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Frequency and predictors of small intestinal bacterial overgrowth in acute pancreatitis
Chidanand Kumbar1, Venkatesh Vaithiyam1, Ravi Teja Reddy1
1Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi 110002, Delhi, India.
Background:
Acute pancreatitis (AP) is associated with intestinal dysmotility, barrier dysfunction, and dysbiosis, which may increase the risk of small intestinal bacterial overgrowth (SIBO). Evidence on the prevalence of SIBO in AP and its clinical correlates is limited.
Aim:
To evaluate the frequency of SIBO in patients with AP and identify the clinical, laboratory, and imaging predictors of SIBO.
Methods:
This hospital-based case-control study was conducted at a tertiary gastroenterology unit in New Delhi, India, from December 2022 to June 2024. Consecutive adults with AP were enrolled as cases, and age- and sex-matched healthy controls (HCs) were included. The glucose hydrogen breath test was used for the diagnosis of SIBO. The predictors of SIBO were examined.
Results:
In total, 30 cases and 60 HC were included in the study. SIBO was detected in 12 (40.0%) cases, significantly higher than in HC (1.7%) (P < 0.001). SIBO occurred more frequently in severe AP [4 (100%)] than in moderate-severe AP [6 (75%)] and mild AP [2 (11.1%)] (P = 0.001). Predominant methane producers were more common among AP cases than among HC [12 (40.0%) vs 8 (13.3%); P = 0.004]. Univariate analysis revealed that factors such as abdominal bloating, obstipation, severe pancreatitis, ileus, systemic inflammatory response syndrome, acute necrotic collection, higher computed tomography severity index score, higher neutrophil-lymphocyte ratio, higher creatinine, and elevated high-sensitivity C-reactive protein were associated with SIBO.
Conclusion:
SIBO was frequent in AP and was strongly associated with disease severity. Larger prospective studies are required to determine whether identifying and treating SIBO can improve clinical outcomes in AP.
Insights
Small intestinal bacterial overgrowth (SIBO) is common in acute pancreatitis (AP), affecting 40% of patients and correlating with disease severity. Identifying SIBO in AP may offer new treatment avenues.
Area of Science:
- Gastroenterology
- Microbiology
- Internal Medicine
Background:
- Acute pancreatitis (AP) is linked to intestinal issues like dysmotility and dysbiosis, potentially increasing small intestinal bacterial overgrowth (SIBO) risk.
- Limited evidence exists on SIBO prevalence and clinical factors in AP patients.
Purpose of the Study:
- To determine the frequency of SIBO in patients diagnosed with AP.
- To identify clinical, laboratory, and imaging predictors associated with SIBO in AP.
Main Methods:
- A case-control study involving 30 AP patients and 60 healthy controls (HC) was conducted in New Delhi.
- The glucose hydrogen breath test was employed for SIBO diagnosis.
- Predictors of SIBO were analyzed using univariate methods.
Main Results:
- SIBO was significantly more prevalent in AP cases (40.0%) compared to HC (1.7%).
- SIBO frequency increased with AP severity: 100% in severe, 75% in moderate-severe, and 11.1% in mild AP.
- Factors like abdominal bloating, obstipation, severe pancreatitis, ileus, SIRS, acute necrotic collection, high CTSI, elevated NLR, creatinine, and hs-CRP were linked to SIBO.
Conclusions:
- SIBO is a frequent complication of AP, strongly associated with disease severity.
- Further prospective research is needed to explore if SIBO diagnosis and treatment can improve AP outcomes.
Related Concept Videos
Acute Pancreatitis I: Introduction
Acute Pancreatitis I: Introduction
Acute pancreatitis is characterized by rapid inflammation of the pancreas, often caused by factors like gallstone blockage or excessive alcohol consumption. Chronic pancreatitis, on the other hand, is a slow, progressive inflammation that may result from long-term alcohol abuse, obstructions in the pancreatic duct, or genetic factors.
The causes of acute pancreatitis include:
Acute Pancreatitis II: Clinical Manifestations and Management
Acute Pancreatitis II: Pathophysiology
Microbiota of the Stomach and Small Intestine
Chronic Pancreatitis I: Introduction

