The gold standard investigation in suspected small bowel bacterial overgrowth is small bowel aspiration. The test is invasive and has a significant false negative rate.
Small bowel aspiration is conveniently performed when a biopsy is being performed to exclude other causes of malabsorption; using a pre-sterilised, sheathed cannula, the 2 ml samples must be transported rapidly to the laboratory for aerobic and anaerobic culture.
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