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Area of Science:

  • Gastroenterology
  • Pulmonology
  • Microbiology

Background:

  • Patients with cystic fibrosis (pwCF) may develop small intestinal bacterial overgrowth (SIBO) due to acid suppression, dysmotility, and post-operative status.
  • SIBO can persist in pwCF, even with modulator therapies, and breath testing is a key diagnostic tool.

Purpose of the Study:

  • To systematically review SIBO diagnostic methods in pwCF.
  • To assess the relationship between SIBO and CF comorbidities like liver disease, fat absorption issues, and eating disorders.

Main Methods:

  • A systematic review of studies assessing SIBO in children and adolescents with CF using H2 and CH4 breath tests.
  • Searched multiple databases up to March 2024, applying PRISMA guidelines and QUADAS 2 for quality assessment.

Main Results:

  • Nine studies involving 206 pwCF were reviewed, all using H2 breath tests, some combined with CH4.
  • Significant variability in breath test protocols, antibiotic cessation timing, and diagnostic cut-offs was observed.
  • No clear association found with liver enzymes, but SIBO may relate to reduced fat absorption and hyporexia.

Conclusions:

  • Limited data and methodological inconsistencies hinder definitive conclusions on SIBO in pwCF.
  • Standardized protocols for SIBO investigation and diagnosis in pwCF are urgently needed.