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Updated: Jan 16, 2026
Quantitative Polymerase Chain Reaction-based Analyses of Murine Intestinal Microbiota After Oral Antibiotic Treatment
Published on: November 17, 2018
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.
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.
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