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Annals of Medicine and Medical Sciences
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Original Article Open Access

Knowledge and Perception Toward Small Intestinal Bacterial Overgrowth Among Adults in Jeddah, Saudi Arabia: A Cross-Sectional Study

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Annals of Medicine and Medical SciencesVol. 05, No. 08, (2026) August 2, 2026pp. 1091 - 1097
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Abstract

Background: Small intestinal bacterial overgrowth (SIBO) occurs with non-specific GI symptoms and tends to occur in clinical correlation with irritable bowel syndrome. The knowledge regarding the awareness of SIBO among the Saudi public is poorly defined, although there are lifestyle factors and medications that are related to gut health. Objectives: To assess the knowledge and perceptions of SIBO among adults in Jeddah, Saudi Arabia. Design: A cross-sectional descriptive study. Methods: A cross-sectional study based on a questionnaire survey was carried out among the adult population above 18 years old living in Saudi Arabia. A knowledge, attitudes, and practices tool was used to identify the socio-demographics, GI symptoms, behavioral habits related to diet and medications, knowledge, perception, and seeking of care for SIBO. Descriptive statistics and chi-square tests were used for the analysis. A p-value less than 0.05 was considered statistically significant. Results: One hundred forty respondents were recruited, of whom 103 (73.6%) were females. Symptoms of GI disease occurred often: 93 (66.4%) suffered from frequent gas or uncomfortable GI borborygmi, 90 (64.3%) experienced early satiety, 92 (65.7%) had unexplained fatigue, and 69 (49.3%) complained of abdominal pains or cramps. Modifiable factors were common: fast food intake twice or thrice a week was reported by 111 respondents (79.3%), eating sweets/sugary foods daily by 76 (54.3%) and taking antibiotics more than once a year by 60 (42.9%) participants. SIBO awareness was low: 91 participants (65.0%) had never heard of SIBO, 81 (57.9%) had no information that breath tests could detect bacterial gases, and 92 (65.7%) did not know whether SIBO could be misdiagnosed as IBS. There were associations between awareness level and the following beliefs: SIBO prevalence, clinical overlap of IBS, usefulness of probiotics, ability to improve condition by diet and prior SIBO therapy. Use of herbal treatments was associated with seeking advice from a doctor for persistent symptoms (p=0.012). Conclusion: Low SIBO awareness among the surveyed group of Saudi residents, despite having high prevalence of GI symptoms and presence of modifiable risk factors. Public health measures need to be developed.

Keywords

Small intestinal bacterial overgrowth Knowledge Perception Saudi Arabia Gastrointestinal symptoms.

Introduction

Small intestinal bacterial overgrowth (SIBO) is a clinical condition whereby either the symptoms, signs or any other laboratory test abnormality results due to excessive bacteria growth or altered bacterial flora within the small intestine [1]. Common symptoms reported by patients suffering from SIBO include bloating, abdominal pain, diarrhea, flatulence, early fullness feeling and fatigue. When severe and persistent, SIBO could also cause malabsorption, nutritional deficiencies, and low quality of life [2-4]. Due to the overlapping symptoms associated with the syndrome with those of irritable bowel syndrome (IBS), as well as other Gut-brain disorders, SIBO remains often undiagnosed or treated empirically [5,6].

Uncertainty about diagnosis makes things even harder. The jejunal aspirate culture method is an invasive procedure rarely used in practice, while the hydrogen/methane breath test is accessible but requires proper patient preparation, correct technique, and interpretation of results [3,7]. Guidelines provided by the American College of Gastroenterology and the American Gastroenterological Association recommend carefully selecting patients and considering risk factors before performing the tests or initiating unnecessary treatment [2,3]. It appears very difficult to implement this advice in practice, with poor public awareness about SIBO and many patients self-managing chronic gastrointestinal symptoms by diet adjustment, herbs, probiotics, acid suppressive drugs, and antibiotics.

