There is a ninefold increase in the prevalence of small intestine bacterial overgrowth among patients with inflammatory bowel disease compared with other individuals, according to results of a meta-analysis.
Gerald J. Holtmann, MD, PhD, MBA, of Princess Alexandra Hospital in Brisbane, Australia, and colleagues wrote that it is widely accepted that IBD alters the gut microbiome, but data on a specific link between IBD and small intestine bacterial overgrowth (SIBO) are limited.
“SIBO symptoms overlap with those of IBD, often making it unclear if it is the cause, consequence or an epiphenomenon in relation to the other disorder,” they wrote. “Thus, a SIBO diagnosis in patients with IBD may be challenging but may have therapeutic implications.”
Investigators searched the literature for studies that reported prevalence of SIBO in patients with IBD and compared it, as well as the odds ratio of SIBO, with a group of control patients.
The analysis included 11 studies comprising 1,176 patients with IBD and 407 controls that all used a breath test to diagnose SIBO.
Researchers determined that 22.3% (95% CI, 19.92–24.68) of patients with IBD had SIBO. Patients with IBD were more than nine times more likely to develop SIBO than individuals in the control group (OR = 9.51; 95% CI, 3.39–26.68). Patients with Crohn’s disease had the highest odds (OR = 10.86; 95% CI, 2.76–42.69), but patients with ulcerative colitis also had a higher chance of being diagnosed with SIBO (OR = 7.96; 95% CI, 1.66–38.35).
When they looked at subgroups of patients with CD, investigators found that patients with fibrostenosing disease (OR = 7.47; 95% CI, 2.51–22.2), and patients with previous bowel surgery (OR = 2.38; 95% CI, 1.65–3.44) experienced increased odds of developing SIBO.
Holtmann and colleagues wrote that alteration of several factors, gastric pH and the integrity of intestinal mucosa, in patients with IBD could contribute to higher prevalence of SIBO, but they noted that more research is needed to determine the clinical implications of their findings.
“The value of treatment of SIBOpositive IBD patients with antibiotic therapy in terms of symptom improvement remains to be firmly established,” they wrote. – by Alex Young
Disclosures: Healio Gastroenterology and Liver Disease could not confirm the authors’ relevant financial disclosures.