Small intestinal bacterial overgrowth and celiac disease: A systematic review with pooled‐data analysis

Losurdo, Giuseppe; Marra, Antonella; Shahini, Endrit; Girardi, Bruna; Giorgio, Floriana; Аморусо, А.; Pisani, Antonio; Piscitelli, Domenico; Barone, M.; Principi, Mariabeatrice; Leo, Alfredo Di; Ierardi, Enzo

doi:10.1111/nmo.13028

Cited by 38 publications

(30 citation statements)

References 52 publications

(134 reference statements)

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“…However, folate deficiency in CD is not very common, possibly due to a higher prevalence of small intestinal bacterial overgrowth in CD, which increases serum folate levels due to bacterial synthesis of folate. [34][35][36] In our study, vitamin B 12 deficiency was found in 14 patients (13.6%), with isolated vitamin B 12 deficiency in 3 patients (2.9%). The prevalence of vitamin B 12 deficiency is variable in different studies and ranges from 8 to 41% of patients.…”

Section: Discussionmentioning

confidence: 49%

“…have reported folate deficiency in 12 and 20% patients of CD, respectively, and described it to be the most common cause of megaloblastic anemia in such patients. However, folate deficiency in CD is not very common, possibly due to a higher prevalence of small intestinal bacterial overgrowth in CD, which increases serum folate levels due to bacterial synthesis of folate …”

Section: Discussionmentioning

confidence: 99%

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Anemia in celiac disease is multifactorial in etiology: A prospective study from India

et al. 2018

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Background and AimsAnemia is one of the most common extraintestinal manifestations of celiac disease (CD), with iron deficiency anemia (IDA) being the predominant cause. However, anemia in CD can have varied etiologies, including mixed nutritional deficiency. We aimed to study the prevalence and etiology of anemia in CD in a north Indian population.MethodsIn this prospective observational study, consecutive patients with documented CD between January 2012 and December 2013 were included, and all patients underwent detailed clinical assessment; hematological investigations including iron profile, serum folate, and vitamin B12 levels; and esophageoduodenoscopy with duodenal biopsies for histopathological examination. Prevalence of anemia and different deficiencies were calculated, and a correlation between hematological parameters and histological findings was found.ResultsOf the 103 patients studied, anemia was detected in 96 patients, giving a prevalence of 93.2% with a baseline hemoglobin of 8.94 ± 2.54 g/dL. Overall, iron deficiency was seen in 84 (81.5%) patients, followed by vitamin B12 deficiency in 14 (13.6%) and folate deficiency in 11 (10.7%) patients; 17 (16.5%) patients had anemia due to mixed nutritional deficiencies, and 4 (3.9%) patients had anemia of chronic disease. The mean hemoglobin and median ferritin levels were significantly lower in patients with severe villous atrophy compared to those with mild atrophy.ConclusionAnemia in patients with CD is multifactorial. Even though iron deficiency is the most common cause, other nutrient deficiencies should always be explored.

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Anemia in celiac disease is multifactorial in etiology: A prospective study from India

et al. 2018

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“…In the group of patients without any predisposing conditions, we included subjects in which factors predisposing to SIBO such as abdominal surgery, celiac disease, connective tissue disorders, and others as listed in. [4][5][6][7][8][9][10] In 6 studies the sub-category of patients without any predisposing conditions was considered. 21,22,24,28,30,32 Three hundred and forty patients were enrolled in this subgroup, which was constituted mainly by healthy controls, elderly patients with diarrhea, and IBS patients.…”

Section: Sub-analysis According To Population Sub-categoriesmentioning

confidence: 99%

“…Several processes predispose to bacterial overgrowth such as anatomical/structural changes of the small intestine (previous gastrointestinal surgery), motility disorders (such as gastroparesis), metabolic disorders (gastric hypochlorhydria and diabetes), organ system dysfunctions (cirrhosis, renal failure, chronic pancreatitis, Crohn's disease, and celiac disease), medications (prolonged use of proton pump inhibitors and antibiotics), and irritable bowel syndrome (IBS). [4][5][6][7][8][9][10] The most common symptoms are diarrhea, abdominal pain and bloating, but weight loss, malnutrition, and deficiency of vitamins (B12, D, A, and E) and minerals (iron and calcium) are possible. 1 The flora of SIBO patients is mainly characterized by the prevalence of coliform bacteria and anaerobes, which cause fermentation of carbohydrates, compete with vitamin and micronutrient absorption and engender microscopic mucosal inflammation, thus leading to the above described symptoms.…”

