Association Between Small Intestinal Bacterial Overgrowth by Glucose Breath Test and Coronary Artery Disease

  • Andre Fialho
  • Andrea Fialho
  • Gursimran Kochhar
  • Aldo L. Schenone
  • Prashanti Thota
  • Arthur J. McCullough
  • Bo Shen
Original Article

Abstract

Background

A possible role of gut bacteria and their metabolic by-products in the development of coronary artery disease (CAD) is suspected. There is a lack of studies evaluating the association of small intestinal bacterial overgrowth (SIBO) with the development of CAD.

Aim

To evaluate the frequency and risk factors for angiography-confirmed CAD in patients with or without SIBO.

Methods

A total of 1059 patients tested for SIBO using the glucose hydrogen/methane breath test from 2006 to 2014 were evaluated. In total, 160 had coronary artery angiography and were included in the study. SIBO-positive patients were compared to SIBO-negative patients. Demographic, clinical, and laboratory variables and the presence of CAD on coronary angiography were analyzed.

Results

Patients with SIBO had a higher frequency of CAD (78.9 vs. 38.6%, p < 0.001), diabetes mellitus (40.0 vs. 22.9%, p = 0.016), chronic kidney disease (26.7 vs. 12.9%, p = 0.025), use of angiotensin conversion enzyme inhibitor/blocker (45.5 vs. 32.9%, p = 0.008), and statins (75.6 vs. 61.4%, p = 0.004). Patients with SIBO had an increased number of coronary arteries affected compared to SIBO-negative patients (1-vessel disease 67.2 vs. 32.8%, p < 0.001; 2-vessel disease 85.7 vs. 14.3%, p < 0.001; and 3-vessel disease 82.4 vs. 17.6%, p < 0.001, respectively). In the stepwise multivariate logistic regression analysis, SIBO remained an independent risk factor for CAD (odds ratio 7.18, 95% confidence interval 3.09–16.67; p < 0.001).

Conclusion

SIBO was found to be associated with CAD and with the number of coronary arteries involved in this study from a single tertiary center. Further studies are necessary to confirm the association of SIBO with CAD. In the presence of risk factors, patients with SIBO may benefit from assessment for CAD.

Keywords

Small intestinal bacterial overgrowth Coronary artery disease Metabolic disease 

Abbreviations

BMI

Body mass index

CAD

Coronary artery disease

CI

Confidence interval

CKD

Chronic kidney disease

DM

Diabetes mellitus

GERD

Gastroesophageal reflux disease

Hb

Hemoglobin

HDL

High-density lipoprotein

HCTZ

Hydrochlorothiazide

IQR

Interquartile range

LPS

Lipopolysaccharide

NASH

Nonalcoholic steatohepatitis

OR

Odds ratio

PPI

Proton pump inhibitor

SIBO

Small intestinal bacterial overgrowth

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Andre Fialho
    • 1
  • Andrea Fialho
    • 1
  • Gursimran Kochhar
    • 2
  • Aldo L. Schenone
    • 1
  • Prashanti Thota
    • 2
  • Arthur J. McCullough
    • 2
  • Bo Shen
    • 2
  1. 1.Department of Internal MedicineThe Cleveland Clinic FoundationClevelandUSA
  2. 2.Department of Gastroenterology/Hepatology-A31The Cleveland Clinic FoundationClevelandUSA

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