Small Intestinal Bacterial Overgrowth (SIBO) and Twelve Groups of Related Diseases—Current State of Knowledge

breath testingdysbiosisgastrointestinal disordersGut MicrobiotaGut-brain axis

Small Intestinal Bacterial Overgrowth (SIBO) and Twelve Groups of Related Diseases—Current State of Knowledge

Why this matters for your gut health

SIBO is often under-recognized outside gastroenterology, yet a growing body of evidence links it to conditions across nearly every organ system. This review consolidates scattered research into a single framework, helping clinicians across specialties (endocrinology, cardiology, dermatology, neurology, oncology, etc.) recognize when SIBO might be complicating or driving a patient’s disease, enabling earlier diagnosis and more targeted treatment.

Summary

This is a comprehensive literature review examining the relationship between small intestinal bacterial overgrowth (SIBO)—a condition defined by excessive/altered bacterial colonization of the small intestine—and 12 broad groups of diseases. Databases searched include PubMed, Science Direct, Web of Science, EMBASE, and Medline (1991–2023). The paper describes SIBO’s pathophysiology, diagnostic methods (breath testing, jejunal aspirate culture, 16S rRNA sequencing), and treatment approaches (antibiotics like rifaximin, dietary changes such as low-FODMAP, fecal microbiota transplantation, probiotics), then systematically reviews evidence linking SIBO to each disease group.

Key findings

Group 1 (Gastrointestinal disorders) has the strongest, best-documented SIBO relationship — includes IBS (51.7% co-occurrence), Crohn’s disease (25–88% prevalence), ulcerative colitis, celiac disease, NAFLD, liver cirrhosis (>50% prevalence), and pancreatitis.
Group 2 (Autoimmune – Systemic sclerosis): SIBO occurs at a 10-fold higher rate than in healthy controls.
Group 3 (Cardiovascular): Linked to heart failure severity, deep vein thrombosis, coronary artery disease, and subclinical atherosclerosis.
Group 4 (Metabolic): Strong links to diabetes (types 1, 2, and gestational), hyperlipidemia (78.9% prevalence), and obesity (2–3x increased risk).
Group 5 (Endocrine): >50% of hypothyroid patients have SIBO.
Group 6 (Nephrological): Significant in chronic kidney injury; acute kidney injury data still limited.
Group 7 (Dermatological): Acne rosacea shows ~46% SIBO prevalence, with symptom resolution after eradication; psoriasis link unclear.
Group 8 (Neurological): Alzheimer’s (~48%) and Parkinson’s disease (~46%) show notable associations; multiple sclerosis needs more research.
Group 9 (Developmental): Autism spectrum disorder shows 31% SIBO prevalence, correlating with symptom severity.
Group 10 (Mental disorders): Depression, anxiety, and stress linked via altered tryptophan/serotonin metabolism.
Group 11 (Genetic): Cystic fibrosis (~31–56% prevalence); Familial Mediterranean Fever affects colchicine responsiveness.
Group 12 (GI cancers): Associated with pancreatic, cholangiocarcinoma, gastric, colorectal, esophagogastric cancers, and hepatocellular carcinoma.

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Citation

Roszkowska, P.; Klimczak, E.; Ostrycharz, E.; Rączka, A.; Wojciechowska-Koszko, I.; Dybus, A.; Cheng, Y.-H.; Yu, Y.-H.; Mazgaj, S.; Hukowska-Szematowicz, B. Small Intestinal Bacterial Overgrowth (SIBO) and Twelve Groups of Related Diseases—Current State of Knowledge. Biomedicines 2024, 12, 1030.