ArticleAlimentary pharmacology & therapeutics2013
Dysmotility and proton pump inhibitor use are independent risk factors for small intestinal bacterial and/or fungal overgrowth.
Article in Alimentary pharmacology & therapeutics, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 86 papers, 8 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
86 citing papers in PubMed, 8 syntheses or guidelines pooled it.
- Proton pump inhibitors are not associated with an increased risk ofGut microbes · 2025Pooled it
- European Consensus on Malabsorption-UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN. Part 1: Definitions, Clinical Phenotypes, and Diagnostic Testing for Malabsorption.United European gastroenterology journal · 2025Guideline
- Pooled it
- Show Me What You Have Inside-The Complex Interplay between SIBO and Multiple Medical Conditions-A Systematic Review.Nutrients · 2022Pooled it
- Using proton pump inhibitors increases the risk of hepato-biliary-pancreatic cancer. A systematic review and meta-analysis.Frontiers in pharmacology · 2022Pooled it
- Breath Tests for the Non-invasive Diagnosis of Small Intestinal Bacterial Overgrowth: A Systematic Review With Meta-analysis.Journal of neurogastroenterology and motility · 2020Pooled it
- Small intestinal bacterial overgrowth in systemic sclerosis: a review of the literature.Archives of dermatological research · 2019Pooled it
- Meta-analysis: proton pump inhibitors moderately increase the risk of small intestinal bacterial overgrowth.Journal of gastroenterology · 2018Pooled it
- Therapeutic Evaluation ofNutrients · 2024Trial
- Beneficial effect of probiotics supplements in reflux esophagitis treated with esomeprazole: A randomized controlled trial.World journal of gastroenterology · 2019Trial
- Clinical Utility and Diagnostic Yield of Duodenal Versus Jejunal Aspirates for Small Intestinal Bacterial or Fungal Overgrowth.Digestive diseases and sciences · 2026Article
- Small intestinal microbiome, the underrated maestro of SIMO disease.FEMS microbiology reviews · 2026Review
- The association of proton pump inhibitors and inflammatory bowel disease from the perspective of gut microbiota perturbation.NPJ biofilms and microbiomes · 2025Review
- Clinical utility of small intestinal bacterial overgrowth (SIBO) testing in guiding management of gas-bloat symptoms after antireflux surgery.Surgical endoscopy · 2025Article
- Small Intestinal Bacterial Overgrowth in a Healthy Female Patient Caused by Long-term Oral Proton Pump Inhibitor Administration.Internal medicine (Tokyo, Japan) · 2025Article
- Methane, Bacteria, Fungi, and Fermentation: Pathophysiology, Diagnosis and Treatment Strategies for Small Intestinal Bacterial Overgrowth, Intestinal Methanogen Overgrowth and Small Intestinal Fungal Overgrowth.Current issues in molecular biology · 2025Review
- Increased fungal burden in the gastrointestinal tract of brain-dead organ donors.Microbiology spectrum · 2025Article
- Review
- The Duration of Proton Pump Inhibitor Therapy and the Risk of Small Intestinal Bacterial Overgrowth: A Systematic Review and Meta-Analysis.Journal of clinical medicine · 2025Review
- Antibiotic Cocktail Exacerbates Esomeprazole-Induced Intestinal Dysmotility While Ameliorating Gastric Dyspepsia in Mice.Antibiotics (Basel, Switzerland) · 2025Article
26 more citing papers are in PubMed but not listed here.
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Authors and funding
5 authors.
Funding
Abstract
backgroundWhether intestinal dysmotility and the use of a proton pump inhibitor (PPI) either independently or together contributes to small intestinal bacterial overgrowth (SIBO), and/or small intestinal fungal overgrowth (SIFO) is not known.
aimTo investigate the role of dysmotility and PPI use in patients with persistent gastrointestinal complaints.
methodsPatients with unexplained gastrointestinal symptoms and negative endoscopy/radiology tests completed a validated symptom questionnaire and underwent 24-h ambulatory antro-duodeno-jejunal manometry (ADJM). Simultaneously, duodenal aspirate was obtained for aerobic, anaerobic and fungal culture. Dysmotility was diagnosed by (>2): absent phase III MMC, absent/diminished postprandial response, diminished amplitude of antral/intestinal phasic activity, impaired antro-duodenal coordination. Bacterial growth ≥10³ CFU/mL or fungal growth was considered evidence for SIBO/SIFO. PPI use was documented. Correlation of symptoms with presence of SIBO or SIFO was assessed.
resultsOne hundred and fifty subjects (M/F = 47/103) were evaluated; 94/150 (63%) had overgrowth: 38/94 (40%) had SIBO, 24/94 (26%) had SIFO and 32/94 (34%) had mixed SIBO/SIFO. SIBO was predominately due to Streptococcus, Enterococcus, Klebsiella and E. coli. SIFO was due to Candida. Eighty of 150 (53%) patients had dysmotility and 65/150 (43%) used PPI. PPI use (P = 0.0063) and dysmotility (P = 0.0003) were independent significant risk factors (P < 0.05) for overgrowth, but together did not pose additional risk. Symptom profiles were similar between those with or without SIBO/SIFO.
conclusionsDysmotility and PPI use were independent risk factors for SIBO or SIFO and were present in over 50% of subjects with unexplained gastrointestinal symptoms. Diagnosis of overgrowth requires testing because symptoms were poor predictors of overgrowth.
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