Small Intestinal Bacterial Overgrowth in the Pediatric Population: A Review of Pathophysiology, Diagnosis, and Management.

PURPOSE OF REVIEW: Small intestinal bacterial overgrowth (SIBO) remains a significant diagnostic and therapeutic challenge in pediatric gastroenterology. This review summarizes the epidemiology, pathophysiology, diagnosis, and management of SIBO in children, with emphasis on recent advances in microbiome science, evolving diagnostic paradigms, and pediatric-specific clinical considerations. RECENT FINDINGS: SIBO is increasingly recognized across a broad range of pediatric conditions, including intestinal failure, motility disorders, disorders of gut-brain interaction, and systemic diseases associated with gastrointestinal dysmotility. Diagnosis remains challenging as currently available tests have important limitations and pediatric-specific diagnostic standards are lacking. Management requires a multifaceted approach that combines antimicrobial therapy, correction of underlying anatomic abnormalities or treatment of dysmotility, nutritional support, and emerging microbiome-directed strategies. Future research should focus on validating pediatric-specific diagnostic criteria, defining optimal treatment regimens, and advancing precision approaches to microbiome characterization and modulation.