Prevalence and predictors of small intestinal bacterial overgrowth in irritable bowel syndrome: a systematic review and meta-analysis

Chen, Binrui; Kim, John Jae-Woo; Zhang, Yawen; Du, Lijun; Dai, Ning

doi:10.1007/s00535-018-1476-9

Cited by 90 publications

(80 citation statements)

References 58 publications

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“…Several studies have explored PPI use as a risk factor for SIBO in various GI conditions. However, the results have been conflicting with some finding a positive and others finding a negative association …”

Section: Discussionmentioning

confidence: 99%

Systematic review with meta‐analysis: the prevalence of small intestinal bacterial overgrowth in inflammatory bowel disease

Shah

Morrison

Burger

et al. 2019

Aliment Pharmacol Ther

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Background: Current data on small intestinal bacterial overgrowth (SIBO) in patients with inflammatory bowel diseases (IBD) are controversial.Aim: To conduct a systematic review and meta-analysis to determine the prevalence of SIBO in patients with ulcerative colitis (UC) and Crohn's disease (CD). Methods: Electronic databases were searched up to May 2018 for studies reporting prevalence of SIBO in IBD patients. The prevalence rate of SIBO among IBD patients and the odds ratio (OR) and 95% CI of SIBO in IBD patients compared with controls were calculated. Results: The final dataset included 11 studies (1175 adult patients with IBD and 407 controls), all utilising breath test for diagnosis of SIBO. The proportion of SIBO in IBD patients was 22.3% (95% CI 19.92-24.68). The OR for SIBO in IBD patients was 9.51 (95% CI 3.39-26.68) compared to non-IBD controls, and high in both CD (OR = 10.86; 95% CI 2.76-42.69) and UC (OR = 7.96; 95% CI 1.66-38.35). In patients with CD, subgroup analysis showed the presence of fibrostenosing disease (OR = 7.47; 95% CI 2.51-22.20) and prior bowel surgery (OR = 2.38; 95% CI 1.65-3.44), especially resection of the ileocecal valve, increased the odds of SIBO. Individual studies suggest that combined small and large bowel disease but not disease activity may be associated with SIBO. Conclusions: Overall, there is a substantial increase in the prevalence of SIBO in IBD patients compared to controls. Prior surgery and the presence of fibrostenosing disease are risk factors for SIBO in IBD. Additional supporting information will be found online in the Supporting Information section at the end of the article. How to cite this article: Shah A, Morrison M, Burger D, et al. Systematic review with meta-analysis: the prevalence of small intestinal bacterial overgrowth in inflammatory bowel disease.

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Section: Discussionmentioning

confidence: 99%

Systematic review with meta‐analysis: the prevalence of small intestinal bacterial overgrowth in inflammatory bowel disease

Shah

Morrison

Burger

et al. 2019

Aliment Pharmacol Ther

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“…Specifically, an excessive bacterial colonization in the small intestine, resembling those normally found in the colon, was speculated to be involved in IBS pathophysiology, namely, small intestinal bacterial overgrowth (SIBO) . SIBO was detected in 4–84% in IBS sufferers using hydrogen breath tests or upper gut aspirate culture .…”

Section: Introductionmentioning

confidence: 99%

Duodenal and rectal mucosal microbiota related to small intestinal bacterial overgrowth in diarrhea‐predominant irritable bowel syndrome