Section: Introductionmentioning

confidence: 99%

Breath Tests for the Non-invasive Diagnosis of Small Intestinal Bacterial Overgrowth: A Systematic Review With Meta-analysis

Losurdo

Leandro

Ierardi

et al. 2020

J Neurogastroenterol Motil

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Background/Aims Small intestinal bacterial overgrowth (SIBO) diagnosis is usually based on non-invasive breath tests (BTs), namely lactulose BT (LBT) and glucose BT (GBT). However, divergent opinions and problems of parameter standardization are still controversial aspects. We aim to perform a meta-analysis to analyze diagnostic performance of LBT/GBT for SIBO diagnosis. Methods We searched in main literature databases articles in which SIBO diagnosis was achieved by LBT/GBT in comparison to jejunal aspirate culture (reference gold standard). We calculated pooled sensitivity, specificity, positive, and negative likelihood ratios and diagnostic odd ratios. Summary receiver operating characteristic curves were drawn and pooled areas under the curve were calculated. Results We selected 14 studies. Pooled sensitivity of LBT and GBT was 42.0% and 54.5%, respectively. Pooled specificity of LBT and GBT was 70.6% and 83.2%, respectively. When delta over baseline cutoff > 20 H 2 parts per million (ppm) was used, GBT sensitivity and specificity were 47.3% and 80.9%; when the cutoff was other than and lower than > 20 ppm, sensitivity and specificity were 61.7% and 86.0%. In patients with abdominal surgery history, pooled GBT sensitivity and specificity gave the impression of having a better performance (81.7% and 78.8%) compared to subjects without any SIBO predisposing condition (sensitivity = 40.6% and specificity = 84.0%). Conclusions GBT seems to work better than LBT. A cutoff of delta H2 expired other than and lower than > 20 ppm shows a slightly better result than > 20 ppm. BTs demonstrate the best effectiveness in patients with surgical reconstructions of gastrointestinal tract.

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“…Further to this, the development of SIBO has been linked to delayed oro-caecal transit time (OCTT) in UC patients associated with inflammatory changes, increased levels of pro-inflammatory cytokines and enhanced oxidative stress (Rana et al, 2014). In addition, a study reported that celiac disease has been hypothesised to be a risk factor of SIBO (Losurdo et al, 2017).…”

Section: Microbial Dysbiosismentioning

confidence: 99%

All disease begins in the gut: Influence of gastrointestinal disorders and surgery on oral drug performance

Hatton

Madla

Rabbie

et al. 2018

International Journal of Pharmaceutics

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The term "disease" conjures a plethora of graphic imagery for many, and the use of drugs to combat symptoms and treat underlying pathology is at the core of modern medicine. However, the effects of the various gastrointestinal diseases, infections, co-morbidities and the impact of gastrointestinal surgery on the pharmacokinetic and pharmacodynamic behaviour of drugs have been largely overlooked. The better elucidation of disease pathology and the role of underlying cellular and molecular mechanisms have increased our knowledge as far as diagnoses and prognoses are concerned. In addition, the recent advances in our understanding of the intestinal microbiome have linked the composition and function of gut microbiota to disease predisposition and development. This knowledge, however, applies less so in the context of drug absorption and distribution for orally administered dosage forms. Here, we revisit and re-evaluate the influence of a portfolio of gastrointestinal diseases and surgical effects on the functionality of the gastrointestinal tract, their implications for drug delivery and attempt to uncover significant links for clinical practice.

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Small intestinal bacterial overgrowth and celiac disease: A systematic review with pooled‐data analysis

Abstract: The heterogeneity of available studies may not support a relationship SIBO-CD. Nevertheless, SIBO could be more common in CD when symptoms do not improve after GFD.

Cited by 38 publications

References 52 publications

Anemia in celiac disease is multifactorial in etiology: A prospective study from India

Anemia in celiac disease is multifactorial in etiology: A prospective study from India

Breath Tests for the Non-invasive Diagnosis of Small Intestinal Bacterial Overgrowth: A Systematic Review With Meta-analysis

All disease begins in the gut: Influence of gastrointestinal disorders and surgery on oral drug performance

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