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

Shah A1,2,3, Morrison M4, Burger D1,2, Martin N1,2, Rich J1,2, Jones M5, Koloski N2,4, Walker MM6, Talley NJ6, Holtmann GJ1,2,3. Aliment Pharmacol Ther. 2019 Feb 8. doi: 10.1111/apt.15133. [Epub ahead of print]


Author information

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.


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 ninefold 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.

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