Search Results (81)

Background: Surgical procedures and alterations of the gastrointestinal (GI) tract increase the risk of small intestinal bacterial overgrowth (SIBO), which is associated with GI symptoms and complications that compromise postoperative recovery. However, the prevalence and clinical impact of SIBO after various upper GI surgical procedures remain poorly understood. Objective: This study aimed to evaluate the prevalence of SIBO after different types of upper GI surgery and to investigate the associated clinical factors. Methods: We conducted an observational study involving 157 patients with a history of upper GI surgery: Roux-en-Y gastric bypass (RYGB), laparoscopic single-anastomosis gastric bypass (OAGB), subtotal (STG) or total gastrectomy (TG), subtotal (SP)or total pancreatectomy (TP), cephalic duodenopancreatectomy (WR), and small bowel resection for Crohn’s disease. A glucose–hydrogen breath test was performed, and demographic, clinical, and treatment-related data were collected. Statistical analyses included t-tests, non-parametric tests, ANOVA, and correlation analyses using R software. Results: At a median follow-up of 25.7 ± 18.1 months, 31% (48/157) of patients tested positive for SIBO. The highest prevalence was observed after RYGB and OAGB (43%), followed by TG (30%), STG (29%), TP/WR (28%), and Crohn’s disease bowel resection (19%). No cases of SIBO were observed after SP. SIBO positivity was significantly associated with bloating and flatulence (p = 0.002), lactose intolerance (p = 0.047), systemic sclerosis (p = 0.042), T2D (p = 0.002), and exposure to adjuvant chemotherapy (p = 0.001) and radiotherapy (p = 0.027). In addition, the risk of SIBO increased proportionally with the duration of GI resection or exclusion (p = 0.013). Conclusions: In our study, the prevalence of SIBO after upper GI surgery was 31%, with the highest incidence (43%) observed in metabolic surgery patients. Importantly, adjuvant radio/chemotherapy was associated with an increased risk of SIBO, and extensive small bowel resection or exclusion was strongly associated with an increased risk of SIBO. Furthermore, the limitations of current diagnostic methods, which lack sufficient sensitivity and specificity, highlight the importance of early screening and standardization of diagnostic techniques to improve patient management and outcomes. Full article

The gastrointestinal (GI) tract is seriously affected by systemic sclerosis (SSc), due to fibrosis and persistent inflammation. Patients with GI involvement frequently exhibit poor nutritional status, which affects disease burden and quality of life. The aim of the present review was to discuss all nutritional issues in SSc and serve as a primer for the nutritional assessment of patients with scleroderma. Patients with SSc suffer from GI impairments that affect the oral cavity, esophagus, stomach, and small and large intestines. Symptomatology includes microstomia, xerostomia, dysphagia, reflux, esophageal dysmotility, small intestinal bacterial overgrowth (SIBO), and fecal incontinence, among others, which may contribute to inadequate food intake. As a result, patients often suffer from malnutrition, sarcopenia, and frailty, while presenting with micronutrient deficiencies that impact disease outcomes and worsen their condition. This aggravated nutritional status is related to greater disease severity, organ involvement, reduced physical function, and increased length of hospitalization and mortality. GI involvement is well-documented within the SSc population, yet routine nutritional assessments are lacking in the hospital setting. Currently, there is a lack of specific recommendations from scientific societies regarding the nutritional care of patients with SSc. Given the high risk of nutritional impairments in this population, systematic assessments should be undertaken, and novel tools tailored to their unique needs should be developed and implemented. Full article

Background/Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) effectively manage type 2 diabetes mellitus (T2DM) but may impair gastrointestinal motility, increasing the risk of small intestinal bacterial overgrowth (SIBO). Diagnostic evaluation of SIBO commonly involves breath testing and clinical assessment. This study aimed to assess the association between GLP-1 RAs or dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) RAs are associated with incident SIBO. Methods: We conducted a retrospective cohort study using the TriNetX global database, identifying adult T2DM patients initiating GLP-1 RA or dual GLP-1/GIP RA therapy versus other second-line T2DM agents (OSLT2DM) from 1 January 2006 to 2 December 2024. Patients with major abdominal surgery, connective tissue disorders, gastroparesis, or other high-risk conditions for SIBO were excluded. 1:1 Propensity score matching was applied. Short-term (<1 year) and long-term (up to 5 years) risks were evaluated with Kaplan–Meier curves and univariable Cox models. Results: After matching, 216,173 patients per cohort were analyzed. Short-term analysis demonstrated a higher incidence of diagnostically confirmed SIBO in patients treated with GLP-1 RA/GIP (0.177 per 1000 patient-years) compared to OSLT2DM (0.083 per 1000 patient-years; HR 2.14, 95% CI 1.13–4.07; p = 0.0491). Long-term analysis indicated a non-significant trend toward increased risk in the GLP-1 RA/GIP group (HR 2.02, 95% CI 0.98–4.12), though Kaplan–Meier analysis revealed a sustained divergence (p = 0.017). Conclusions: GLP-1 RA and dual GLP-1/GIP RA therapy are associated with increased short-term SIBO risk. Symptom-driven SIBO breath-test evaluation may be warranted in patients initiating these agents. Full article