Rapid nutrition and lifestyle changes have been taking place in Saudi Arabia. These include the increased consumption of fast food and sweets together with increased sedentary behavior despite the concern about inappropriate use of antimicrobials, although there are certain restrictions on their non-prescribed distribution [8-11]. All these issues may affect the prevalence of gastrointestinal symptoms, the balance of microflora and the care-seeking behavior of the patients. However, most studies conducted in Saudi Arabia focused on IBS, functional gastrointestinal disorders, use of antibiotics and complementary medicines, rather than on the level of public awareness about SIBO [8-12].

This knowledge gap is directly relevant to the activities of pharmacists, general practitioners, and gastroenterologists. Knowing whether adult people know what SIBO is, whether they can differentiate it from IBS, and seek proper treatment can help to develop health education, conduct medication counseling, control inappropriate use of antibiotics, and refer the patients. Thus, we wanted to investigate knowledge, attitude, and practices concerning SIBO among adults living in Saudi Arabia

Methods

Study Design and Setting: In this study, we used a cross-sectional design conducted among the public living in Jeddah, Makkah Province, Saudi Arabia. Data were collected using a structured online questionnaire during the period from January to March 2026.

Study Population and Sampling: Participants of the study were adults aged 18 years and above from the city of Jeddah, Saudi Arabia. The pre-study sample size was calculated using the Cochran formula for estimating the sample size for unknown population as: N = PQZ^2/d^2 where N is the sample size, P is the prevalence of the attribute in the population (0.5 to maximize variance), Q = 1 – p, Z is the standard normal deviate for a certain confidence interval (1.96 for 95% confidence interval) and d is the margin of error (0.05) [13]. Therefore, the calculation would be as follows: N = (1.96^2 × 0.5 × 0.5) / (0.05^2) = 384. However, 140 participants answered the online questionnaire, which constitutes 37% response rate. A convenience sampling technique was employed to recruit participants, and the survey link was shared with specific groups on social media sites (WhatsApp, Facebook, Telegram) [14-16].

Data Collection Tool: Both versions of the questionnaire (English & Arabic) were created in a structured format. The tool went through validation by two public health specialists to ensure its appropriateness and relevance to the Saudi Arabian context, with changes being made in accordance with their suggestions. The pilot study involved 20 students who completed the tool, resulting in a Cronbach’s alpha of 0.71.

The questionnaire consisted of the following five sections: sociodemographic information; gastrointestinal symptoms and dietary habits; medical history, medications, and lifestyle information; knowledge and awareness of small intestine bacterial overgrowth (SIBO); attitudes/practices concerning SIBO diagnostics, treatment, probiotics, diet, herbal medicines, and specialist treatment.

Statistical Analysis: Data was entered and coded using the Statistical Package for Social Sciences, version 26 (Armonk, NY: IBM Corp). Categorical variables were calculated in terms of frequencies and percentages. Relationships between categorical variables were measured by means of chi-square test. The statistical significance level was p<0.05.

Ethical Considerations: The study was conducted in accordance with the ethical standards in the 1975 Declaration of Helsinki. Ethical approval (IRRB-06-02032026) was obtained from Ibn Sina National College (ISNC) Institutional Research Review Board (IRRB). Written informed consent was obtained from all participants before participation. Confidentiality and anonymity were maintained by ensuring that no personal identifiers were collected. Data were securely stored and accessible only to the research team.

Results

Sociodemographic characteristics of participants: The study included 140 adults. Females comprised 103 respondents (73.6%) and males 37 (26.4%). The largest age groups were 29-39 years (47/140, 33.6%) and 18-28 years (45/140, 32.1%), followed by 50-59 years (24/140, 17.1%) (Table 1).

Table 1 Sociodemographic characteristics of respondents (N=140)
Characteristic Category n %
Gender Female 103 73.6
Male 37 26.4
Age group (years) 18-28 48 34.3
29-39 47 33.6
40-49 13 9.3
50-59 24 17.1
>65 8 5.7

Gastrointestinal Symptoms and Lifestyle-Related Factors: Gastrointestinal symptoms were frequent. Abdominal pain or cramps were reported by 69 respondents (49.3%), frequent gas or uncomfortable bowel sounds by 93 (66.4%), early satiety by 90 (64.3%), persistent fatigue by 92 (65.7%), and nausea after eating by 25 (17.9%) (Table 2). Symptoms worsened during psychological stress in 95 respondents (67.9%) and affected daily life mildly or significantly in 82 respondents (58.5%) (Table 3).

