Eradication of Small Intestinal Bacterial Overgrowth in Systemic Sclerosis: Current Treatment and Perspectives—A Narrative Review

Radić, Mislav; Belančić, Andrej; Vučković, Marijana; Fajkić, Almir; Rogoznica Pavlović, Marija; Radić, Josipa

doi:10.3390/biomedicines13122932

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Eradication of Small Intestinal Bacterial Overgrowth in Systemic Sclerosis: Current Treatment and Perspectives—A Narrative Review

by

Mislav Radić

^1,2,*,†

,

Andrej Belančić

^3,*,†

,

Marijana Vučković

⁴,

Almir Fajkić

⁵

,

Marija Rogoznica Pavlović

⁶

and

Josipa Radić

^2,4

¹

Department of Internal Medicine, Division of Rheumatology, Allergology and Clinical Immunology, Center of Excellence for Systemic Sclerosis in Croatia, University Hospital of Split, 21000 Split, Croatia

²

Internal Medicine Department, School of Medicine, University of Split, 21000 Split, Croatia

³

Department of Basic and Clinical Pharmacology with Toxicology, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia

⁴

Department of Internal Medicine, Division of Nephrology and Dialysis, University Hospital of Split, 21000 Split, Croatia

⁵

Department of Pathophysiology, Faculty of Medicine, University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina

⁶

Hospital for Medical Rehabilitation of Heart and Lung Diseases and Rheumatism “Thalassotherapia-Opatija”, 51410 Opatija, Croatia

^*

Authors to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

Biomedicines 2025, 13(12), 2932; https://doi.org/10.3390/biomedicines13122932 (registering DOI)

Submission received: 17 October 2025 / Revised: 20 November 2025 / Accepted: 27 November 2025 / Published: 28 November 2025

(This article belongs to the Special Issue Small Intestinal Bacterial Overgrowth and Antimicrobial)

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Abstract

Small intestinal bacterial overgrowth (SIBO) is a major yet underrecognized driver of gastrointestinal morbidity in systemic sclerosis (SSc). Disordered motility, fibrosis, and dysbiosis promote microbial stasis, malabsorption, and malnutrition, contributing substantially to impaired quality of life and survival. Diagnostic accuracy remains limited: jejunal aspirate culture is invasive, whereas breath testing offers only moderate sensitivity and specificity. Empirical antibiotic therapy yields transient symptom relief, but recurrence is common, and evidence guiding optimal eradication strategies is sparse. Adjunctive measures, including probiotics, prokinetics, and dietary interventions, remain variably applied, with heterogeneous outcomes across studies. Novel microbiome-targeted, neuromodulatory, and antifibrotic therapies are emerging as promising mechanism-based options. Bearing this in mind, this narrative review aims to consolidate current knowledge on SIBO eradication in SSc. We first outline the pathophysiological rationale and clinical relevance of bacterial overgrowth. We then synthesize available evidence for treatment strategies, appraise barriers to durable remission, and discuss implications for multidisciplinary management. Finally, we highlight emerging approaches, including microbiome-directed therapies, novel prokinetics, and antifibrotic interventions, and define priorities for future clinical research.

Keywords: systemic sclerosis; small intestinal bacterial overgrowth; SIBO; gut microbiota; gastrointestinal dysmotility; antibiotic therapy; probiotics

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MDPI and ACS Style

Radić, M.; Belančić, A.; Vučković, M.; Fajkić, A.; Rogoznica Pavlović, M.; Radić, J. Eradication of Small Intestinal Bacterial Overgrowth in Systemic Sclerosis: Current Treatment and Perspectives—A Narrative Review. Biomedicines 2025, 13, 2932. https://doi.org/10.3390/biomedicines13122932

AMA Style

Radić M, Belančić A, Vučković M, Fajkić A, Rogoznica Pavlović M, Radić J. Eradication of Small Intestinal Bacterial Overgrowth in Systemic Sclerosis: Current Treatment and Perspectives—A Narrative Review. Biomedicines. 2025; 13(12):2932. https://doi.org/10.3390/biomedicines13122932

Chicago/Turabian Style

Radić, Mislav, Andrej Belančić, Marijana Vučković, Almir Fajkić, Marija Rogoznica Pavlović, and Josipa Radić. 2025. "Eradication of Small Intestinal Bacterial Overgrowth in Systemic Sclerosis: Current Treatment and Perspectives—A Narrative Review" Biomedicines 13, no. 12: 2932. https://doi.org/10.3390/biomedicines13122932

APA Style

Radić, M., Belančić, A., Vučković, M., Fajkić, A., Rogoznica Pavlović, M., & Radić, J. (2025). Eradication of Small Intestinal Bacterial Overgrowth in Systemic Sclerosis: Current Treatment and Perspectives—A Narrative Review. Biomedicines, 13(12), 2932. https://doi.org/10.3390/biomedicines13122932

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Eradication of Small Intestinal Bacterial Overgrowth in Systemic Sclerosis: Current Treatment and Perspectives—A Narrative Review

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