Faculty of Medicine, Faculty of Health and Behavioral Sciences, The University of Queensland, Brisbane, Australia.
Princess Alexandra Hospital, Department of Gastroenterology and Hepatology, Brisbane, Queensland, Australia.
Am J Gastroenterol. 2021 May 1;116(5):935-942. doi: 10.14309/ajg.0000000000001197.
This systematic review and meta-analysis aimed to determine the role of small intestinal bacterial overgrowth (SIBO) in patients with functional dyspepsia (FD).
Electronic databases were searched until July 2020 for studies reporting prevalence of SIBO in FD. The prevalence rates, odds ratio, and 95% confidence intervals (CIs) of SIBO in FD and controls were calculated.
Seven studies with 263 patients with FD and 84 controls were identified. The odds for SIBO in patients with FD were significantly higher as compared to that in controls (odds ratio = 4.3, 95% CI, 1.1-17.5, 4 studies, 234 participants); however, there was moderate heterogeneity in this analysis. Including high-quality, case-control studies (all using glucose breath tests [GBTs]), the risk of SIBO in patients with FD as compared to controls was 2.8 higher (95% CI 0.8-10.0, 3 studies, 200 participants) with minimal heterogeneity in this analysis. Using the lactulose breath test, SIBO prevalence in FD was significantly higher (53.4%, 95% CI 33.9-71.9, 3 studies, 110 participants) as compared to that with GBT (17.2%, 95% CI 8.6-31.6, 4 studies, 153 participants). Substantial heterogeneity was found in studies using the lactulose breath test but not in studies using GBT. There was no significant difference in SIBO prevalence in patients with FD according to FD subtype.
This meta-analysis suggests a link between FD and SIBO. The quality of evidence is low and can be largely attributed to the type of breath test for SIBO diagnosis and clinical heterogeneity. More appropriately designed studies are required to confirm the link between SIBO and FD.
本系统评价和荟萃分析旨在确定小肠细菌过度生长（SIBO）在功能性消化不良（FD）患者中的作用。
检索电子数据库，截至 2020 年 7 月，以获取报告 FD 中 SIBO 患病率的研究。计算 FD 患者和对照组中 SIBO 的患病率、比值比和 95%置信区间（CI）。
确定了 7 项研究，其中包括 263 例 FD 患者和 84 例对照。与对照组相比，FD 患者发生 SIBO 的几率明显更高（比值比=4.3，95%CI，1.1-17.5，4 项研究，234 名参与者）；然而，该分析存在中度异质性。纳入高质量的病例对照研究（均使用葡萄糖呼气试验[GBT]），FD 患者 SIBO 的风险比对照组高 2.8 倍（95%CI 0.8-10.0，3 项研究，200 名参与者），且该分析中的异质性极小。使用乳果糖呼气试验，FD 中 SIBO 的患病率明显更高（53.4%，95%CI 33.9-71.9，3 项研究，110 名参与者），而 GBT 为 17.2%（95%CI 8.6-31.6，4 项研究，153 名参与者）。使用乳果糖呼气试验的研究中存在明显的异质性，但使用 GBT 的研究中则没有。FD 亚型患者的 SIBO 患病率无显著差异。
本荟萃分析表明 FD 与 SIBO 之间存在关联。证据质量低，主要归因于 SIBO 诊断的呼气试验类型和临床异质性。需要进行更多设计合理的研究来证实 SIBO 与 FD 之间的联系。
