Prevalence of small intestinal bacterial overgrowth in patients with gastroparesis: a systematic review and meta-analysis
Gastroenterology and Hepatology from Bed to Bench,
Aim: We performed a systematic review and meta-analysis to identify the prevalence of small intestinal bacterial overgrowth (SIBO) in patients with gastroparesis.
Background: Several studies have suggested an association between SIBO and gastroparesis, which is characterized by delayed gastric emptying in the absence of mechanical obstruction.
Methods: A comprehensive search was performed using MEDLINE, EMBASE, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) through January, 2022 for randomized controlled trials and observational studies reporting the prevalence of SIBO in gastroparesis. Pooled prevalence was estimated using a random effects model. Heterogeneity was assessed by using the inconsistency index (I2).
Results: Among the 976 articles identified, 43 studies were selected for full text review. Six studies, with 385 patients, were deemed eligible for inclusion, with a perfect agreement between investigators (kappa=1.0). Overall, 379 patients were diagnosed with gastroparesis by gastric emptying scintigraphy and six were diagnosed with a wireless motility capsule. The pooled prevalence of SIBO was 41% (95% confidence interval 0.23-0.58). SIBO was diagnosed using jejunal aspirate cultures (N=15, 8.4%), lactulose breath test (N=80, 44.7%), glucose breath test (N=30, 16.8%), D-xylose breath test (N=52, 29.1%), and hydrogen breath test (N=2, 1.1%). Heterogeneity was significant and noted to be high at 91%. Only one study reported SIBO diagnosis in controls, therefore no pooled odds ratio was calculated.
Conclusion: SIBO was present in almost half of the patients with gastroparesis. Future studies should examine and identify the association between SIBO and gastroparesis.
- Gut-brain axis
How to Cite
2. Camilleri M, Sanders KM. Gastroparesis. Vol. 162, Gastroenterology. W.B. Saunders; 2022. p. 68-87.e1.
3. Parkman HP, Yates K, Hasler WL, Nguyen L, Pasricha PJ, Snape WJ, et al. Clinical features of idiopathic gastroparesis vary with sex, body mass, symptom onset, delay in gastric emptying, and gastroparesis severity. Gastroenterology. 2011;140(1):101-115.e10.
4. So Ykan I, Ri S, Siek S, Kiernan B, Mccallum RW. Demography, Clinical Characte ristics, Psychological and Abuse Pro® les, Treatment, and Long-Term Follow-up of Patie nts with Gastroparesis. Vol. 43, Digestive Diseases and Sciences. 1998.
5. Syed AR, Wolfe MM, Calles-Escandon J. Epidemiology and Diagnosis of Gastroparesis in the United States: A Population-based Study. Journal of Clinical Gastroenterology. 2020 Jan 1;54(1):50–4.
6. Moshiree B, Potter M, Talley NJ. Epidemiology and Pathophysiology of Gastroparesis. Vol. 29, Gastrointestinal Endoscopy Clinics of North America. W.B. Saunders; 2019. p. 1–14.
7. Bures J, Cyrany J, Kohoutova D, Förstl M, Rejchrt S, Kvetina J, et al. Small intestinal bacterial overgrowth syndrome. World Journal of Gastroenterology. 2010;16(24):2978–90.
8. Quigley EMM, Murray JA, Pimentel M. AGA Clinical Practice Update on Small Intestinal Bacterial Overgrowth: Expert Review. Gastroenterology. 2020 Oct 1;159(4):1526–32.
9. Quigley EMM. The Spectrum of Small Intestinal Bacterial Overgrowth (SIBO). Vol. 21, Current Gastroenterology Reports. Current Medicine Group LLC 1; 2019.
10. Waldron B, Cullen PT, Kumar R, Smith D, Jankowski J, Hopwood D, et al. Evidence for hypomotility in non-ulcer dyspepsia: A prospective multifactorial study. Gut. 1991;32(3):246–51.
11. Triadafilopoulos G. Utility of wireless motility capsule and lactulose breath testing in the evaluation of patients with chronic functional bloating. BMJ Open Gastroenterology. 2016 Dec 31;3(1).
