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

Shah, Ayesha; Morrison, Mark; Burger, Daniel; Martin, Neal; Rich, Justin; Jones, Michael; Koloski, Natasha A.; Walker, Marjorie M.; Talley, Nicholas J.; Holtmann, Gerald

doi:10.1111/apt.15133

Cited by 83 publications

(79 citation statements)

References 71 publications

(156 reference statements)

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“…The high prevalence of SIBO observed can be explained, at least in part, by the fact that in CD, there are several predisposing factors for SIBO, such as surgery involving the gastrointestinal tract, especially ileocecal resection, dysmotility and stenoses or fistulas (14) . The rate of SIBO in this study is in agreement with that reported in other studies in patients with CD, ranging from 15% to 45% (3,(15)(16)(17)(18) , suggesting that SIBO is a common complication in patients with CD in various populations worldwide. Ricci et al (18) found an increased prevalence of SIBO in patients with CD compared to controls (32.6% vs 12.4%).…”

Section: Discussionsupporting

confidence: 92%

Prevalence and Factors Associated With Small Intestinal Bacterial Overgrowth in Patients With Crohn’s Disease: A Retrospective Study at a Referral Center

Bertges¹,

Chebli

2020

Arq. Gastroenterol.

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BACKGROUND: Small intestinal bacterial overgrowth (SIBO) appears to be common in patients with Crohn’s disease (CD). The rate of SIBO has been estimated at 25%-88% in this setting. However, different demographic, socioeconomic, and disease-related factors may exist between South American and North American or European populations that may limit the generalization of these findings, as the data are mainly derived from North American or European studies. OBJECTIVE: We studied the prevalence and predictors of SIBO in CD outpatients. METHODS: In this retrospective study, between June 2011 and June 2016, the medical records of 110 CD patients were assessed for presence of SIBO using the H2/CH4 glucose breath test. Univariate analysis was performed to investigate the potential association between SIBO and demographic, disease-related data, systemic markers of inflammation (C-reactive protein and erythrocyte sedimentation rate). RESULTS: The SIBO rate was high in CD patients (30%). Patients with and without SIBO were comparable according to demographics, systemic inflammatory biomarkers, and disease characteristics, except to the stricturing phenotype more common in the SIBO-positive CD patients (48.5% vs 19.5%, P=0.001). CONCLUSION: In Brazilian CD patients, SIBO is a highly prevalent condition. Stricturing phenotype demonstrated association with SIBO. An individualized screening plan followed by the timely treatment for SIBO should be carried out as part of quality of care improvement in CD individuals.

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Section: Discussionsupporting

confidence: 92%

Prevalence and Factors Associated With Small Intestinal Bacterial Overgrowth in Patients With Crohn’s Disease: A Retrospective Study at a Referral Center

Bertges¹,

Chebli

2020

Arq. Gastroenterol.

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“…Our recent systematic reviews and meta‐analyses, found an increased prevalence of SIBO in IBS and IBD, 12 irrespective of the mode of SIBO diagnosis applying the established routine techniques. Traditionally, hydrogen production on breath testing has been linked to diarrhea, 11 however, in recent years there has been increasing interest in the association between methane positivity on breath testing and constipation 49 .…”

Section: Discussionmentioning

confidence: 95%

“…There is emerging evidence for a link between intestinal dysbiosis, including SIBO, and diseases such as IBS, 11 IBD 12 and chronic liver disease 13 . Many patients in these groups are likely to be on a PPI, often for management of unexplained gastrointestinal symptoms or overlapping conditions 36 .…”

Section: Discussionmentioning

confidence: 99%

“…For decades SIBO was defined as microbial dysbiosis, underpinned by excessive numbers of bacteria (or increased bacterial load) in the small intestine 8‐10 . An association of SIBO with a variety of chronic conditions including functional gastrointestinal disorders (FGIDs), 11 inflammatory bowel disease (IBD), 12 and chronic liver disease 13 has been reported. In addition, treatment with proton pump inhibitors (PPI) potentially impairing the acid barrier of the stomach might be a risk factor for SIBO 14 .…”

Section: Introductionmentioning

confidence: 99%

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Duodenal bacterial load as determined by quantitative polymerase chain reaction in asymptomatic controls, functional gastrointestinal disorders and inflammatory bowel disease

