Do you prefer formal testing to establish a diagnosis of SIBO/IMO over empiric treatment?  

Great practical question. I prefer formal testing for several reasons: Even though postprandial bloating and distention along with change in bowel habits are the hallmarks of SIBO/IMO, they are non-specific and can be caused by myriad of other organic causes. A normal breath test would direct th...

The symptoms of SIBO are too subjective and nonspecific to justify treatment without a confirmed diagnosis.

SIBO is such an undefined syndrome (disease), with such subjective symptoms, and testing is imperfect, treatment is guesswork at best - i.e., rifaximin - kills gram-positive, gram-negative bacteria, aerobes, as well as anaerobes, is broad-spectrum, and is part of the treatment plan for both Methane ...