Abstract：
OBJECTIVE: Patients with intestinal failure (IF) have abnormal intestinal anatomy, secretion, and dysmotility, which impairs intestinal homeostatic mechanisms and may lead to small intestinal bacterial overgrowth (SIBO). We conducted a systematic review and meta-analysis to determine the prevalence of SIBO in patients with IF and to identify risk factors for SIBO.
METHODS: MEDLINE (PubMed) and Embase electronic databases were searched from inception to December 2023 for studies that reported the prevalence of SIBO in IF. The prevalence rates, odds ratio (OR), and 95% confidence intervals of SIBO in IF and the risk factors for SIBO in IF were calculated using random effects model.
RESULTS: Final dataset included nine studies reporting on 407 patients with IF. The prevalence of SIBO in IF was 57.5% (95% CI 44.6-69.4), with substantial heterogeneity in this analysis (I2 = 80.9, P = 0.0001). SIBO prevalence was sixfold higher in patients with IF who received parenteral nutrition (PN) compared with IF patients not on PN (OR = 6.0, 95% CI 3.0-11.9, P = 0.0001). Overall, the prevalence of SIBO in patients with IF using PPI/acid-suppressing agents (72.0%, 95% CI 57.5-83.8) was numerically higher compared with IF patients not using these agents (47.6%, 95% CI 25.7-70.2).
CONCLUSIONS: This systematic review and meta-analysis suggests that there is an increased risk of SIBO in patients with IF and that PN, and potentially, the use of PPI/acid-suppressing agents is risk factors for SIBO development in patients with IF. However, the quality of evidence is low and can be attributed to lack of case-control studies and clinical heterogeneity seen in the studies.
METHODS: MEDLINE (PubMed) and Embase electronic databases were searched from inception to December 2023 for studies that reported the prevalence of SIBO in IF. The prevalence rates, odds ratio (OR), and 95% confidence intervals of SIBO in IF and the risk factors for SIBO in IF were calculated using random effects model.
RESULTS: Final dataset included nine studies reporting on 407 patients with IF. The prevalence of SIBO in IF was 57.5% (95% CI 44.6-69.4), with substantial heterogeneity in this analysis (I2 = 80.9, P = 0.0001). SIBO prevalence was sixfold higher in patients with IF who received parenteral nutrition (PN) compared with IF patients not on PN (OR = 6.0, 95% CI 3.0-11.9, P = 0.0001). Overall, the prevalence of SIBO in patients with IF using PPI/acid-suppressing agents (72.0%, 95% CI 57.5-83.8) was numerically higher compared with IF patients not using these agents (47.6%, 95% CI 25.7-70.2).
CONCLUSIONS: This systematic review and meta-analysis suggests that there is an increased risk of SIBO in patients with IF and that PN, and potentially, the use of PPI/acid-suppressing agents is risk factors for SIBO development in patients with IF. However, the quality of evidence is low and can be attributed to lack of case-control studies and clinical heterogeneity seen in the studies.
摘要：
目的：肠衰竭（IF）患者肠道解剖结构异常，分泌，和运动障碍，这会损害肠道稳态机制，并可能导致小肠细菌过度生长（SIBO）。我们进行了系统评价和荟萃分析，以确定IF患者中SIBO的患病率，并确定SIBO的危险因素。
方法：MEDLINE（PubMed）和Embase电子数据库从开始到2023年12月进行了搜索，以获得报告在IF中SIBO患病率的研究。患病率，比值比(OR)，使用随机效应模型计算IF中SIBO的95%置信区间和IF中SIBO的危险因素。
结果：最终数据集包括9项报告407例IF患者的研究。SIBO在IF中的患病率为57.5%（95%CI44.6-69.4），在本分析中具有实质性异质性(I2=80.9，P=0.0001)。接受肠外营养（PN）的IF患者的SIBO患病率比未接受PN的IF患者高6倍（OR=6.0，95％CI3.0-11.9，P=0.0001）。总的来说,使用PPI/酸抑制剂的IF患者中SIBO的患病率（72.0%，与不使用这些药物的IF患者相比，95%CI57.5-83.8)在数值上较高(47.6%，95%CI25.7-70.2）。
结论：本系统综述和荟萃分析提示，在IF和PN患者中，SIBO的风险增加，潜在的,PPI/抑酸剂的使用是IF患者发生SIBO的危险因素.然而,证据质量较低,可归因于缺乏病例对照研究和研究中的临床异质性.
方法：MEDLINE（PubMed）和Embase电子数据库从开始到2023年12月进行了搜索，以获得报告在IF中SIBO患病率的研究。患病率，比值比(OR)，使用随机效应模型计算IF中SIBO的95%置信区间和IF中SIBO的危险因素。
结果：最终数据集包括9项报告407例IF患者的研究。SIBO在IF中的患病率为57.5%（95%CI44.6-69.4），在本分析中具有实质性异质性(I2=80.9，P=0.0001)。接受肠外营养（PN）的IF患者的SIBO患病率比未接受PN的IF患者高6倍（OR=6.0，95％CI3.0-11.9，P=0.0001）。总的来说,使用PPI/酸抑制剂的IF患者中SIBO的患病率（72.0%，与不使用这些药物的IF患者相比，95%CI57.5-83.8)在数值上较高(47.6%，95%CI25.7-70.2）。
结论：本系统综述和荟萃分析提示，在IF和PN患者中，SIBO的风险增加，潜在的,PPI/抑酸剂的使用是IF患者发生SIBO的危险因素.然而,证据质量较低,可归因于缺乏病例对照研究和研究中的临床异质性.
