Ayesha Shah1,2,3, Mark Morrison4, Daniel Burger1,2, Neal Martin1,2, Justin Rich1,2, Mike Jones5, Natasha Koloski2,4, Marjorie M Walker6, Nicholas J Talley6, Gerald J Holtmann1,2,3. 1. The University of Queensland, Faculty of Medicine and Faculty of Health and Behavioural Sciences, Brisbane, QLD, Australia. 2. Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia. 3. Translational Research Institute, Princess Alexandra Hospital, Brisbane, QLD, Australia. 4. University of Queensland, Diamantina Institute, Microbial Biology and Metagenomics, QLD, Australia. 5. Macquarie University, Department of Psychology, Sydney, NSW, Australia. 6. University of Newcastle, Newcastle, NSW, Australia.
Abstract
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.
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 IBDpatients. The prevalence rate of SIBO among IBDpatients and the odds ratio (OR) and 95% CI of SIBO in IBDpatients 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 IBDpatients was 22.3% (95% CI 19.92-24.68). The OR for SIBO in IBDpatients 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 IBDpatients compared to controls. Prior surgery and the presence of fibrostenosing disease are risk factors for SIBO in IBD.
Authors: Arjun Gandhi; Ayesha Shah; Michael P Jones; Natasha Koloski; Nicholas J Talley; Mark Morrison; Gerald Holtmann Journal: Gut Microbes Date: 2021 Jan-Dec
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