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Meta-Analysis
. 2022 Oct 18:2022:2469513.
doi: 10.1155/2022/2469513. eCollection 2022.

Hepatic Encephalopathy in Cirrhotic Patients and Risk of Small Intestinal Bacterial Overgrowth: A Systematic Review and Meta-Analysis

Xin Feng  1 , Xiaoqing Li  2 , Xin Zhang  1 , Weiqing Chen  3 , Yin Tian  1 , Qingqing Yang  1 , Yingying Yang  1 , Hui Pan  1 , Zheng Jiang  2
Affiliations
Meta-Analysis

Hepatic Encephalopathy in Cirrhotic Patients and Risk of Small Intestinal Bacterial Overgrowth: A Systematic Review and Meta-Analysis

Xin Feng et al. Biomed Res Int. .

Abstract

Background: 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.

Methods: 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.

Results: 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, P = 0.002). The heterogeneity was moderate (I 2 = 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.

Conclusions: 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.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the selection process of the articles.
Figure 2
Figure 2
Forest plot of the odds ratios of SIBO in HE patients compared with controls.
Figure 3
Figure 3
Funnel plot showing the odds ratios of publication bias in SIBO papers.
Figure 4
Figure 4
Forest plot of the odds ratios of SIBO based on the SIBO diagnostic test.
Figure 5
Figure 5
Forest plot of the odds ratios of SIBO in patients with Child-Pugh class A compared with patients with Child-Pugh classes B and C.
See this image and copyright information in PMC

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