Department of Gastroenterology, The People's Hospital of Yubei District of Chongqing City, Chongqing 401120, China.
Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
Biomed Res Int. 2022 Oct 18;2022:2469513. doi: 10.1155/2022/2469513. eCollection 2022.
Hepatic encephalopathy (HE) is a neurological and psychiatric syndrome. Recent evidence suggests that HE is not only a disease of the liver and brain but is also related to the gut. Small intestinal bacterial overgrowth (SIBO) is well known to be associated with cirrhosis, but the relationship between SIBO and HE is unclear. We conducted this comprehensive systematic review and meta-analysis to determine the association between SIBO and HE in cirrhotic patients.
We conducted a comprehensive literature search of all studies on the association of SIBO and HE in cirrhotic patients using the PubMed and Embase electronic databases. Studies were screened, and relevant data were extracted and analysed. We calculated the number of cases of SIBO in patients with HE and controls. We then compared the prevalence of SIBO between the two groups to calculate the odds ratios (ORs) and 95% confidence intervals (CIs). Funnel plots were constructed to identify potential publication bias.
Six studies with 414 participants (219 HE patients and 195 controls) met the inclusion criteria. The prevalence of SIBO in cirrhotic patients with HE was significantly higher than that in those without HE. The combined OR was 4.43 (95% CI 1.73-11.32, = 0.002). The heterogeneity was moderate ( = 66%), and the funnel plot suggested no significant publication bias. Subgroup analysis showed that the OR was 1.95 (95% CI 0.63-6.09) in studies using the lactulose breath test (LBT) and 7.60 (95% CI 3.50-16.50) in studies using the glucose breath test (GBT). The prevalence of SIBO in cirrhotic patients was also related to the severity of liver disease.
Our meta-analysis identified a strong association between SIBO and HE, and the risk of SIBO was 4.43 times higher among cirrhotic patients with HE than among those without HE. SIBO could be a predisposing factor for the development of HE in cirrhotic patients. Therefore, the importance of SIBO should be emphasized in patients with HE.
肝性脑病（HE）是一种神经和精神综合征。最近的证据表明，HE 不仅是肝脏和大脑的疾病，而且还与肠道有关。小肠细菌过度生长（SIBO）众所周知与肝硬化有关，但 SIBO 与 HE 之间的关系尚不清楚。我们进行了这项全面的系统评价和荟萃分析，以确定肝硬化患者中 SIBO 与 HE 之间的关联。
我们使用 PubMed 和 Embase 电子数据库对所有关于肝硬化患者 SIBO 与 HE 关联的研究进行了全面的文献检索。筛选研究并提取和分析相关数据。我们计算了 HE 患者和对照组中 SIBO 病例的数量。然后，我们比较了两组之间 SIBO 的患病率，以计算比值比（OR）和 95%置信区间（CI）。绘制漏斗图以识别潜在的发表偏倚。
纳入了 6 项研究，共 414 名参与者（219 名 HE 患者和 195 名对照组）。HE 肝硬化患者的 SIBO 患病率明显高于无 HE 的患者。合并 OR 为 4.43（95%CI 1.73-11.32， = 0.002）。异质性中等（ = 66%），漏斗图表明无显著发表偏倚。亚组分析表明，乳果糖呼气试验（LBT）研究中的 OR 为 1.95（95%CI 0.63-6.09），葡萄糖呼气试验（GBT）研究中的 OR 为 7.60（95%CI 3.50-16.50）。肝硬化患者 SIBO 的患病率也与肝病严重程度有关。
我们的荟萃分析确定了 SIBO 与 HE 之间存在强烈关联，并且 HE 肝硬化患者的 SIBO 风险比无 HE 的患者高 4.43 倍。SIBO 可能是肝硬化患者发生 HE 的一个诱发因素。因此，在 HE 患者中应强调 SIBO 的重要性。
