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PPIs and SIBO Small intestinal bacterial overgrowth (SIBO) commonly occurs in patients on omeprazole (PPI) and in atrophic gastritis (a condition leading to very low stomach acid).[183] SIBOoccurs significantly more frequently among long term PPI users than patients with IBS or control subjects.[184] Considering that low stomach acid is an important risk factor for the development of SIBO, recent research has focused on the mechanism by which PPIs lead to SIBO