12. Schatz RA, Zhang Q, Lodhia N, Shuster J, Toskes PP, Moshiree B. Predisposing factors for positive D-Xylose breath test for evaluation of small intestinal bacterial overgrowth: A retrospective study of 932 patients. World Journal of Gastroenterology. 2015 Apr 21;21(15):4574–82.
13. George NS, Sankineni A, Parkman HP. Small intestinal bacterial overgrowth in gastroparesis. Digestive Diseases and Sciences. 2014 Mar;59(3):645–52.
14. Calderon G, Siwiec RM, Bohm ME, Nowak T v., Wo JM, Gupta A, et al. Delayed Gastric Emptying Is Not Associated with a Microbiological Diagnosis of Small Intestinal Bacterial Overgrowth. Digestive Diseases and Sciences. 2021 Jan 1;66(1):160–6.
15. Bohm M, Siwiec RM, Wo JM. Diagnosis and management of small intestinal bacterial overgrowth. Vol. 28, Nutrition in Clinical Practice. 2013. p. 289–99.
16. Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies-NHLBI, NIH https://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools/cohort 1/4 Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies Guidance for Assessing the Quality of Observational Cohort and Cross-Sectional Studies [Internet]. Available from: https://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools/cohort
17. Rothstein Hannah, Sutton AJ, Borenstein Michael. Publication bias in meta-analysis : prevention, assessment and adjustments. Wiley; 2005. 356 p.
18. 975 AGING [Internet]. 2022. Available from: www.aging-us.com
19. Shah A, Talley NJ, Jones M, Kendall BJ, Koloski N, Walker MM, et al. Small Intestinal Bacterial Overgrowth in Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of Case-Control Studies. Am J Gastroenterol. 2020 Feb 1;115(2):190–201.
20. Wijarnpreecha K, Werlang ME, Watthanasuntorn K, Panjawatanan P, Cheungpasitporn W, Gomez V, et al. Obesity and Risk of Small Intestine Bacterial Overgrowth: A Systematic Review and Meta-Analysis. Digestive Diseases and Sciences. 2020 May 1;65(5):1414–22.
21. Wijarnpreecha K, Lou S, Watthanasuntorn K, Kroner PT, Cheungpasitporn W, Lukens FJ, et al. Small intestinal bacterial overgrowth and nonalcoholic fatty liver disease: A systematic review and meta-analysis. Vol. 32, European Journal of Gastroenterology and Hepatology. Lippincott Williams and Wilkins; 2020. p. 601–8.
22. Su T, Lai S, Lee A, He X, Chen S. Meta-analysis: proton pump inhibitors moderately increase the risk of small intestinal bacterial overgrowth. Vol. 53, Journal of Gastroenterology. Springer Tokyo; 2018. p. 27–36.
23. Szurszewski JH. A migrating electric complex of the canine small intestine [Internet]. Vol. 21. 1969. Available from: www.physiology.org/journal/ajplegacy
24. Vantrappen G, Janssens J, Hellemans J, Ghoos Y. The Interdigestive Motor Complex of Normal Subjects and Patients with Bacterial Overgrowth of the Small Intestine.
25. Camilleri M, Malagelada JR. Abnormal intestinal motility in diabetics with the gastroparesis syndrome. Vol. 14, European Journal of Clinical Investigation. 1984.
26. Camilleri M, Parkman HP, Shafi MA, Abell TL, Gerson L. Clinical guideline: Management of gastroparesis. Vol. 108, American Journal of Gastroenterology. 2013. p. 18–37.
27. Camilleri M, Chedid V, Ford AC, Haruma K, Horowitz M, Jones KL, et al. Gastroparesis. Vol. 4, Nature Reviews Disease Primers. Nature Publishing Group; 2018.
29. Lee AA, Rao S, Nguyen LA, Moshiree B, Sarosiek I, Schulman MI, et al. Validation of Diagnostic and Performance Characteristics of the Wireless Motility Capsule in Patients With Suspected Gastroparesis. Clinical Gastroenterology and Hepatology. 2019 Aug 1;17(9):1770-1779.e2.
30. Mearin F, Camilleri M, Malagelada JR. Pyloric dysfunction in diabetics with recurrent nausea and vomiting. Gastroenterology. 1986;90(6):1919–25.
- Abstract Viewed: 0 times