The human gastrointestinal tract hosts a complex ecosystem known as the gut microbiota, which plays a crucial part in digestion and immune system function. Among the clinically recognized manifestations of dysbiosis in this system are Small Intestinal Bacterial Overgrowth (SIBO), Intestinal Methanogen Overgrowth (IMO), Small Intestinal Fungal Overgrowth (SIFO), and Large Intestinal Bacterial Overgrowth (LIBO). This study aims to investigate the complex pathophysiological mechanisms underlying these syndromes and their diagnostics and therapeutic options, focusing primarily on the roles of methane-producing archaea and fungal overgrowth. The methods employed in this study involve a comprehensive analysis and synthesis of peer-reviewed articles, systematic reviews, clinical trials, and meta-analyses. This review summarizes that methane production by Methanobrevibacter smithii was linked to altered fermentation, reduced microbial diversity, and slowed intestinal transit. Fungal species were associated with increased intestinal permeability, inflammation, and biofilm formation. Targeted interventions addressing microbial imbalances demonstrated potential therapeutic value. This review highlights the complex and multifactorial nature of gut dysbiosis, revealing its impact beyond the gastrointestinal tract. While emerging therapies targeting methanogens, fungi, and biofilms show promise, further research is essential to optimize their clinical application. The findings emphasize the need for interdisciplinary collaboration to refine diagnostic and therapeutic strategies. Full article

Background/Objectives: Coronavirus disease 2019 (COVID-19) is associated with gastrointestinal (GI) symptoms. Small intestinal bacterial overgrowth (SIBO) is emerging as a significant GI sequela post-COVID-19 infection. This study aimed to evaluate the prevalence and incidence of SIBO post-COVID-19 infection across different age groups and to identify associated risk factors in a global cohort. Methods: A retrospective study utilized the TriNetX database and included adult patients (≥18 years) diagnosed with SIBO following COVID-19 infection (1 January 2022–30 May 2024). A propensity score matching (1:1) was used to adjust for demographics and SIBO risk factors. Kaplan–Meier survival analysis assessed the SIBO incidence within 12 months. Results: Among 1,660,092 COVID-19 patients and 42,322,017 controls, SIBO was diagnosed in 353 COVID-19 patients without hydrogen breath tests (BT) and 78 with BT, compared to 3368 controls without BT and 871 with BT. Age-specific analysis demonstrated a clear, progressive increase in the SIBO incidence, becoming distinctly significant by 6 months and highest at 12 months post-infection. The highest risks were noted in ages 60–69 (0.011% vs. 0.004%, OR 2.6, p = 0.0003) and 70–79 (0.011% vs. 0.005%, OR 2.0, p = 0.0004), with younger age groups (30–49 years) also showing significantly increased risks. The medication analysis revealed strong associations with chronic opioid, proton pump inhibitor, and antidiarrheal medication. Conclusions: COVID-19 significantly increased the risk of SIBO, particularly within the first 12 months post-infection, across various age groups and, notably, in association with certain chronic medications. Clinical vigilance and targeted management strategies are recommended to mitigate long-term GI consequences. Full article

