Frequency and predictors of small intestinal bacterial overgrowth in acute pancreatitis

doi:10.4292/wjgpt.v17.i2.118784

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World Journal of Gastrointestinal Pharmacology and Therapeutics

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2150-5349

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Case Control Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Pharmacol Ther. Jun 5, 2026; 17(2): 118784
Published online Jun 5, 2026. doi: 10.4292/wjgpt.v17.i2.118784

Frequency and predictors of small intestinal bacterial overgrowth in acute pancreatitis

Chidanand Kumbar, Venkatesh Vaithiyam, Ravi Teja Reddy, Kartik Mehta, Aarushi Ahuja, Ajay Kumar, Ashok Dalal, Sanjeev Sachdeva

Chidanand Kumbar, Venkatesh Vaithiyam, Ravi Teja Reddy, Kartik Mehta, Aarushi Ahuja, Ajay Kumar, Ashok Dalal, Sanjeev Sachdeva, Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi 110002, Delhi, India

Co-first authors: Chidanand Kumbar and Venkatesh Vaithiyam.

Author contributions: Vaithiyam V and Kumbar C contributed equally to this manuscript and are co-first authors. Vaithiyam V, Kumbar C, and Sachdeva S contributed to conceptualization, writing, reviewing, and editing; Kumbar C, Vaithiyam V, and Reddy RT wrote the original draft; Kumbar C, Vaithiyam V, and Reddy RT participated in data acquisition and drafting the manuscript; Dalal A, Kumar A, Ahuja A, Mehta K, and Kumbar C participated in data interpretation and critical revision of the manuscript; Vaithiyam V and Sachdeva S performed the final review of the manuscript, and all authors have read and approved the final version of the manuscript.

Institutional review board statement: The study was approved by the Institute Ethics Committee of Maulana Azad Medical College, New Delhi. The ethical clearance document number is No. F.1/IEC/MAMC/94/06/2022/No. 484.

Informed consent statement: Written informed consent was obtained from all participants.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: De-identified participant data stored in the Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, will be made available by the corresponding author upon reasonable request.

Corresponding author: Sanjeev Sachdeva, MD, Head, Professor, Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, JL Nehru Marg, New Delhi, 110002, India, sanjeevgastro@rediffmail.com.

Received: January 12, 2026
Revised: February 2, 2026
Accepted: March 5, 2026
Published online: June 5, 2026
Processing time: 136 Days and 20.2 Hours

Abstract

BACKGROUND

Acute pancreatitis (AP) is associated with intestinal dysmotility, barrier dysfunction, and dysbiosis, which may increase the risk of small intestinal bacterial overgrowth (SIBO). Evidence on the prevalence of SIBO in AP and its clinical correlates is limited.

AIM

To evaluate the frequency of SIBO in patients with AP and identify the clinical, laboratory, and imaging predictors of SIBO.

METHODS

This hospital-based case-control study was conducted at a tertiary gastroenterology unit in New Delhi, India, from December 2022 to June 2024. Consecutive adults with AP were enrolled as cases, and age- and sex-matched healthy controls (HCs) were included. The glucose hydrogen breath test was used for the diagnosis of SIBO. The predictors of SIBO were examined.

RESULTS

In total, 30 cases and 60 HC were included in the study. SIBO was detected in 12 (40.0%) cases, significantly higher than in HC (1.7%) (P < 0.001). SIBO occurred more frequently in severe AP [4 (100%)] than in moderate-severe AP [6 (75%)] and mild AP [2 (11.1%)] (P = 0.001). Predominant methane producers were more common among AP cases than among HC [12 (40.0%) vs 8 (13.3%); P = 0.004]. Univariate analysis revealed that factors such as abdominal bloating, obstipation, severe pancreatitis, ileus, systemic inflammatory response syndrome, acute necrotic collection, higher computed tomography severity index score, higher neutrophil-lymphocyte ratio, higher creatinine, and elevated high-sensitivity C-reactive protein were associated with SIBO.

CONCLUSION

SIBO was frequent in AP and was strongly associated with disease severity. Larger prospective studies are required to determine whether identifying and treating SIBO can improve clinical outcomes in AP.

Keywords: Acute pancreatitis; Small intestinal bacterial overgrowth; Glucose hydrogen breath test; Methane; Gut dysbiosis

Core Tip: Small intestinal bacterial overgrowth (SIBO) is an under-recognized disease entity in acute pancreatitis (AP). In this case-control study, SIBO was significantly more prevalent among patients with AP than among healthy controls, with a strong graded association with disease severity. SIBO was more common in those with systemic inflammatory response, ileus, and pancreatic necrosis. The predominant methane-producer status was more frequent in patients with AP than in healthy controls. These findings reinforce the clinical relevance of small intestinal dysbiosis in AP and provide a therapeutic window for early management to decrease the morbidity and mortality.