Yang

Zhang

Hong

et al. 2019

J of Gastro and Hepatol

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Key wordsglucose hydrogen breath test, irritable bowel syndrome, microbial dysbiosis index, mucosalassociated microbiota, small intestinal bacterial overgrowth. AbstractBackground and Aim: Small intestinal bacterial overgrowth (SIBO) has been proposed as an etiologic factor in irritable bowel syndrome, particularly the diarrhea-predominant subtype (IBS-D). We aimed to identify potential intestinal microbial pattern in IBS-D patients with SIBO. Methods: Diarrhea-predominant irritable bowel syndrome patients fulfilling Rome III criteria were recruited and randomly divided into an exploratory cohort (57 cases) and a validation cohort (20 cases). SIBO was identified according to standard glucose hydrogen breath test. For 16S rRNA gene sequencing, samples of duodenal mucosa, duodenal fluid, rectal mucosa, and fresh feces were collected and performed. The α and β diversity, as well as differences in microbial composition and function, in SIBO + and SIBO À IBS-D subjects were evaluated. Results: The microbial diversity and composition obviously differed between SIBO + and SIBO À IBS-D in duodenal and rectal mucosa but not in duodenal fluid and fresh feces. For rectal mucosal microbiota, it displayed markedly reduced aerobe and Gram-negative bacteria and increased facultative anaerobe and Gram-positive bacteria, moreover, altered functions of microbial metabolism in SIBO + IBS-D. Significantly higher rectal mucosarelated microbial dysbiosis index was observed in SIBO + IBS-D, and a cut-off value at À0.37 had a sensitivity of 56.55% and specificity of 90.91% to identify the SIBO in IBS-D subjects. Conclusions: Mucosal microbiota, rather than luminal bacteria, has a more apparent dysbiosis in SIBO + IBS-D patients relative to those without SIBO. Rectal mucosaassociated microbiota may act as a potential predictor of SIBO in IBS-D patients.

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“…The pathophysiology of IBS is multifactorial and has been suggested to include an altered bacterial composition of the gut. Additionally, small intestinal bacterial overgrowth (SIBO), characterized by abnormally high amounts of colonizing bacteria in the small bowel, has been suggested as an important feature in at least subsets of patients 2 .…”

mentioning

confidence: 99%

Evidence of altered mucosa-associated and fecal microbiota composition in patients with Irritable Bowel Syndrome

Sundin

Aziz

Nordlander

et al. 2020

Sci Rep

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Altered bacterial composition and small intestinal bacterial overgrowth (SiBo) may be associated with irritable bowel syndrome (IBS). This study aimed to determine the fecal and mucosa-associated bacterial composition along the gastrointestinal (GI) tract and to assess SIBO in IBS. Bacterial composition of feces, and mucosa of the duodenum and sigmoid colon was determined by 16S rRNAamplicon-sequencing. SIBO was evaluated by bacterial culture of duodenal aspirate, glucose and lactulose breath tests. Mucosal antibacterial gene expression was assessed by PCR Array. The bacterial profiles of feces and the mucosa of sigmoid colon, but not duodenum, differed between IBS patients (n = 17) and HS (n = 20). The IBS specific bacterial profiles were linked to the colonic antibacterial gene expression. Fecal bacterial profile differed between IBS subtypes, while the mucosa-associated bacterial profile was associated with IBS symptom severity and breath tests results at baseline (H 2 and/or cH 4 ≥ 15 ppm). The prevalence of SIBO was similar between IBS patients and HS. This study demonstrates that alterations in the bacterial composition of the sigmoid colon of iBS patients were linked to symptoms and immune activation. While breath tests reflected the mucosa-associated bacterial composition, there was no evidence for high prevalence of SIBO or small intestinal bacterial alterations in IBS.

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Prevalence and predictors of small intestinal bacterial overgrowth in irritable bowel syndrome: a systematic review and meta-analysis

Cited by 90 publications

References 58 publications

Systematic review with meta‐analysis: the prevalence of small intestinal bacterial overgrowth in inflammatory bowel disease

Systematic review with meta‐analysis: the prevalence of small intestinal bacterial overgrowth in inflammatory bowel disease

Duodenal and rectal mucosal microbiota related to small intestinal bacterial overgrowth in diarrhea‐predominant irritable bowel syndrome

Evidence of altered mucosa-associated and fecal microbiota composition in patients with Irritable Bowel Syndrome

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