Hepatic Encephalopathy in Cirrhotic Patients and Risk of Small Intestinal Bacterial Overgrowth: A Systematic Review and Meta-Analysis

Table 1

Main characteristics of the studies included in this meta-analysis.

Study	Country	Etiology	SIBO diagnostic test	SIBO diagnostic criteria	Prevalence of SIBO	Average age (years)	Male/female	Quality assessment
Weisberg et al. [11]	United States	HCV cirrhosis	LBT	10 g lactulose load is orally administered, (a) fasting breath H2 of >20 ppm, (b) increase in breath H2 in <90 min, (c) dual H2 peaks (12 ppm increase over baseline with decrease of 5 ppm before second peak), or (d) fasting breath CH4 of >10 ppm	Cases: 21/28 (75%); Controls: 3/6 (50%)	—	—	6
Jun et al. [12]	Korea	Cirrhosis	LBT	15 g lactulose load is orally administered, a basal hydrogen value of >20 ppm, or early hydrogen peak of ≥20 ppm (≥10 ppm in the case of methane gas) in the first 90 min	Cases: 8/9 (89%); Controls: 24/44 (55%)		38/15	7
Gupta et al. [13]	India	Cirrhosis (alcohol, HBV, HCV, and others)	GBT	75 g glucose load is orally administered, rise of  ppm over the baseline value within 2 hours	Cases: 22/57 (39%); Controls: 4/45 (9%)	Cases: 50.28; Controls: 44.9	Cases: 43/14; Controls: 41/4	7
Lunia et al. [14]	India	Cirrhosis (alcohol, HBV, HCV, and others)	GBT	100 g glucose load is orally administered, a rise of  ppm over the baseline value within 3 hours	Cases: 21/44 (48%); Controls: 5/31 (16%)	Cases: Controls:	Cases: 32/12; Controls: 23/8	8
Zhang et al. [15]	China	Cirrhosis (alcohol, HBV, and HCV)	GBT	A rise in breath hydrogen by 12 ppm above the basal level after glucose ingestion	Cases: 17/26 (65%); Controls: 3/34(9%)		46/14	7
Abid et al. [16]	Pakistan	Cirrhosis (irrespective of cause)	LBT	50 g lactulose load is orally administered, rise of  ppm over the baseline value within 90 min	Cases: 17/55 (31%); Controls: 11/35 (31%)	Cases: Controls:	Cases: 29/26; Controls: 19/16	8

LBT: lactulose breath test; GBT: glucose breath test; ppm: parts per million; SIBO: small intestinal bacterial overgrowth.