Background/Objectives: Small intestinal bacterial overgrowth (SIBO) is frequently observed in patients treated with proton pump inhibitors (PPIs), yet the role of treatment duration in modulating SIBO risk remains unclear. This meta-analysis aims to evaluate the temporal association between PPI use duration and SIBO risk. Methods: Following the PRISMA 2020 guidelines, a systematic search was conducted across MEDLINE/PubMed, EMBASE, the Cochrane Library, the Russian Science Citation Index, and Google Scholar from 1985 to June 2025 and was previously registered in PROSPERO under the registration number CRD420251031719. Eligible studies included observational designs or clinical trials assessing SIBO in adult PPI users. Results: Twenty-nine studies (n = 3682 PPI patients; n = 2907 controls) were included. The pooled SIBO prevalence among PPI-treated patients was 36.839% (95% CI: 29.703–44.277), significantly higher than that among controls (19.887%; 95% CI: 12.027–29.399). PPI use was associated with increased SIBO risk (OR = 2.143; 95% CI: 1.446–3.175), with high heterogeneity (I² = 77.61%). A duration-dependent trend was observed: our meta-regression analysis demonstrated a significant positive association between PPI treatment duration and SIBO prevalence with the regression coefficient 4.265% (95% CI: 1.827–6.384; p = 0.0024), indicating that each additional month of PPI therapy was associated with a 4.265 percentage increase in SIBO risk. Conclusions: PPI use significantly increases the risk of SIBO, with longer treatment durations associated with higher odds. Full article

Various enteropathies, including immune-mediated (IME) and infection-related conditions, can lead to small intestinal mucosal injury and malabsorption. While immune dysregulation plays a central role in diseases like celiac disease and autoimmune enteropathy, other conditions such as small intestinal bacterial overgrowth (SIBO) and tropical sprue (TS) involve infectious or microbial pathogenesis. Common clinical manifestations include weight loss, chronic diarrhea, and nutritional deficiencies. While celiac disease (CD) remains the most prevalent IME in adults, an expanding spectrum of non-celiac enteropathies has been recognized, including autoimmune enteropathy (AIE), common variable immunodeficiency disease (CVID), olmesartan-induced enteropathy, tropical sprue, and small intestinal bacterial overgrowth. These conditions often present with overlapping clinical, serological, and histological features, complicating their differentiation from CD. Accurate diagnosis is critical for the timely initiation of effective treatment to prevent disease progression and associated complications such as severe malabsorption and enteropathy-associated T-cell lymphoma (EATL). The small intestine plays a dual role in nutrient absorption and immune regulation, making it uniquely vulnerable to immune dysregulation. In IMEs, hyperactive immune responses disrupt intestinal homeostasis, leading to mucosal damage and impaired nutrient absorption. Although CD is the prototypical IME, increasing the recognition of non-celiac IMEs, it highlights the need for a more nuanced approach to small bowel biopsy interpretation. This review explores the histopathological and clinical features of common IMEs, with a focus on distinguishing non-celiac disorders that mimic CD. By enhancing the understanding of these conditions, this review aims to improve diagnostic accuracy, facilitate appropriate therapeutic interventions, and mitigate complications associated with delayed or misdiagnosis. A multidisciplinary approach involving gastroenterologists and pathologists is emphasized to optimize outcomes for patients with IMEs. Immune-mediated enteropathies result from an abnormal immune response of the small intestinal mucosa to non-pathogenic molecules, often leading to malabsorption syndrome. The most common symptoms include weight loss, chronic diarrhea, and nutritional deficiencies. While celiac disease (CD) is the most well-known immune-mediated enteropathy (IME) in adults, other related disorders have been identified in recent years. These conditions share many clinical and histopathological features, therefore making differentiations between them challenging. This study aims to review the most common immune-mediated enteropathies, with a focus on non-celiac disorders that should be considered in the differential diagnosis of celiac disease in small bowel biopsies. Full article

Background: The medical management and non-transplant surgical options for children with short bowel syndrome (SBS)are maximized as first-line treatments. The purpose of this review is to summarize the currently available evidence and new management strategies in children with SBS. Methods: A systematic review of the literature was conducted on data from the last four years, focusing on both the effectiveness and safety of intestinal lengthening procedures, as well as frameworks for the prevention of complications and the achievement of enteral autonomy. Results: Of 546 abstracts that were screened, a total of 27 relevant full-text articles published between 2021 and 2025 were reviewed. The literature that was review showed that, over the past four years, the most commonly used lengthening procedure was serial transverse enteroplasty (STEP), which resulted in a 50–70% increase in bowel length, a decrease in PN dependency in most cases, and weaning off PN in 42–73% of patients. The longitudinal intestinal lengthening technique (LILT) has been used less frequently, allowing a similar 70% increase in small bowel length and 32–52% of patients to wean off PN, but with a higher mortality rate. The main reasons for surgery in patients with SBS patients were the inability to wean off PN, intestinal dysmotility, and bacterial overgrowth. Over the last decade, several new techniques—such as induced intestinal lengthening, distraction enterogenesis, ileal lengthening through internal distraction, and double-barrel enteroplasty—have been described as options for the treatment of a limited bowel length and less invasive modalities. Conclusions: Autologous gastrointestinal reconstructive surgery, as a part of multidisciplinary management, remains vital for managing children with SBS. Full article

