Abstract
Objective: We conducted this systematic review and meta-analysis to estimate the prevalence of SIBO in diabetic patients and to determine the association between SIBO and diabetes.Methods: A comprehensive literature search of the PubMed, Cochrane Library and EMBASE databases from inception to June 2021 was conducted for studies correlating SIBO with diabetes. Studies were screened, and relevant data were extracted and analysed. The pooled prevalence of SIBO among diabetic patients and the odds ratio of SIBO among diabetic patients compared with controls were calculated.Results: Fourteen studies including 1417 diabetic patients and 649 controls met the inclusion criteria. The pooled prevalence of SIBO in diabetes was 29% (95% CI 20–39%). The odds ratio of SIBO in diabetic patients was 2.91 (95% CI 0.82–10.32, p=0.1) compared with controls. Subgroup analyses showed that the prevalence of SIBO in diabetes was higher in studies using jejunal aspirate culture for diagnosis (39%, 95% CI 12–66%) than in those using the lactulose breath test (31%, 95% CI 18–43%) or glucose breath test (29%, 95% CI 14–43%). The prevalence of SIBO in diabetes was higher in studies conducted in Western countries (35%, 95% CI 21–49%) than in those conducted in Eastern countries (24%, 95% CI 14–34%), and the prevalence of SIBO in type 1 diabetes (25%, 95% CI 14%–36%) was not significantly different from that in type 2 diabetes (30%, 95% CI 13%–47%).Conclusions: Twenty-nine percent of diabetic patients tested positive for SIBO, and the risk of SIBO in diabetic patients was 2.91 times higher than that in patients without diabetes. Diabetes could be a predisposing factor for the development of SIBO, especially among patients diagnosed by jejunal aspirate culture or those in Western populations.
Highlights
Small intestinal bacterial overgrowth (SIBO) is defined as the presence of excessive numbers of bacteria and/or abnormal types of bacteria in the small bowel, causing gastrointestinal symptoms that include malnutrition, diarrhoea and abdominal distension [1]
Since two different diagnostic tests for SIBO were performed with different results in one study [28], we separately calculated the prevalence of SIBO in two different studies
Some studies have reported that the levels of inflammatory cytokines and oxidative stress-related parameters are significantly higher in both T1DM patients and T2DM patients than in controls [12, 20, 33,34,35,36,37,38,39,40]
Summary
Small intestinal bacterial overgrowth (SIBO) is defined as the presence of excessive numbers of bacteria and/or abnormal types of bacteria in the small bowel, causing gastrointestinal symptoms that include malnutrition, diarrhoea and abdominal distension [1]. The normal intestinal microbial balance is maintained by many important mechanisms that include gastric acid secretion, anatomical integrity of the digestive tract, propulsive peristaltic activity, and secretory IgA immunoglobulins [2]. Failure of these mechanisms can be responsible for the development of SIBO. The gold standard for diagnosing SIBO is jejunal aspirate culture (JAC). Recent studies have shown that SIBO is closely associated with various diseases, including Crohn's disease [3], irritable bowel syndrome [4], functional www.aging-us.com dyspepsia [5], hepatic encephalopathy [6], and nonalcoholic fatty liver disease [7]
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