Dietary exposures were common: 111 respondents (79.3%) consumed fast food two to three times per week, 76 (54.3%) consumed sweets or sugary foods daily, and 43 (30.7%) frequently consumed carbonated beverages. Antibiotic use more than once during the previous year was reported by 60 respondents (42.9%), while 32 (22.8%) reported acid-reducing medication use for at least one week. Prior IBS diagnosis was reported by 39 respondents (27.9%), and previous gastrointestinal surgery by 18 (12.9%) (Table 2).

Table 2 Gastrointestinal symptoms, dietary habits, medical history, and medication exposure reported by respondents (N=140)
Domain Variable Category n %
Gastrointestinal Symptoms Abdominal pain or cramps No 71 50.7
Yes 69 49.3
Frequent gas or uncomfortable bowel sounds No 47 33.6
Yes 93 66.4
Early satiety/heaviness when eating No 50 35.7
Yes 90 64.3
Dietary Habits Fast-food intake Four to five times per week 14 10.0
Three to four times per week 8 5.7
Two to three times per week 111 79.3
Daily 7 5.0
Frequent carbonated beverage intake No 97 69.3
Yes 43 30.7
Food triggers for gastrointestinal symptoms (Total trigger responses = 213) High-fiber foods 24 11.3
Carbohydrate-rich foods 57 26.8
Dairy products 88 41.3
Sugary foods 44 20.7
Total trigger responses 213 100.0
Medical History Diagnosed with irritable bowel syndrome (IBS) No 101 72.1
Yes 39 27.9
Prior gastrointestinal surgery No 122 87.1
Gallbladder removal 6 4.3
Gastric sleeve surgery 5 3.6
Gastric sleeve + gallbladder removal 5 3.6
Gastric sleeve + gastric bypass + gallbladder removal 2 1.4
Medication, Herbal, and Diet Exposure Herbal remedy used for digestive symptoms Chamomile 21 15.0
Honey with lemon 4 2.9
None 54 38.6
Mint 34 24.3
Anise 27 19.3
Antibiotic use >1 time in past year No 80 57.1
Yes 60 42.9
Acid-reducing medication use No 108 77.1
One week 9 6.4
Two weeks 5 3.6
Three weeks 1 0.7
One month 17 12.1
Daily sweets/sugary food intake No 64 45.7
Yes 76 54.3
Table 3 Symptom severity and impact on daily life (N=140)
Variable Category n %
Frequent diarrhea Three times daily 3 2.1
No 117 83.6
Twice daily 2 1.4
Once daily 18 12.9
Consulted doctor for chronic digestive symptoms No 95 67.9
Yes 45 32.1
Symptoms affect daily life No 58 41.4
Yes, mildly 66 47.1
Yes, significantly 16 11.4
Symptoms worsen after sugary foods Yes 44 31.4
No 96 68.6
Persistent fatigue/exhaustion without clear cause No 48 34.3
Yes 92 65.7
Nausea after eating No 115 82.1
Yes 25 17.9
Symptoms worsen during psychological stress No 45 32.1
Yes 95 67.9

Knowledge and Perception Toward SIBO: SIBO awareness was low. Ninety-one respondents (65.0%) had never heard of SIBO, 81 (57.9%) did not know that breath tests can detect gases produced by bacteria, and 92 (65.7%) did not know whether SIBO symptoms can be misdiagnosed as IBS. Among respondents who reported prior awareness, healthcare professionals, social media, friends/relatives, and the internet were all cited as information sources (Table 3).

Despite limited awareness, attitudes toward professional care were favorable. Most respondents identified SIBO as abnormal bacterial overgrowth (120/140, 85.7%), and 129 (92.1%) preferred specialist-supervised treatment. However, only 10 respondents (7.1%) had used any SIBO treatment. Uncertainty remained high regarding SIBO prevalence (80/140, 57.1% answered 'I do not know'), probiotic benefit (84/140, 60.0%), and diet-related improvement (66/140, 47.1%) (Table 4).