Background/Objectives: Childhood obesity is a growing global concern linked to metabolic disorders such as nonalcoholic fatty liver disease (NAFLD). Small intestinal bacterial overgrowth (SIBO) may exacerbate these conditions by promoting systemic inflammation and metabolic dysfunction. This review evaluates the prevalence of SIBO in obese children, its association with inflammatory and metabolic markers, and the efficacy of diagnostic and therapeutic strategies. Methods: A systematic search of PubMed, Scopus, and Web of Science (2010–present) was conducted using Boolean operators: (‘small intestinal bacterial overgrowth’ OR ‘SIBO’) AND ‘prevalence’ AND (‘low-grade inflammatory markers’ OR ‘metabolic status’) AND ‘gut microbiome’ AND ‘dysbiosis’ AND ‘obese children’. Results: The data show that SIBO is frequently observed in obese pediatric populations and is associated with gut dysbiosis, impaired nutrient absorption, and reduced production of short-chain fatty acids. These changes contribute to increased intestinal permeability, endotoxemia, and chronic low-grade inflammation. Several microbial taxa have been proposed as biomarkers and therapeutic targets. Diagnostic inconsistencies persist, but treatments such as probiotics, prebiotics, dietary interventions, and selective antibiotics show potential, pending further validation. Conclusions: Early identification and treatment of SIBO with tailored strategies may help reduce metabolic complications and improve outcomes in children with obesity. Full article

Short bowel syndrome (SBS) is a malabsorptive condition resulting from reduced functional small intestinal length. SBS is closely related to intestinal failure (IF), defined as the reduction of functional intestinal mass below that which can sustain life, resulting in parenteral nutrition (PN) support for 60 days or greater within a consecutive 74-day period. IF frequently results from intestinal resection necessitated by such diseases as necrotizing enterocolitis in children and Crohn’s disease in adults. Clinical manifestations of IF may include diarrhea, growth failure, bacterial overgrowth, and vitamin deficiencies. Nutritional rehabilitation is the cornerstone of IF management. Surgical interventions are aimed at preserving intestinal length and restoring continuity. Medical management involves individualized enteral and parenteral nutrition therapy, GLP-2 agonists (e.g., teduglutide) that promote mucosal growth, and drugs for symptom management such as antidiarrheals. Experimental therapies such as the use of devices to induce intestinal growth through distraction enterogenesis are under development for the treatment of IF. An interdisciplinary approach involving surgeons, gastroenterologists, dietitians, nurses, and social workers is crucial in the management of these complex patients. Ultimately, a combination of nutritional, medical, and surgical management may be necessary to improve clinical outcomes in patients with IF. Full article

Small intestinal bacterial overgrowth (SIBO) is a functional digestive disorder whose incidence has been acknowledged by several medical associations, such as the American Gastroenterological Association. It is estimated that between 14% and 40% of patients diagnosed with irritable bowel syndrome also have SIBO, highlighting the importance of accurate diagnosis to enable effective treatment plans. Nutrition and diet therapy play a pivotal role in SIBO management, not only in alleviating symptoms but also in preventing relapses. The objective of this review is to gather updated information on dietary management for SIBO to define the role of the dietitian and determine the most suitable nutritional therapy based on scientific evidence. The review will encompass various strategies, ranging from specific diets to dietary supplements, as well as the potential contribution of dietary treatment to improving SIBO. Full article

Background/Objectives: Small Intestinal Bacterial Overgrowth (SIBO) and Small Intestinal Fungal Overgrowth (SIFO) are distinct yet often overlapping conditions characterized by an abnormal increase in microbial populations within the small intestine. SIBO results from an overgrowth of colonic bacteria, while SIFO is driven by fungal overgrowth, primarily involving Candida species. Both conditions present with nonspecific gastrointestinal (GI) symptoms such as bloating, abdominal pain, diarrhea, and malabsorption, making differentiation between SIBO and SIFO challenging. This review aims to elucidate the underlying mechanisms, risk factors, diagnostic challenges, and management strategies associated with SIBO and SIFO. Methods: A comprehensive review of current literature was conducted, focusing on the pathophysiology, diagnostic modalities, and therapeutic approaches for SIBO and SIFO. Results: SIBO is commonly associated with factors such as reduced gastric acid secretion, impaired gut motility, and structural abnormalities like bowel obstruction and diverticula. It is frequently diagnosed using jejunal aspirates (≥10⁵ colony forming units (CFUs)/mL) or breath tests. In contrast, SIFO is linked to prolonged antibiotic use, immunosuppression, and gut microbiome dysbiosis, with diagnosis relying on fungal cultures from small intestinal aspirates due to the absence of standardized protocols. Conclusion: The clinical overlap and frequent misdiagnosis of SIBO and SIFO highlight the need for improved diagnostic tools and a multidisciplinary approach to management. This review emphasizes the importance of understanding the mechanisms behind SIBO and SIFO, how they relate to other health outcomes, and potential management strategies to optimize patient care and therapeutic outcomes. Full article

