Digestive Diseases and Sciences

, Volume 63, Issue 2, pp 412–421 | Cite as

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 ShenEmail author
Original Article



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.


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


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.


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).


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.


Small intestinal bacterial overgrowth Coronary artery disease Metabolic disease 



Body mass index


Coronary artery disease


Confidence interval


Chronic kidney disease


Diabetes mellitus


Gastroesophageal reflux disease




High-density lipoprotein




Interquartile range




Nonalcoholic steatohepatitis


Odds ratio


Proton pump inhibitor


Small intestinal bacterial overgrowth



Dr. Bo Shen is supported by the Ed and Joey Story Endowed Chair.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to disclose.


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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
    Email author
  1. 1.Department of Internal MedicineThe Cleveland Clinic FoundationClevelandUSA
  2. 2.Department of Gastroenterology/Hepatology-A31The Cleveland Clinic FoundationClevelandUSA

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