目的:小肠细菌过度生长(SIBO)和乳糜泻(CeD)的症状经常重叠,研究表明SIBO和CeD之间存在联系。因此,我们进行了系统评价和荟萃分析,以比较CeD患者和对照组的SIBO患病率,并评估抗微生物治疗对SIBO阳性CeD患者胃肠道症状的影响。
方法:搜索电子数据库,直至2022年2月,研究报告CeD中SIBO患病率。患病率,比值比(OR),计算CeD和对照中SIBO的95%置信区间(CI)。
结果:我们纳入了14项研究,742名CeD患者和178名对照。CED中SIBO的合并患病率为18.3%(95%CI:11.4-28.1),具有很大的异质性。包括健康对照的病例对照研究,CeD患者的SIBO患病率显著升高(OR5.1,95%CI:2.1-12.4,P=0.0001),具有最小的异质性。利用呼气测试,CeD患者的SIBO患病率为20.8%(95%CI:11.9-33.7),与基于培养的方法相比,几乎高出两倍,为12.6%(95%CI:5.1-28.0),在两个分析中都有很大的异质性。对无麸质饮食(GFD)无反应的CeD患者的SIBO患病率与对GFD有反应的患者相比没有统计学上的升高(OR1.5,95%CI:0.4-5.0,P=0.511)。SIBO阳性CeD患者的抗生素治疗导致95.6%(95%CI:78.0-99.9)的胃肠道症状改善和呼气试验正常化。
结论:这项研究表明SIBO和CeD之间存在联系。虽然SIBO可以解释CeD对GFD的无反应,在对GFD无反应的CeD患者中,SIBO患病率在统计学上并不高。证据总体质量较低,主要是由于实质性的“临床异质性”和可用诊断测试的有限敏感性/特异性。
OBJECTIVE: Symptoms of small intestinal bacterial overgrowth (SIBO) and celiac disease (CeD) often overlap, and studies suggest a link between SIBO and CeD. We thus conducted a systematic review and meta-analysis to compare SIBO prevalence in CeD patients and controls and assessed effects of antimicrobial therapy on gastrointestinal symptoms in SIBO positive CeD patients.
METHODS: Electronic databases were searched until February 2022 for studies reporting SIBO prevalence in CeD. Prevalence rates, odds ratio (OR), and 95% confidence intervals (CI) of SIBO in CeD and controls were calculated.
RESULTS: We included 14 studies, with 742 CeD patients and 178 controls. The pooled prevalence of SIBO in CeD was 18.3% (95% CI: 11.4-28.1), with substantial heterogeneity. Including case-control studies with healthy controls, SIBO prevalence in CeD patients was significantly increased (OR 5.1, 95% CI: 2.1-12.4, P = 0.0001), with minimal heterogeneity. Utilizing breath tests, SIBO prevalence in CeD patients was 20.8% (95% CI: 11.9-33.7), almost two-fold higher compared with culture-based methods at 12.6% (95% CI: 5.1-28.0), with substantial heterogeneity in both analyses. SIBO prevalence in CeD patients nonresponsive to a gluten free diet (GFD) was not statistically higher as compared with those responsive to GFD (OR 1.5, 95% CI: 0.4-5.0, P = 0.511). Antibiotic therapy of SIBO positive CeD patients resulted in improvement in gastrointestinal symptoms in 95.6% (95% CI: 78.0-99.9) and normalization of breath tests.
CONCLUSIONS: This study suggests a link between SIBO and CeD. While SIBO could explain nonresponse to a GFD in CeD, SIBO prevalence is not statistically higher in CeD patients non-responsive to GFD. The overall quality of the evidence is low, mainly due to substantial \"clinical heterogeneity\" and the limited sensitivity/specificity of the available diagnostic tests.