Table 2.
Summary of findings.
| Mode of diagnosis of SIBO in CLD | No of studies | CLD patients, n | Controls, n | SIBO in CLD patients, n | SIBO in Controls, n | Pooled prevalence rates of SIBO in CLD patients, % (95% CI) | Pooled prevalence rates of SIBO in controls, % (95% CI) | Pooled prevalence of SIBO in CLD, OR (95% CI) | Assessment of heterogeneity between studies |
|---|---|---|---|---|---|---|---|---|---|
| ALL tests (including all studies) | 34 | 2130 | 1222 | 807 | 173 | 37.9 (35.8–40.0) | 14.2 (12.2–16.2) | 6.7 (4.6–9.7, p < 0.001) | I2 = 48.1%, p < 0.001 |
| BREATH TESTS only | 27 | 1923 | 1042 | 749 | 170 | 38.9 (36.7–41.1) | 16.3 (14.1–18.7) | 5.6 (4.0–7.6, p < 0.001) | I2 = 52.5%, p < 0.001 |
| LBT | 13 | 747 | 400 | 338 | 58 | 45.2 (41.6–48.9) | 14.5 (11.2–18.3) | 5.2 (3.6–7.3, p < 0.001) | I2 = 0%, p = 0.759 |
| GBT | 14 | 1176 | 642 | 411 | 112 | 34.9 (32.2–37.7) | 17.4 (14.5–20.6) | 7.7 (3.7–16.0, p < 0.001) | I2 = 71.3%, p < 0.001 |
| CULTURE cut off 105 cfu/ml | 8 | 221 | 163 | 82 | 6 | 37.1 (30.7–43.8) | 3.6 (1.3–7.8) | 9.6 (4.3–21.9, p < 0.001) | I2 = 0%, p = 0.630 |
| CULTURE cut off 103 cfu/ml | 2 | 62 | 25 | 41 | 11 | 66.1 (52.9–77.6) | 44.0 (24.2–65.0) | 9.9 (1.7–57.8, p = 0.010) | I2 = 0%, p = 0.650 |
| ALL tests (including only healthy asymptomatic controls) | 28 | 1774 | 819 | 644 | 59 | 36.3 (34.1–38.5) | 7.2 (5.5–9.1) | 7.8 (5.7–10.7, p < 0.001) | I2 = 0%, p = 0.831 |
| All tests (including only High-quality studies) | 23 | 1425 | 701 | 524 | 46 | 36.7 (34.2–39.3) | 6.5 (4.8–8.6) | 7.9 (5.6–11.2, p < 0.001) | I2 = 0%, p = 0.633 |
| SIBO in CLD with | |||||||||
| Cirrhosis | 19 | 1120 | NA | 455 | NA | 42.9 (35.9–50.2) | NA | NA | I2 = 79.1%, p < 0.001 |
| Compensated cirrhosis | 10 | 242 | NA | 70 | NA | 29.6 (18.8–43.3) | NA | NA | I2 = 71.4%, p < 0.001 |
| Decompensated cirrhosis | 10 | 437 | NA | 217 | NA | 53.5 (41.6–65.1) | NA | NA | I2 = 80.0%, p < 0.001 |
| Without cirrhosis | 18 | 1010 | NA | 361 | NA | 36.9 (27.4–47.6) | NA | NA | I2 = 88.4%, p < 0.001 |
| Portal hypertension | 8 | 219 | NA | 98 | NA | 50.0 (34.5–65.3) | NA | NA | I2 = 75.1%, p < 0.001 |
| Ascites | 9 | 282 | NA | 129 | NA | 53.7 (38.7–68.0) | NA | NA | I2 = 77.7%, p < 0.001 |
| Spontaneous bacterial peritonitis | 5 | 60 | NA | 34 | NA | 57.7 (38.8–74.5) | NA | NA | I2 = 32.1%, p = 0.207 |
| Hepatic encephalopathy | 4 | 84 | NA | 29 | NA | 41.0 (15.7–72.3) | NA | NA | I2 = 75.6%, p = 0.017 |
| Variceal bleeding | 2 | 84 | NA | 27 | NA | 39.5 (12.1–75.6) | NA | NA | I2 = 88.3%, p = 0.003 |
| MASLD | 14 | 882 | NA | 335 | NA | 43.0 (31.1–55.7) | NA | NA | I2 = 89.1%, p < 0.001 |
| MASH | 9 | 149 | NA | 58 | NA | 41.3 (26.4–58.0) | NA | NA | I2 = 66.5%, p = 0.002 |
| HBV hepatitis | 5 | 267 | NA | 113 | NA | 42.1 (34.1–50.5) | NA | NA | I2 = 31.2%, p = 0.213 |
| HCV hepatitis | 4 | 56 | NA | 23 | NA | 35.3 (10.0–73.0) | NA | NA | I2 = 71.6%, p = 0.014 |
| Alcoholic liver disease | 9 | 253 | NA | 86 | NA | 37.3 (25.7–50.5) | NA | NA | I2 = 66.4%, p = 0.002 |
| Autoimmune liver disease | 4 | 106 | NA | 27 | NA | 29.6 (21.1–39.7) | NA | NA | I2 = 41.0%, p = 0.165 |
| Cryptogenic liver disease | 5 | 83 | NA | 24 | NA | 33.3 (18.7–51.8) | NA | NA | I2 = 42.6%, p = 0.137 |
| SIBO in CLD patients on PPI vs not on PPI | 4 | NA | NA | NA | NA | NA | NA | 2.0 (0.5–7.9), p = 0.323 | I2 = 36.9%, p = 0.191 |
CLD, chronic liver disease; SIBO, small intestinal bacterial overgrowth; PPI, proton pump inhibitor; MASLD, Metabolic dysfunction-associated steatotic liver disease; MASH, Metabolic dysfunction-associated steatohepatitis; NA, not applicable; n, number; OR, odds ratio; CI, confidence interval; GBT, glucose breath test; LBT, lactulose breath test; cfu/ml, colony forming units per millilitre.