UEG Week 2025: Relive the Highlights

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Introduction

Patients with intestinal failure (IF) have abnormalities of intestinal anatomy, secretion, and/or motility, and physiological protective mechanisms regulating small intestinal bacterial counts are impaired, which can lead to small intestinal bacterial overgrowth. There are five key mechanisms that drive intestinal failure, of which, short bowel syndrome (SBS) following surgical resection is the most common. Less frequent mechanisms include enterocutaneous fistula, dysmotility, obstruction and malabsorption. Small intestinal bacterial overgrowth (SIBO) and catheter related blood stream infections (CRBSI) are two of the most common complications with a direct impact on morbidity and mortality. Parenteral nutrition (PN) use in intestinal failure has also been proposed as an independent risk factor for development of SIBO. However, the reported prevalence of SIBO in patients with IF is variable. We thus conducted a systematic review and meta-analysis aimed to determine the prevalence of SIBO in patients with IF and to identify the risk factors that predict SIBO in this cohort.

Aims & Methods

MEDLINE (PubMed) and Embase electronic databases were searched from inception to April 2023 for studies that reported the prevalence of SIBO in IF. The prevalence rates, odds ratio (OR) and 95% confidence intervals of SIBO in IF were calculated using DerSimonian and Laird random effects model, and further subgroup analysis stratified according to mode of SIBO diagnosis and short-bowel syndrome cause of IF were conducted. This study was registered with PROSPERO (CRD42023414010).

Results

Six prevalence studies reporting on 313 patients with IF were included in this systematic review and meta-analysis. Overall, the prevalence of SIBO in IF was 55.2% (95% CI: 41.5-68.2), with considerable heterogeneity in this analysis (I²=79.2, p=0.0001), with slightly increased SIBO prevalence in IF patients on parenteral nutrition (61.1% 95% CI 31.6-84.3). There was no difference in CRBSI in SIBO positive (45.5%, 95% CI: 28.1-63.6) as compared to SIBO negative IF patients (45.7%, 95%CI 16.7-76.6). Utilizing duodenal aspirate and culture SIBO prevalence in patients with IF was significantly higher as compared to that with glucose breath test (OR 2.59, 95% CI 1.2-5.8, p=0.03), with moderate heterogeneity noted in this analysis (I²=53.9, p=0.054). There was no difference in SIBO prevalence in patients with IF due to SBS (49.1%, 95% CI 42.7-55.4) as compared to IF due to other causes (53.5%, 95%CI 37.7-68.8).

Conclusion

This systematic review and meta-analysis suggests a link between SIBO and IF, with higher SIBO prevalence in patients with IF diagnosed utilizing small bowel aspirate and culture. Parenteral nutrition appeared to be risk factor for SIBO in IF. Moreover, there was no like between SIBO and CRBSI in patients with IF. However, the results need to be interpreted with caution, due to the low sensitivity and specificity of the SIBO diagnostic tests, lack of case control studies and clinical heterogeneity seen in the prevalence studies. Further prospective studies are required to further assess the link between SIBO and IF and explore the risk factors for SIBO in IF.

SMALL INTESTINAL BACTERIAL OVERGROWTH IN INTESTINAL FAILURE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Xiaomin Ma 1, Ayesha Shah 2, Thomas Fairlie 3, Neal Martin 1, Michael P. Jones 4, Natasha A Koloski 5, Mark Morrison 6, Gerald J. Holtmann 2, Angela Tietto 7

1 Princess Alexandra Hospital, Brisbane, Australia|||University of Queensland, Brisbane, Australia

2 Princess Alexandra Hospital, Brisbane, Australia|||University of Queensland, Brisbane, Australia|||Translational Research Institute, Brisbane, Australia

3 Princess Alexandra Hospital, Brisbane, Australia|||Translational Research Institute, Brisbane, Australia

4 Macquarie University, Sydney, Australia

5 Princess Alexandra Hospital, Brisbane, Australia|||University of Queensland, Brisbane, Australia|||University of Newscastle, Newcastle, Australia

6 Princess Alexandra Hospital, Brisbane, Australia|||University of Queensland, Brisbane, Australia|||University of Queensland, Brisbane, Australia

7 University of Padova, Padova, Italy

Conference

UEG Week Copenhagen 2023

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

The small intestine: A hidden treasure! (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

UEG Mistakes In Articles

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Familial Mediterranean fever (FMF), also called periodic disease, Armenian disease, etc., is a prototypical autoinflammatory disorder where the underlying mechanism is the dysfunction of innate immunity, resulting in unprovoked episodes of inflammation.¹ Although considered rare worldwide, it is prevalent in people of Mediterranean origin; however, one can expect to encounter patients in all parts of the modern world. FMF is a monogenic disease with autosomal recessive inheritance.² Unlike other monogenic disorders, the diagnosis remains largely clinical, and it is important to understand the limitations of genetic testing. Another distinguishing feature is the well-established effectiveness of lifelong monotherapy with colchicine in preventing attacks and complications.³

Mistakes in Familial Mediterranean Fever and how to avoid them

Manik Gemilyan, Gagik Hakobyan

Topics

Primary Care

Published

2025

UEG Podcast Episode

Journal Podcast

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Fecal microbiota transplantation and the impact of COVID-19

Iago Rodríguez-Lago 1, Siew Chien Ng 2

1 Hospital Universitario de Galdakao, Bilbao, Spain

2 Chinese University of Hong Kong, Hong Kong

Topics

Gut Microbiota

Published

2022

UEG Standards and Guidelines

Clinical Practice Guideline

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MAIN RECOMMENDATIONS

ESGE recommends the combination of endoscopic ultrasound-guided tissue acquisition (EUS-TA) and endoscopic retrograde cholangiopancreatography (ERCP)-based tissue acquisition as the preferred diagnostic approach for tissue acquisition in patients with jaundice and distal extrahepatic biliary stricture in the absence of a pancreatic mass.
ESGE suggests that brushing cytology should be completed along with fluoroscopy-guided biopsies, wherever technically feasible, in patients with perihilar biliary strictures.
ESGE suggests EUS-TA for perihilar strictures when ERCP-based modalities yield insufficient results, provided that curative resection is not feasible and/or when cross-sectional imaging has shown accessible extraluminal disease.
SGE suggests using standard ERCP diagnostic modalities at index ERCP. In the case of indeterminate biliary strictures, ESGE suggests cholangioscopy-guided biopsies, in addition to standard ERCP

Diagnostic work-up of bile duct strictures: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Antonio Facciorusso

Publisher

European Society of Gastrointestinal Endoscopy