P1970 - Prevalence of Small Intestinal Bacterial Overgrowth Among Patients With Gastroparesis: A Systematic Review and Meta-Analysis

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Renato Beas, MD

Indiana University School of Medicine
Indianapolis, IN, United States

Renato Beas, MD¹, Adrian Riva-Moscoso, MS², Rawan Aljaras, MD³, Mirian Ramirez Rojas, MLIS⁴, Andrea Shin, MD¹, Gerardo Calderon, MD¹
¹Indiana University School of Medicine, Indianapolis, IN; ²School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Lima, Peru; ³Indiana University, Indianapolis, IN; ⁴Ruth Lilly Medical Library, Indianapolis, IN

Introduction: Several studies have demonstrated an association between small intestinal bacterial overgrowth (SIBO) and gastroparesis, which is characterized by delayed gastric emptying in the absence of mechanical obstruction.

Methods: Pubmed, MEDLINE, EMBASE, and Scopus were searched through May, 2020 for randomized controlled trials and observational studies reporting the prevalence of SIBO in gastroparesis. Two independent reviewers extracted data. Pooled prevalence was estimated using a random effects model. Heterogeneity was assessed by the inconsistency index (I²).

Results: Among 976 articles identified, 43 studies were identified for full text review. Six studies were deemed eligible for inclusion, with perfect agreement between investigators (kappa=1.0). Two studies included patients with gastroparesis based on history without diagnostic testing and therefore were excluded. A total of 385 subjects with gastroparesis were included in these 6 studies (Table 1) of whom 379 were diagnosed with gastroparesis by gastric emptying scintigraphy and 6 were diagnosed by wireless motility capsule. The pooled prevalence of SIBO was 41% (95% CI 0.23-0.58). SIBO diagnosis was made with jejunal aspirate cultures (N=15, 8.4%), lactulose breath test (N=80, 44.7%), glucose breath test (N=30, 16.8%), D-xylose breath test (N=52, 29.1%), and hydrogen breath test (N=2, 1.1%). Heterogeneity was significant and noted to be high at 91% (Figure 1). Only one study reported SIBO diagnosis in controls, therefore no pooled odds ratio was calculated.

Discussion: SIBO was present in almost half of the patients with gastroparesis; however, most studies lack controls. Therefore, it is unclear if patients with gastroparesis are at higher risk than the general population.

Figure: Figure 1: Forest plot of SIBO pooled prevalence in adults with gastroparesis

Study	Study design	Location	Gastroparesis diagnostic tool	Gastroparesis (N)	SIBO diagnostic tool	SIBO (N)
Waldron 1991	Cross Sectional	UK	Gastric scintigraphy	21	Hydrogen Breath Test	2
Reddymasu 2010	Retrospective Cohort	USA	Gastric scintigraphy	50	Glucose Breath Test	30
George 2014	Retrospective Cohort	USA	Gastric scintigraphy	201	Lactulose Breath Test	79
Schatz 2015	Cross Sectional	USA	Gastric scintigraphy	74	D-Xylose Breath Test	52
Triadafilopoulos 2016	Retrospective Cohort	USA	Wireless motility capsule	6	Lactulose Breath Test	1
Calderon 2021	Retrospective Cohort	USA	Gastric scintigraphy	33	Jejunal Aspirate Culture	15

Table: Table 1: Characteristics of included studies

Disclosures:

Renato Beas indicated no relevant financial relationships.

Adrian Riva-Moscoso indicated no relevant financial relationships.

Rawan Aljaras indicated no relevant financial relationships.

Mirian Ramirez Rojas indicated no relevant financial relationships.

Andrea Shin indicated no relevant financial relationships.

Gerardo Calderon indicated no relevant financial relationships.

Renato Beas, MD¹, Adrian Riva-Moscoso, MS², Rawan Aljaras, MD³, Mirian Ramirez Rojas, MLIS⁴, Andrea Shin, MD¹, Gerardo Calderon, MD¹. P1970 - Prevalence of Small Intestinal Bacterial Overgrowth Among Patients With Gastroparesis: A Systematic Review and Meta-Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.