ROLE OF PROKINETIC AGENTS IN PREVENTING SMALL INTESTINAL BACTERIAL OVERGROWTH (SIBO) RECURRENCE: A NARRATIVE REVIEW
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.5819Keywords:
Small Intestinal Bacterial Overgrowth; SIBO; Prokinetic Agents; Migrating Motor Complex; MMC; Gastrointestinal MotilityAbstract
Background: Small intestinal bacterial overgrowth (SIBO) involves the pathological proliferation of bacteria in the small bowel, causing symptoms like bloating and abdominal pain. Although rifaximin is effective for initial eradication, the condition frequently relapses. This recurrence is primarily driven by the failure of the migrating motor complex (MMC), specifically its phase III "housekeeping" function.
Aim: This review evaluates the clinical utility of prokinetic agents in maintaining SIBO remission and examines whether their administration extends the symptom-free interval in high-risk populations.
Material and methods: A systematic search of PubMed and Scopus was conducted to synthesize evidence on MMC dysfunction and the efficacy of various prokinetic agents in preventing bacterial regrowth.
Results: Research indicates that SIBO patients experience a 60% reduction in MMC-related clearance compared to healthy controls. The synergistic integration of prokinetic therapy into the antibiotic eradication phase has been shown to significantly enhance bacterial clearance rates. Among these agents, prucalopride demonstrates high efficacy in delaying relapses and extending the duration of remission. Clinical success depends heavily on nocturnal dosing during the interdigestive state to maximize mechanical cleansing.
Conclusions: Prokinetic pharmacotherapy is an essential component of maintaining remission in SIBO by directly addressing MMC dysfunction - the primary pathophysiological cause of relapse. The selection of a therapeutic agent should be tailored to the patient’s clinical phenotype, considering metabolic safety and the symptom profile. Despite promising data, this review underscores the need for large-scale randomized controlled trials to establish standardized diagnostic and therapeutic guidelines.
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