Shah

Talley

Koloski

et al. 2020

Aliment Pharmacol Ther

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Summary Background Small intestinal bacterial overgrowth may play a role in gastrointestinal and non‐gastrointestinal diseases. Aims To use quantitative polymerase chain reaction (qPCR) to determine and compare bacterial loads of duodenal biopsies in asymptomatic controls, and patients with functional gastrointestinal disorders (FGIDs) and inflammatory bowel disease (IBD) including ulcerative colitis (UC) and Crohn’s disease (CD). To define effects of gastric acid inhibition on bacterial load, explore links of bacterial load and gastrointestinal symptoms in response to a standardised nutrient challenge and compare bacterial load with glucose breath test results. Methods In 237 patients (63 controls, 84 FGID and 90 IBD), we collected mucosal samples under aseptic conditions during endoscopy extracted and total DNA. Bacterial load metric was calculated utilising qPCR measurements of the bacterial 16S rRNA gene, normalised to human beta‐actin expression. Standard glucose breath test and nutrient challenge test were performed. Results The duodenal microbial load was higher in patients with FGID (0.22 ± 0.03) than controls (0.07 ± 0.05; P = 0.007) and patients with UC (0.01 ± 0.05) or CD (0.02 ± 0.09), (P = 0.0001). While patients treated with proton pump inhibitors (PPI) had significantly higher bacterial loads than non‐users (P < 0.05), this did not explain differences between patient groups and controls. Bacterial load was significantly (r = 0.21, P < 0.016) associated with the symptom response to standardised nutrient challenge test. Methane, but not hydrogen values on glucose breath test were associated with bacterial load measured utilising qPCR. Conclusions Utilising qPCR, a diagnosis of FGID and treatment with PPI were independently associated with increased bacterial loads. Increased bacterial loads are associated with an augmented symptom response to a standardised nutrient challenge.

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“…A growing body of scientific evidence highlights the importance of the small intestine microbiome in normal human physiology and response to dietary interventions [2,3]. Alterations in the small intestine microbiome are implicated in a number of human disorders, such as malnutrition [4,5], obesity, and metabolic disease [6], inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) [7][8][9], and drug side effects [10]. Despite the apparent importance of the small intestine microbiome in human health, it remains understudied and poorly characterized largely because of the procedural and logistical complexities associated with its sampling in humans (methods are too invasive and require specialized healthcare facilities).…”

Section: Introductionmentioning

confidence: 99%

Self-reinoculation with fecal flora changes microbiota density and composition leading to an altered bile-acid profile in the mouse small intestine

2020

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Background: The upper gastrointestinal tract plays a prominent role in human physiology as the primary site for enzymatic digestion and nutrient absorption, immune sampling, and drug uptake. Alterations to the small intestine microbiome have been implicated in various human diseases, such as non-alcoholic steatohepatitis and inflammatory bowel conditions. Yet, the physiological and functional roles of the small intestine microbiota in humans remain poorly characterized because of the complexities associated with its sampling. Rodent models are used extensively in microbiome research and enable the spatial, temporal, compositional, and functional interrogation of the gastrointestinal microbiota and its effects on the host physiology and disease phenotype. Classical, culture-based studies have documented that fecal microbial self-reinoculation (via coprophagy) affects the composition and abundance of microbes in the murine proximal gastrointestinal tract. This pervasive selfreinoculation behavior could be a particularly relevant study factor when investigating small intestine microbiota. Modern microbiome studies either do not take self-reinoculation into account, or assume that approaches such as single housing mice or housing on wire mesh floors eliminate it. These assumptions have not been rigorously tested with modern tools. Here, we used quantitative 16S rRNA gene amplicon sequencing, quantitative microbial functional gene content inference, and metabolomic analyses of bile acids to evaluate the effects of selfreinoculation on microbial loads, composition, and function in the murine upper gastrointestinal tract.Results: In coprophagic mice, continuous self-exposure to the fecal flora had substantial quantitative and qualitative effects on the upper gastrointestinal microbiome. These differences in microbial abundance and community composition were associated with an altered profile of the small intestine bile acid pool, and, importantly, could not be inferred from analyzing large intestine or stool samples. Overall, the patterns observed in the small intestine of non-coprophagic mice (reduced total microbial load, low abundance of anaerobic microbiota, and bile acids predominantly in the conjugated form) resemble those typically seen in the human small intestine.Conclusions: Future studies need to take self-reinoculation into account when using mouse models to evaluate gastrointestinal microbial colonization and function in relation to xenobiotic transformation and pharmacokinetics or in the context of physiological states and diseases linked to small intestine microbiome and to small intestine dysbiosis.

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

Cited by 83 publications

References 71 publications

Prevalence and Factors Associated With Small Intestinal Bacterial Overgrowth in Patients With Crohn’s Disease: A Retrospective Study at a Referral Center

Prevalence and Factors Associated With Small Intestinal Bacterial Overgrowth in Patients With Crohn’s Disease: A Retrospective Study at a Referral Center

Duodenal bacterial load as determined by quantitative polymerase chain reaction in asymptomatic controls, functional gastrointestinal disorders and inflammatory bowel disease

Self-reinoculation with fecal flora changes microbiota density and composition leading to an altered bile-acid profile in the mouse small intestine

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