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©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Mar 20, 2026; 16(1): 107169
Published online Mar 20, 2026. doi: 10.5662/wjm.v16.i1.107169
Published online Mar 20, 2026. doi: 10.5662/wjm.v16.i1.107169
Exploring effectiveness of Metronidazole, Bismuth, and Rifaximin in treating small intestinal bacterial overgrowth and irritable bowel syndrome: A systematic review
Qaim Shah, CEO, Medical Specialist & Gastroenterologist at Shah Medical Complex Mardan, Pakistan. MSc in Gastroenterology, University of South Wales, Cardiff CF37 1DL, United Kingdom
Jonathan Soldera, Tutor, Gastroenterology and Acute Medicine, Learna Ltd. in Association with University of South Wales, Cardiff CF37 1DL, United Kingdom
Author contributions: Shah Q contributed to study conception, design, data collection, analysis, and manuscript drafting; Soldera J contributed to study supervision, statistical analysis, translation, and critical revision of the manuscript for important intellectual content; both authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest relevant to the content of this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jonathan Soldera, PhD, Tutor, Msc Program, Learna Ltd. in Association with University of South Wales, Treforest, Cardiff CF37 1DL, United Kingdom.
Received: March 17, 2025
Revised: April 21, 2025
Accepted: July 8, 2025
Published online: March 20, 2026
Processing time: 330 Days and 12.5 Hours
Revised: April 21, 2025
Accepted: July 8, 2025
Published online: March 20, 2026
Processing time: 330 Days and 12.5 Hours
Core Tip
Core Tip: This study compares the efficacy and safety of Metronidazole, Bismuth, and Rifaximin in managing small intestinal bacterial overgrowth (SIBO) and irritable bowel syndrome (IBS). Rifaximin showed the greatest clinical benefit, particularly in diarrhea-predominant IBS patients, with minimal side effects. Metronidazole was effective for SIBO but associated with higher gastrointestinal side effects. Bismuth demonstrated some effectiveness, particularly in combination therapies, but was less pronounced than the other two antibiotics. Further research is needed to optimize treatment strategies and assess long-term outcomes.