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Although small-intestinal bacterial overgrowth (SIBO) is, by definition, a problem in the gastrointestinal tract, a review published in Biomedicines suggests that it has wide-ranging consequences, with associations across multiple body systems. This review included 12 different disease groups, such as metabolic diseases, autoimmune diseases, etc., for which SIBO is either a risk factor, a promoter of disease, or a consequence of disease. It also includes specific pathogenic mechanisms and therapies influenced by SIBO.
The most well-known associated diseases are gastrointestinal, including IBS, IBD, celiac, NAFLD, liver cirrhosis, and pancreatitis. IBS, for example, has substantial overlap with SIBO, as the rate of bacterial overgrowth among people with IBS-D is over 3-fold that of a healthy population (52% vs 17%), with more severe symptoms attributed in part to excessive growth of the genus Prevotella. Similarly, a recent meta-analysis found the prevalence of SIBO in people with IBD to be over 5-fold compared to controls, with multiple symptoms predictive of risk, including bloating, flatulence, abdominal surgery, and stricturing/penetrating disease. SIBO has also been linked to elevated blood levels of endotoxin, TLR2, and TLR4 among people with ulcerative colitis, inflammatory signals that may promote disease progression.
Regarding autoimmune diseases, systemic sclerosis (SSc) is a risk factor for SIBO, with as many as 39–62% of patients estimated to have bacterial overgrowth (a 10-fold increased prevalence) that is responsible for non-specific GI symptoms. Fecal calprotectin has emerged as a possible indicator of SIBO in multiple diseases, including SSc, with one study reporting an approximate sensitivity of 94% and specificity of 74% for SIBO with levels > 72 μg/g (among patients with SSc).
Cardiovascular diseases associated with SIBO include heart failure, deep vein thrombosis, coronary artery disease (CAD), and subclinical atherosclerosis, with elevated endotoxin levels providing at least one mechanism of action for exacerbating disease. For example, the Journal of the American Heart Association published a study that found 45% of people with heart failure tested positive for SIBO, which in turn increased the risk for rehospitalization and cardiovascular death (the primary end points of this study). Indeed, SIBO was an independent risk factor for this endpoint, with over a 2-fold increase in risk. In a separate study, SIBO was linked to over a 5-fold increase in risk for subclinical atheromatous plaques (including abdominal, carotid, and lower extremity plaques).
Among metabolic diseases, diabetes (both types) is associated with a nearly 3-fold increase in the risk of SIBO. SIBO has also been linked to worse glycemic control among diabetics and poorer beta-cell function. It has also been associated with hyperlipidemia and obesity.
This review also covers neurological diseases, developmental and mental disorders, as well as kidney and dermatological conditions, which should prompt clinicians to be aware of SIBO’s impact and the importance of its diagnosis.
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