Table 4 Knowledge, perception, and practice toward small intestinal bacterial overgrowth (SIBO) (N=140)
Variable Category n %
Aware breath tests detect bacterial gases No 25 17.9
I do not know 81 57.9
Yes 34 24.3
Think SIBO symptoms can be misdiagnosed as irritable bowel syndrome (IBS) No 14 10.0
I do not know 92 65.7
Yes 34 24.3
Ever heard of SIBO No 91 65.0
Yes 49 35.0
Source of SIBO information Internet 11 7.9
Friend or relative 16 11.4
Doctor/healthcare professional 19 13.6
Social media 18 12.9
Definition of SIBO Gastritis 13 9.3
Abnormal overgrowth of bacteria 120 85.7
Colon ulcers 7 5.0
Think SIBO is common I do not know 80 57.1
No 21 15.0
Yes 39 27.9
Think probiotics may benefit some SIBO patients No 6 4.3
I do not know 84 60.0
Yes 50 35.7
Prefer specialist-supervised treatment No 11 7.9
Yes 129 92.1
Symptoms improve with a specific diet No 7 5.0
I do not know 66 47.1
Yes 67 47.9
Used any SIBO treatment No 130 88.6
Yes 16 11.4
Treatment type used Antibiotics 2 12.5
Herbal/natural medicines 5 31.3
Dietary modification only 4 25.0
Probiotics 5 31.3

Associations Between Awareness, Symptoms, Practices, and Perceptions: SIBO awareness was not significantly associated with abdominal pain or cramps, frequent gas or uncomfortable bowel sounds, early satiety, fast-food intake, or frequent carbonated beverage consumption (Table 5). However, awareness of SIBO was significantly associated with several perception- and treatment-related variables. Participants who had heard of SIBO were more likely to believe that SIBO is common (p<0.001), recognize that SIBO symptoms may be confused with irritable bowel syndrome (IBS) symptoms (p<0.001), perceive probiotics as potentially beneficial (p=0.003), report symptom improvement with a specific diet (p=0.044), and report previous use of SIBO treatment (p<0.001). No significant association was observed between SIBO awareness and preference for specialist-supervised treatment (p=0.576) or the general definition of SIBO (p=0.313) (Table 5).

Table 5 Associations between SIBO awareness and gastrointestinal symptoms, dietary habits, perceptions, and treatment-related practices
Domain Variable Category Never heard of SIBO Heard of SIBO p value
Gastrointestinal symptoms Abdominal pain or cramps No 51 20 0.086
Yes 40 29
Frequent gas or uncomfortable bowel sounds No 35 12 0.095
Yes 56 37
Early satiety or heaviness after eating No 32 18 0.853
Yes 59 31
Dietary habits Fast-food consumption Four to five times/week 13 1 0.067
Three to four times/week 5 3
Two to three times/week 67 44
Daily 6 1
Frequent carbonated beverage intake No 63 34 0.983
Yes 28 15
Perceptions Definition of SIBO Gastritis 10 3 0.313
Abnormal bacterial overgrowth 78 42
Colon ulcers 3 4
Think SIBO is common I do not know 63 17 <0.001*
No 12 9
Yes 16 23
SIBO symptoms can be confused with IBS symptoms No 4 2 <0.001*
I do not know 56 11
Yes 31 36
Probiotics may benefit some SIBO patients No 3 3 0.003*
I do not know 64 20
Yes 24 26
Treatment-related practices Prefer specialist-supervised treatment No 8 3 0.576
Yes 83 46
Symptoms improve with a specific diet No 2 5 0.044*
I do not know 48 18
Yes 41 26
Used any treatment for SIBO No 90 40 <0.001*
Yes 1 9

Discussion

This cross-sectional study addresses an important gap in knowledge about the burden of gastrointestinal symptoms and the level of SIBO awareness among adults in Saudi Arabia. Namely, two-thirds of respondents had no previous awareness of SIBO, and most respondents were unaware of the possible diagnostic value of breath tests and the fact that SIBO symptoms overlap with those of IBS [17]. Simultaneously, the subjects reported various symptoms characteristic of SIBO and other functional disorders of the digestive tract, such as gas and bowel pain, feeling full quickly after meals, fatigue, and stress-induced exacerbation of symptoms.

