrowth (SIBO), defined as growth of bacteria equal to or in excess of 105 colony forming unit per mL of upper gut aspirate, is common in several digestive diseases. Recently, overgrowth of bacteria in excess of 103 colony forming unit per mL of upper gut aspirate has been termed as low-grade SIBO. It is found more commonly in patients with IBS, particularly in female gender, older age, diarrhoe-predominant IBS, those with marked bloating and flatulence, on proton pump inhibitor and narcotic intake, and low haemoglobin, and is commoner than healthy controls. It also occurs in inflammatory bowel disease, particularly Crohn disease, malabsorption syndrome, non-alcoholic fatty liver disease, cirrhosis of liver, gastrointestinal motility disorders, chronic pancreatitis etc. Hydrogen breath tests using various substrates like glucose and lactulose are being used more and more to diagnose SIBO. Though quantitative culture of jejunal aspirate is considered as gold standard for the diagnosis of SIBO, hydrogen breath tests, in spite of their low sensitivity, are popular for their non-invasiveness. Glucose hydrogen breath test is more acceptable for the diagnosis of SIBO as conventionally accepted double-peak criterion on lactulose hydrogen breath test is very insensitive and recently described early-peak criterion is often false positive. C13 D-xylose and bile acid breath tests have also been used to diagnose SIBO. Several therapeutic trials targeting gut microbes using antibiotics and probiotics further proved the concept. A recent proof of the concept study showing high frequency of symptom improvement among patients with IBS with SIBO further supports this hypothesis. However, following treatment with antibiotics, such as rifaximin, recurrence of SIBO is common, which often respond to repeat treatment with rifaximin. Improving small intestinal motility has been shown to prevent recurrence of SIBO.

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Learning Objectives:

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• Definition of small intestinal bacterial overgrowth

• Frequency and clinical significance of small intestinal bacterial overgrowth in different digestive diseases

• Pathogenesis of small intestinal bacterial overgrowth

• Clinical manifestation of small intestinal bacterial overgrowth

• Diagnosis of small intestinal bacterial overgrowth

• Treatment of small intestinal bacterial overgrowth