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Small intestinal bacterial overgrowth and celiac disease: A systematic review with pooled‐data analysis
Author(s) -
Losurdo G.,
Marra A.,
Shahini E.,
Girardi B.,
Giorgio F.,
Amoruso A.,
Pisani A.,
Piscitelli D.,
Barone M.,
Principi M.,
Di Leo A.,
Ierardi E.
Publication year - 2017
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/nmo.13028
Subject(s) - medicine , gastroenterology , small intestinal bacterial overgrowth , meta analysis , asymptomatic , confidence interval , incidence (geometry) , disease , irritable bowel syndrome , physics , optics
Background A link between small intestinal bacterial overgrowth ( SIBO ) and celiac disease ( CD ) has been hypothesized. Methods Literature search was performed in main medical databases. Methods of analysis/inclusion criteria were based on Preferred Reporting Items for Systematic reviews and Meta‐Analyses recommendations. The end‐point was to estimate, by a pooled‐data analysis, SIBO prevalence in CD . Proportions/percentages and their 95% confidence intervals ( CI ) were calculated by inverse variance method, whereas odd ratios ( OR ) and their 95% CI were estimated, where available, based on the Mantel‐Haenszel method. Data were entered into the RevMan 5.3 software. Key Results Eleven articles fulfilled considered criteria. The pooled mean prevalence of SIBO in CD was 20% (95% CI of 10%‐30%). In comparison to asymptomatic controls, CD was associated to higher risk of SIBO , with an OR of 10.52 (95% CI 2.69‐41.21, P =.0007). Jejunal aspirate culture assessed SIBO prevalence of 11% (95% CI 3%‐19%) in CD , whereas breath tests detected a higher value (23%, 95% CI 10%‐37%). The pooled prevalence of SIBO in CD patients who were symptomatic despite a GFD was 28% (95% CI 10%‐47%), higher than in asymptomatic celiac patients (pooled prevalence of 10%, with a 95% CI of 3%‐16%), despite not statistically significant ( P =.06). When GFD ‐unresponsive CD was defined only by clinical persistence of symptoms, the prevalence of SIBO was higher than in the case of villous atrophy association (31% vs 16% P =.33). Conclusions 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 .