title: Small intestinal bacterial overgrowth and celiac disease: A systematic review with pooled-data analysis.
abstract: BACKGROUND
  A link between small intestinal bacterial overgrowth (SIBO) and celiac disease (CD) has been hypothesized.
  
  
  METHODS
  Literature search was performed in main medical databases. Methods of analysis/inclusion criteria were based on Preferred Reporting Items for Systematic reviews and Meta-Analyses recommendations. The end-point was to estimate, by a pooled-data analysis, SIBO prevalence in CD. Proportions/percentages and their 95% confidence intervals (CI) were calculated by inverse variance method, whereas odd ratios (OR) and their 95% CI were estimated, where available, based on the Mantel-Haenszel method. Data were entered into the RevMan 5.3 software.
  
  
  RESULTS
  Eleven articles fulfilled considered criteria. The pooled mean prevalence of SIBO in CD was 20% (95% CI of 10%-30%). In comparison to asymptomatic controls, CD was associated to higher risk of SIBO, with an OR of 10.52 (95% CI 2.69-41.21, P=.0007). Jejunal aspirate culture assessed SIBO prevalence of 11% (95% CI 3%-19%) in CD, whereas breath tests detected a higher value (23%, 95% CI 10%-37%). The pooled prevalence of SIBO in CD patients who were symptomatic despite a GFD was 28% (95% CI 10%-47%), higher than in asymptomatic celiac patients (pooled prevalence of 10%, with a 95% CI of 3%-16%), despite not statistically significant (P=.06). When GFD-unresponsive CD was defined only by clinical persistence of symptoms, the prevalence of SIBO was higher than in the case of villous atrophy association (31% vs 16% P=.33).
  
  
  CONCLUSIONS
  The heterogeneity of available studies may not support a relationship SIBO-CD. Nevertheless, SIBO could be more common in CD when symptoms do not improve after GFD.
authors.affiliation: Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico di Bari, University of Bari, Bari, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Losurdo
authors.affiliation: Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico di Bari, University of Bari, Bari, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Marra
authors.affiliation: Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico di Bari, University of Bari, Bari, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Shahini
authors.affiliation: Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico di Bari, University of Bari, Bari, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Girardi
authors.affiliation: Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico di Bari, University of Bari, Bari, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Giorgio
authors.affiliation: Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico di Bari, University of Bari, Bari, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Amoruso
authors.affiliation: Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico di Bari, University of Bari, Bari, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Pisani
authors.affiliation: Section of Pathology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico di Bari, University of Bari, Bari, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Piscitelli
authors.affiliation: Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico di Bari, University of Bari, Bari, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Barone
authors.affiliation: Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico di Bari, University of Bari, Bari, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Principi
authors.affiliation: Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico di Bari, University of Bari, Bari, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Di Leo
authors.affiliation: Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico di Bari, University of Bari, Bari, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Ierardi
mesh_terms: D001424:Bacterial Infections / Q000150:complications / Q000453:epidemiology*; D002446:Celiac Disease / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology*; D006801:Humans; D007421:Intestine, Small / Q000382:microbiology*
keywords: breath test; celiac disease; gluten-free diet; small intestinal bacterial overgrowth