The results are consistent with the literature, indicating that SIBO symptoms are nonspecific and can often be confused with IBS and other functional disorders of gut-brain interaction [17-20]. American College of Gastroenterology (ACG) and American Gastroenterological Association (AGA) guidelines highlight the importance of standardized procedures and careful interpretation of test results because of the limits of both breath test and symptom-based diagnosis of SIBO [2,3,7]. Low level of awareness is meaningful since people with chronic symptoms may consider them normal and try self-treatment or alternative therapy.

Dietary and medication-related findings have practical relevance from a public health perspective. Frequent consumption of fast food and sugary items is typical for nutrition transition in Saudi Arabia and can cause symptoms or change of gut microbiota [8,9]. Recurrent antibiotic use is relevant specifically from a perspective of pharmacy practice. Previous research documented access to nonprescribed antibiotics and then studied the effects of national restrictions on dispensing antibiotics [21,22]. In the present study, 42.9% of respondents used antibiotics more than once during a year. Therefore, pharmacists need to educate people about the appropriate use of antibiotics and the associated changes of gut microbiota [23,24].

Correlation analysis provides some insight into educational targets. SIBO awareness did not correlate with symptom frequency or dietary behavior, which indicates that the presence of symptoms does not necessarily increase knowledge about the disease [25]. However, awareness correlated strongly with beliefs about the prevalence of SIBO, SIBO and IBS overlap, probiotic effectiveness, effectiveness of dietary modification, and prior treatments. Thus, targeted education may lead to a different interpretation of symptoms and different decisions regarding treatment even if symptom frequency will not immediately change. Moreover, correlation of herbal medicine use and visiting physicians indicates that self-care and formal visits can co-exist in this population.

Several limitations of the study should be noted. Sample size was small, and sample consisted mainly of females, which can limit generalizability of the study to the entire Saudi adult population. The source thesis did not provide a recruitment-flow diagram, geographical distribution of participants, response rate, and psychometric properties of the questionnaire. Symptoms and exposures were self-reported, which leads to potential recall and social desirability bias. Since only awareness and symptom patterns were examined, but not SIBO itself using breath test or culturing, one cannot interpret findings as an estimate of SIBO prevalence. Nevertheless, the study has generated valuable baseline information about an underresearched public health and pharmacy practice issue.

Practical implications are obvious. Pharmacists and primary care practitioners should incorporate information about SIBO and its relationship with IBS when advising adults with constant bloating, early satiety, abdominal pain, fatigue, or altered bowel sounds. Public health efforts should improve knowledge of breath testing procedure, proper indications for consultation with specialists, and inappropriate use of antibiotics as well as evidence-based approaches to diets, probiotics, and herbs. Future research should include probability sampling, validated questionnaires on knowledge, attitudes, and practices in Arabic, regional stratification, and confirmed SIBO to characterize the burden accurately.

Conclusion

In a Saudi sample, adults reported a high burden of gastrointestinal symptoms and modifiable digestive-health behaviors but a low level of SIBO awareness and diagnostic knowledge. SIBO awareness was related to people's beliefs and treatment practices, but not directly to symptom burden. The findings suggest the need for pharmacist-led and public health interventions to increase digestive health literacy and rational antibiotic use.

Declarations

Ethical Clearance

The study was conducted in accordance with the ethical standards in the 1975 Declaration of Helsinki. Ethical approval (IRRB-06-02032026) was obtained from Ibn Sina National College (ISNC) Institutional Research Review Board (IRRB). Written informed consent was obtained from all participants before participation. Confidentiality and anonymity were maintained by ensuring that no personal identifiers were collected. Data were securely stored and accessible only to the research team.

Contributors

GKK, MAE, and ENA: Conceptualization, Methodology, Investigation, Data collection and curation, Writing original draft, YSK, EIA, and EB: Conceptualization, Methodology, Formal analysis, Data curation, Visualization, Software, Writing – review and editing. BAY: Supervision, Conceptualization, Formal analysis, Data collection and curation, Writing – review and editing. All authors approved the final manuscript

Conflict of interest

The authors declare that there is no conflict of interest

Funding/ financial support

This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sector.

Acknowledgements

None

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