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Progressive Increase in Small Intestinal Bacterial Overgrowth Risk Following COVID-19 Infection: A Global
Yilin Song1,2, Thai Hau Koo3, Benjamin D Liu4
1Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD 21201, USA.
Diseases (Basel, Switzerland)
|September 26, 2025
Summary
COVID-19 significantly increases the risk of small intestinal bacterial overgrowth (SIBO) within 12 months post-infection. This risk is higher in older adults and associated with certain medications, necessitating clinical vigilance for long-term gastrointestinal health.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Epidemiology
Background:
- Gastrointestinal (GI) symptoms are common in COVID-19.
- Small intestinal bacterial overgrowth (SIBO) is an emerging GI complication following COVID-19.
- Understanding SIBO prevalence post-COVID-19 is crucial for patient management.
Purpose of the Study:
- To determine the prevalence and incidence of SIBO after COVID-19 infection.
- To analyze SIBO risk across different age demographics.
- To identify risk factors associated with SIBO post-COVID-19.
Main Methods:
- Retrospective analysis of the TriNetX database (January 2022 - May 2024).
- Inclusion of adult patients diagnosed with SIBO post-COVID-19.
- Propensity score matching and Kaplan-Meier survival analysis for SIBO incidence within 12 months.
Main Results:
- COVID-19 patients showed a significantly increased incidence of SIBO compared to controls.
- SIBO incidence progressively increased with time post-infection, peaking at 12 months.
- Increased SIBO risk observed in older adults (60-79 years) and those using specific medications (opioids, PPIs, antidiarrheals).
Conclusions:
- COVID-19 is a significant risk factor for developing SIBO within the first year.
- Age and use of certain chronic medications are associated with higher SIBO risk post-COVID-19.
- Clinical awareness and targeted interventions are recommended for managing post-COVID-19 GI issues.
Keywords:
TriNetX databasecoronavirus disease 2019 (COVID-19)gut microbiotarenin–angiotensin systemsmall intestinal bacterial overgrowth (SIBO)More Related Videos
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