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Links between Celiac Disease and Small Intestinal Bacterial Overgrowth: A Systematic Review and Meta-Analysis

J Gastroenterol Hepatol. 2022 Jun 22. doi: 10.1111/jgh.15920. Online ahead of print.


BACKGROUND AND AIMS: Symptoms of small intestinal bacterial overgrowth (SIBO) and celiac disease (CeD) often overlap, and studies suggest a link between SIBO and CeD. We thus conducted a systematic review and meta-analysis to compare SIBO prevalence in CeD-patients and controls and assessed effects of antimicrobial therapy on gastrointestinal symptoms in SIBO positive CeD-patients.

METHODS: Electronic databases were searched until February-2022 for studies reporting SIBO prevalence in CeD. Prevalence rates, Odds Ratio (OR) and 95% confidence intervals (CI) of SIBO in CeD and controls were calculated.

RESULTS: We included 14 studies, with 742 CeD-patients and 178 controls. The pooled prevalence of SIBO in CeD was 18.3%(95%CI:11.4-28.1), with substantial heterogeneity. Including case-control studies with healthy controls, SIBO prevalence in CeD-patients was significantly increased (OR5.1, 95%CI:2.1-12.4, p=0.0001), with minimal heterogeneity. Utilizing breath tests, SIBO prevalence in CeD-patients was 20.8%(95%CI:11.9-33.7), almost two-fold higher compared to culture-based methods at 12.6%(95%CI:5.1-28.0), with substantial heterogeneity in both analyses. SIBO prevalence in CeD-patients nonresponsive to a gluten free diet (GFD) was not statistically higher as compared to those responsive to GFD (OR1.5, 95%CI:0.4-5.0, p=0.511). Antibiotic therapy of SIBO positive CeD-patients resulted in improvement in gastrointestinal symptoms in 95.6%(95%CI:78.0-99.9) and normalization of breath tests.

CONCLUSIONS: This study suggests a link between SIBO and CeD. While SIBO could explain nonresponse to a GFD in CeD, SIBO prevalence is not statistically higher in CeD-patients non-responsive to GFD. The overall quality of the evidence is low, mainly due to substantial ‘clinical heterogeneity’ and the limited sensitivity/specificity of the available diagnostic tests.

PMID:35734803 | DOI:10.1111/jgh.15920

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