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Meta-Analysis
. 2024 Jan 30;30(1):7-16.
doi: 10.5056/jnm22187.

Symptomatic Response to Antibiotics in Patients With Small Intestinal Bacterial Overgrowth: A Systematic Review and Meta-analysis

Will Takakura  1   2 , Ali Rezaie  2   3 , William D Chey  1 , Jiajing Wang  2 , Mark Pimentel  2   3
Affiliations
Meta-Analysis

Symptomatic Response to Antibiotics in Patients With Small Intestinal Bacterial Overgrowth: A Systematic Review and Meta-analysis

Will Takakura et al. J Neurogastroenterol Motil. .

Abstract

Background/aims: We performed a systematic review and meta-analysis evaluating the symptomatic response rate to antibiotics in patients with small intestinal bacterial overgrowth (SIBO). Similarly, we performed a meta-analysis on the symptomatic response to antibiotics in irritable bowel syndrome (IBS) patients with and without SIBO.

Methods: MEDLINE, EMBASE, Web of Science, and Cochrane databases were searched from inception to March 2021. Randomized controlled trials and prospective studies reporting dichotomous outcomes were included.

Results: There were 6 studies included in the first meta-analysis comparing the efficacy of antibiotics to placebo or no antibiotic. This included 196 patients, of whom 101 received antibiotics and 95 received placebo or no antibiotics. Significantly more patients improved with antibiotics (relative risk [95% CI] = 2.46 [1.33-4.55], P = 0.004). There were 4 studies included in the analysis comparing symptomatic response rates in IBS patients with or without SIBO with 266 IBS patients, of whom 172 had SIBO and 94 did not. The pooled response rate for symptomatic response was 51.2% in the SIBO group vs 23.4% in the no SIBO group, respectively. Significantly more IBS patients with SIBO responded to antibiotics compared to those without SIBO (relative risk [95% CI] = 2.07 [1.40-3.08], P = 0.0003).

Conclusions: Antibiotics appear to be efficacious in treating SIBO, although small sample sizes and poor data quality limit this interpretation. Symptomatic response rates also appear to be higher in IBS patients with SIBO. This may be the first example of precision medicine in IBS as opposed to our current empiric treatment approach. Large-multicenter studies are needed to verify the results.

Keywords: Breath tests; Intestine, small; Irritable bowel syndrome; Meta-analysis; Symptom assessment.

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Conflict of interest statement

Conflicts of interest: Will Takakura and Jiajing Wang reports no conflict of interest. Mark Pimentel is a consultant for Bausch Health, Ferring Pharmaceuticals Inc, Salvo, Ardelyx, 9 meters, and Vivante Health Inc. Mark Pimentel has received grant support from Bausch Health and Synthetic Biologics. Ali Rezaie is a consultant/speaker for and has received grant support from Bausch Health. In addition, Cedars-Sinai Medical Center has licensing agreements Hobbs Medical, Aytu Biosciences and Gemelli Biotech. Ali Rezaie and Mark Pimentel have equity in Gemelli Biotech, and Mark Pimentel has equity in 9 meters and Synthetic Biologics. William D Chey reported being a Board member of the American College of Gastroenterology, International Foundation of Functional GI Disorders, and the Rome Foundation; compensation as a consultant from AbbVie, Alnylam, Atmo, Bayer, BioAmerica, Ironwood Pharmaceuticals, QOL Medical, Nestle, Phathom Pharmaceuticals, RedHill Biopharma, Salix/Valeant, Takeda, and Vibrant; grant/research support from BioAmerica, Commonwealth Diagnostics International, QOL Medical, Salix; stock/stock options in Isothrive, Kiwi Bioscience, GI on Demand, and Modify Health; and patents relating to methods and kits for identifying food sensitivities and intolerances, digital manometry, and a rectal expulsion device.

Figures

Figure 1
Figure 1
Schematic for study inclusion. SIBO, small intestinal bacterial overgrowth.
Figure 2
Figure 2
Forrest plot of studies comparing the efficacy of antibiotics in small intestinal bacterial overgrowth (SIBO). The pooled response rate was 49.5% vs 13.7% for those treated with antibiotics vs no antibiotics, respectively. Relative risk (95% CI) of improvement was 2.46 (1.33-4.55), P = 0.004. Heterogeneity was Q = 6.37, P = 0.270.
Figure 3
Figure 3
Forrest plot of studies comparing the efficacy of antibiotics in irritable bowel syndrome (IBS) patients with or without small intestinal bacterial overgrowth (SIBO). The pooled response rate was 51.2% vs 23.4% in the SIBO and no SIBO group, respectively. Relative risk (95% CI) for improvement was 2.07 (1.40-3.08), P = 0.0003. Heterogeneity was I = 0.01%, P = 0.300.
See this image and copyright information in PMC

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