Small Intestinal Bacterial Overgrowth in Irritable Bowel Syndrome: Systematic Review and Meta-analysis

Ford, Alexander C.; Spiegel, Brennan M.R.; Talley, Nicholas J.; Moayyedi, Paul

doi:10.1016/j.cgh.2009.06.031

Cited by 351Gastrointestinal motility and disordersGut microbiota and healthMicroscopic Colitis

Small Intestinal Bacterial Overgrowth in Irritable Bowel Syndrome: Systematic Review and Meta-analysis

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Ford, Alexander C., Spiegel, Brennan M.R., Talley, Nicholas J., Moayyedi, Paul·2009·Clinical Gastroenterology and Hepatology

DOI 10.1016/j.cgh.2009.06.031

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Abstract

Background & aims Small intestinal bacterial overgrowth (SIBO) has been proposed as an etiologic factor in irritable bowel syndrome (IBS), but evidence is conflicting. We conducted a systematic review and meta-analysis of the prevalence of SIBO in IBS.Methods MEDLINE and EMBASE were searched up to November 2008. Case series and case-control studies applying diagnostic tests for SIBO in unselected adults meeting diagnostic criteria for IBS were eligible. Prevalence of a positive test for SIBO was extracted and pooled for all studies, and compared between cases and controls using an odds ratio and 95% confidence interval (CI).Results Twelve studies were identified containing 1921 subjects meeting criteria for IBS. Pooled prevalence of a positive lactulose or glucose hydrogen breath test was 54% (95% CI, 32%-76%) and 31% (95% CI, 14%-50%), respectively, with statistically significant heterogeneity between study results. Prevalence of a positive jejunal aspirate and culture was 4% (95% CI, 2%-9%). The pooled odds ratio for any positive test for SIBO in cases compared with healthy asymptomatic controls was 3.45 (95% CI, 0.9-12.7) or 4.7 (95% CI, 1.7-12.95), depending on the criteria used to define a positive test, with statistically significant heterogeneity for both.Conclusions Prevalence of SIBO in individuals meeting diagnostic criteria for IBS was highest with breath testing. The prevalence in cases with IBS compared with controls varied according to criteria used to define a positive test. The role of testing for SIBO in individuals with suspected IBS remains unclear.

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Small intestinal bacterial overgrowth and altered intestinal microbiota are implicated in subgroups of functional bowel disorder patients.
“Moreover, small intestinal bacterial overgrowth (SIBO)25 and altered intestinal microbiota26 are implicated in subgroups of FBD patients.”
From Intestinal microbiota in functional bowel disorders: a Rome foundation report (2013) · cites this paper as [25]
A meta-analysis review showed that small intestinal bacterial overgrowth (SIBO) was present between 4% and up to 54% in IBS, suggesting that microbiota alterations may play a role in a subset of patients.
“A metaanalysis review showed that small intestinal bacterial overgrowth (SIBO) was present between 4% and up to 54% in IBS [55] , suggesting that microbiota alterations may play a role in a subset of patients.”
From Intestinal microbiota in health and disease: Role of bifidobacteria in gut homeostasis (2014) · cites this paper as [55]
A meta-analysis of studies using hydrogen breath testing reported a pooled prevalence of SIBO in patients with IBS of 54-64%.
“A meta-analysis of studies using HBT reported a pooled prevalence of SIBO in patients with IBS of 54–64% (61).”
From Intestinal microbiota and immune function in the pathogenesis of irritable bowel syndrome (2013) · cites this paper as [61]

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Authors: Ford, A. C., Spiegel, B. M. R., Talley, N. J., & Moayyedi, P.
Affiliations: McMaster University (CA)
University of California, Los Angeles (US)
Mayo Clinic in Florida (US)
Corresponding author: Ford, Alexander C.
ORCID: Ford, Alexander C.
Spiegel, Brennan M.R.
Talley, Nicholas J.
Moayyedi, Paul
Venue: Clinical Gastroenterology and Hepatology
Publisher: Elsevier BV
Published: 2009-12
Volume: 7
Issue: 12
Pages: 1279-1286
ISSN: 1542-3565 (ISSN-L)
DOI: 10.1016/j.cgh.2009.06.031
OpenAlex: W2087956925
Cited by: 351
References: 49
Citations by year: 2026: 11 · 2025: 9 · 2024: 8 · 2023: 12 · 2022: 15 · 2021: 20 · 2020: 18 · 2019: 19 · 2018: 15 · 2017: 22 · 2016: 20 · 2015: 36 · 2014: 35 · 2013: 29 · 2012: 30
FWCI: 4.19
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Clinical Gastroenterology and Hepatology (publishedVersion)
PubMed (publishedVersion)
Funders: American College of Gastroenterology
Topics: Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
Health Sciences › Medicine › Epidemiology › Microscopic Colitis
Keywords: small intestinal bacterial overgrowth, irritable bowel syndrome, SIBO prevalence, lactulose breath test, glucose hydrogen breath test
MeSH terms: Bacteria, Bacterial Infections, Humans, Intestine, Small, Irritable Bowel Syndrome

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Small Intestinal Bacterial Overgrowth in Irritable Bowel Syndrome: Systematic Review and Meta-analysis

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