Systematic review and meta‐analysis: Small intestinal bacterial overgrowth in chronic pancreatitis

Abstract

Background: Evidence on small intestinal bacterial overgrowth (SIBO) in patients with chronic pancreatitis (CP) is conflicting. Aim: The purpose of this study was to perform a systematic review and meta-analysis on the prevalence of SIBO in CP and to examine the relationship of SIBO with symptoms and nutritional status. Methods: Case-control and cross-sectional studies investigating SIBO in CP patients were analysed. The prevalence of positive tests was pooled across studies, and the rate of positivity between CP cases and controls was calculated. Results: In nine studies containing 336 CP patients, the pooled prevalence of SIBO was 36% (95% confidence interval (CI) 17-60%) with considerable heterogeneity (I 2 ¼ 91%). A sensitivity analysis excluding studies employing lactulose breath test gave a pooled prevalence of 21.7% (95% CI 12.7-34.5%) with lower heterogeneity (I 2 ¼ 56%). The odds ratio for a positive test in CP vs controls was 4.1 (95% CI 1.6-10.4) (I 2 ¼ 59.7%). The relationship between symptoms and SIBO in CP patients varied across studies, and the treatment of SIBO was associated with clinical improvement. Conclusions: One-third of CP patients have SIBO, with a significantly increased risk over controls, although results are heterogeneous, and studies carry several limitations. The impact of SIBO and its treatment in CP patients deserve further investigation.

The Gut Microbiome in Pancreatic Disease

“…45, 46 SIBO can exacerbate pancreatic exocrine insufficiency (PEI) suggesting that treatment of SIBO would help patients with PEI. 47 In a meta-analyses by Capurso et al, the mean prevalence of SIBO in patients with chronic pancreatitis was reported to be 36% (95%CI 17–60%), 48 although significant heterogeneity between studies was noted. In a subsequent study, Jandhayala et al examined 16 patients with chronic pancreatitis, 14 with chronic pancreatitis with diabetes and 10 healthy controls.…”

Endoscopic and Conservative Management of Chronic Pancreatitis and Its Complications

“…Therefore, with burping, flatulence, dyspepsia, and other symptoms related to food intake, SIBO should be considered, especially in patients after pancreatic surgery or antibiotic therapy or in those with DM [46]. …”

Intestinal microbiota and pancreatic diseases

“…В 2016 г. опубликованы результаты метаанализа, в который вошли 9 рандомизированных исследова ний (336 больных ХП) [25]. Отбирались исследова ния, в которых СИБР диагностировали с помощью водородных дыхательных тестов (с глюкозой, га лактозой, сахарозой или ксилозой) и/или бактерио логического исследования аспирата из тонкой киш ки.…”