Background: Small intestinal bacterial overgrowth (SIBO) is a dysbiosis marked by an excessive proliferation of bacteria in the small intestine, resulting in abdominal symptoms that significantly affect patients’ quality of life. Objectives: This study aims to evaluate the impact of a comprehensive therapeutic approach in improving the quality of life of patients with SIBO. Methods: For this purpose, standardized questionnaires were used at baseline, 30 days and 90 days, including the IBS-QOL (Irritable Bowel Syndrome Quality of Life Questionnaire), the GSRS (Gastrointestinal Symptom Rating Scale), the EuroQOL-5D, and the Bristol Scale. Results: The results show that a comprehensive approach, combining pharmacological treatment, appropriate dietary intervention, and strategies aimed at improving gut microbiota and intestinal permeability, produces a sustained improvement in the quality of life of a significant proportion of patients who participated in the study. Furthermore, the results suggest that, although gas normalization is a relevant indicator, clinical improvement and quality of life depend considerably on patients’ subjective perception of their health. Conclusions: This finding underscores the importance of recognizing SIBO as a prevalent condition that requires accurate diagnoses and individualized treatments to improve patients’ well-being. Full article

Rosacea is a common inflammatory skin disease, characterized by erythema, papules and pustules. The pathophysiology of rosacea remains unclear, but the complex interplay between environmental and genetic factors may act as a trigger to an abnormal innate immune response associated with a multifaceted neurovascular reaction. Increasing evidence suggests that the gut microbiota is significantly involved in the pathogenesis of rosacea, playing an important role in the inflammatory cutaneous response. Dysbiosis, small intestinal bacterial overgrowth, Helicobacter pylori infection and innate immune system dysregulation mutually contribute to the pathophysiology of rosacea, but more extensive future research is needed to better clarify their precise mechanisms of action. Many dietary triggers have been postulated for this disease; however, there is a lack of well-made and controlled studies able to undoubtedly demonstrate a causal relationship between rosacea and diet. We analyzed the available studies on the role of diet and gut microbiome in rosacea and the positive clinical effects reported by the current literature on probiotics, prebiotics, postbiotics and nutrients. Ultimately, this article improves our understanding of the gut–skin axis in rosacea, focusing on how probiotic supplementation and diet could improve the clinical management of patients affected by this common and debilitating disease. Full article

Background: Children with short bowel syndrome (SBS) have abnormal intestinal anatomy, secretion, or motility, which can lead to small intestinal bacterial overgrowth (SIBO). In this paper, we describe our experience with SIBO in children with SBS, focusing on potential risk factors, clinical presentation, and antibiotic treatment. Methods: A single-center retrospective descriptive cohort study of all episodes of clinically suspected SIBO in 16 children with SBS on home parenteral nutrition (HPN) between January 2018 and December 2022 was performed. Results: The mean small bowel remnant was 47 cm (SD = 31.5), with an absent ileocecal valve in 61.5% (8/13). Five children (31.2%) had at least 1 episode of clinically suspected SIBO, with a total of 25 episodes. The most common clinical presentation was diarrhea (76%), followed by meteorism (56%), loss of appetite (48%), flatulence (48%), weight loss (36%), abdominal pain (25%), and vomiting (12%). Fifty-six percent (16/25) of SIBO episodes were treated with one type of antibiotic, 36% (9/25) with two types, and 8% (2/25) with three types. Symptom resolution was achieved in 56% (14/25) of SIBO episodes after one course of antibiotic therapy. Two children (12.5%) had refractory and recurrent SIBO episodes treated with cyclic antibiotic regimens. Conclusions: SIBO can affect the ability of children with SBS to successfully wean off HPN. Diagnostic tests have innate challenges, and early clinical suspicion is paramount. Antibiotic therapy should be individualized considering the child’s age, gastrointestinal anatomy, and the risk of SIBO recurrence. Full article