SMALL INTESTINAL BACTERIAL OVERGROWTH IN PEOPLE WITH CYSTIC FIBROSIS: SYSTEMATIC REVIEW.

Q2 Medicine
Arquivos de Gastroenterologia Pub Date : 2025-05-02 eCollection Date: 2025-01-01 DOI:10.1590/S0004-2803.24612024-110
Maria Lidiane Lavor Landim, José Dirceu Ribeiro, Daniela de Souza Paiva Borgli, Danielle Rossana Queiroz Martins Bonilha, Elizete Aparecida Lomazi, Maria de Fátima Correa Pimenta Servidoni
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引用次数: 0

Abstract

Background: In patients with cystic fibrosis (pwCF) acid suppression therapy, gastrointestinal dysmotility, and post-operative bowel status, may predispose to the development of small intestinal bacterial overgrowth (SIBO). SIBO may continue to be present in the progression of the disease even on modulators. Breath testing is the most simple, non-invasive and available method for diagnosing SIBO. There are some divergencies over the operational procedures used to carry out and interpret breath tests in pwCF.

Objective: We performed a systematic review of SIBO in pwCF to assess the methods used in breath tests and the existence of causal relationship between SIBO and following CF co-morbidities: liver disease, fat absorption, and eating disorders.

Methods: We searched the PubMed, Cochrane Library, Embase, LILACS, MEDLINE, OpenGray, medRxiv, Google Scholar, and CAPES databases up to March 20, 2024. We selected clinical cohort and case-control studies to assess SIBO in cwCF. We selected studies that met the following criteria: (1) participants - children and adolescents diagnosed with CF; (2) intervention - assessment of SIBO using H2 and CH4 breath tests; (3) control - patients without SIBO; and (4) outcome - assessment of breath tests for SIBO diagnosis and the causal relationship between SIBO and CF co-morbidities. The PRISMA statement was used to report the search. QUADAS 2 tool was used for assessing the quality of each study methodology. The protocol for this review was registered in the Prospective Registration of Systematic Review Database (CRD42024503593).

Results: The search strategy identified 279 studies. After screening titles and abstracts, 36 studies were selected for full-text review and 27 were excluded; nine studies involving 206 pwCFs were reviewed. All nine studies used H2 breath tests as a diagnostic method for SIBO, and five of them used a combined H2/CH4 test. There was no consistency in the timing of cessation of antibiotic therapy prior to testing. All patients performed the test after an overnight fast. A basal sample was collected prior to substrate (glucose or lactulose) ingestion, which ranged from 7 to 20 ppm. There was great variability between respiratory sample collection times, being times 0, 15, 30, 45, 60, 90, and 120 minutes the most used protocol. The methods for performing breath tests varied widely, making it difficult to reach conclusions on the role of SIBO as a co-morbidity in pwCF. There was no association between increased serum AST, ALT, and GGT levels and positive breath tests. There was no agreement regarding the role of SIBO and nutritional deficiency, but a reduction in fat absorption and the presence of hyporexia have been described under this condition.

Conclusion: Data on assessment of SIBO in pwCF is limited by the small number of studies available, the lack of appropriate controls in some studies, and the varying test methodology and diagnostic cut-offs applied. Protocols to investigate and diagnosing SIBO in pwCF need to be developed.

囊性纤维化患者小肠细菌过度生长:系统评价。
背景:在囊性纤维化(pwCF)患者中,抑酸治疗、胃肠道运动障碍和术后肠道状态可能易导致小肠细菌过度生长(SIBO)的发展。SIBO可能继续存在于疾病的进展中,甚至在调节剂上。呼吸测试是诊断SIBO最简单、无创和可用的方法。在pwCF中进行和解释呼吸测试的操作程序存在一些分歧。目的:我们对pwCF中的SIBO进行了系统回顾,以评估呼吸测试中使用的方法,以及SIBO与以下CF合并症(肝脏疾病、脂肪吸收和饮食失调)之间是否存在因果关系。方法:检索截至2024年3月20日的PubMed、Cochrane Library、Embase、LILACS、MEDLINE、OpenGray、medRxiv、谷歌Scholar和CAPES数据库。我们选择临床队列和病例对照研究来评估cwCF中的SIBO。我们选择符合以下标准的研究:(1)参与者-诊断为CF的儿童和青少年;(2)干预-使用H2和CH4呼气试验评估SIBO;(3)对照组——无SIBO患者;(4)结果-评估SIBO诊断的呼吸试验以及SIBO与CF合并症之间的因果关系。PRISMA语句用于报告搜索。使用QUADAS 2工具评估每个研究方法的质量。本综述的方案已在系统评价数据库前瞻性注册(CRD42024503593)中注册。结果:搜索策略确定了279项研究。筛选标题和摘要后,36项研究入选全文综述,27项被排除;我们回顾了涉及206个pwcf的9项研究。所有9项研究均使用H2呼气试验作为SIBO的诊断方法,其中5项研究使用H2/CH4联合试验。在检测前停止抗生素治疗的时间没有一致性。所有患者在禁食一晚后都进行了测试。在摄入底物(葡萄糖或乳果糖)之前收集基础样品,其范围从7到20 ppm。呼吸样本采集时间之间存在很大差异,最常用的方法是0、15、30、45、60、90和120分钟。进行呼吸测试的方法差异很大,因此很难得出SIBO作为pwCF合发疾病的作用的结论。血清AST、ALT和GGT水平升高与呼吸试验阳性之间没有关联。关于SIBO和营养缺乏的作用还没有达成一致意见,但在这种情况下,脂肪吸收减少和缺氧的存在已被描述。结论:可获得的研究数量少,一些研究缺乏适当的对照,以及不同的测试方法和应用的诊断截止值,限制了pwCF中SIBO的评估数据。需要制定调查和诊断pwCF中SIBO的方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Arquivos de Gastroenterologia
Arquivos de Gastroenterologia Medicine-Gastroenterology
CiteScore
2.00
自引率
0.00%
发文量
109
审稿时长
9 weeks
期刊介绍: The journal Arquivos de Gastroenterologia (Archives of Gastroenterology), a quarterly journal, is the Official Publication of the Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia IBEPEGE (Brazilian Institute for Studies and Research in Gastroenterology), Colégio Brasileiro de Cirurgia Digestiva - CBCD (Brazilian College of Digestive Surgery) and of the Sociedade Brasileira de Motilidade Digestiva - SBMD (Brazilian Digestive Motility Society). It is dedicated to the publishing of scientific papers by national and foreign researchers who are in agreement with the aim of the journal as well as with its editorial policies.
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