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

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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

Table 1 Etiology, disease severity, clinical features, laboratory parameters, and computed tomography findings among patients with acute pancreatitis, n (%)

1a: Etiology of acute pancreatitis, n = 30
1	Ethanol	10 (33.3)
2	Biliary	15 (50.0)
3	Idiopathic	3 (10.0)
4	Ethanol plus biliary	2 (6.7)
1b: Severity of acute pancreatitis, n = 30
1	Mild	18 (60.0)
2	Moderate	8 (26.7)
3	Severe	4 (13.3)
1c: Local complications, n = 30
1	APFC	3 (10.0)
2	ANC	9 (30.0)
3	SVT	5 (16.7)
4	Ileus	11 (36.7)
1d: Systemic complications, n = 30
1	AKI	2 (6.7)
2	Sepsis	2 (6.7)
3	ALI	7 (23.3)
1e: Symptoms among cases, n = 30
1	Pain abdomen	30 (100)
2	Vomiting	25 (83.3)
3	Obstipation/constipation	21 (70)
4	Bloating	13 (43.3)
5	Abdominal distension	12 (40.0)
6	Fever	10 (33.3)
7	Jaundice	6 (20.0)
8	Breathlessness	5 (16.7)
1f: Baseline clinical and laboratory parameters among acute pancreatitis cases, median (range)
1	Height in cm	167 (152-175)
2	Weight in kg	64 (52-91)
3	BMI (kg/m²)	23.68 (18.59-36.26)
4	Hb (gm %)	12.6 (7.8-16.4)
5	TLC (cells/mm³)	12050 (5400-23500)
6	Neutrophil (%)	82 (57-94)
7	Lymphocytes (%)	12 (4-33)
8	NLR	6.83 (1.75-23.5)
9	Platelets (lac/mm³)	2.025 (0.53-6.29)
10	HsCRP (mg/dL)	34.25 (1.6-338)
11	Serum procalcitonin (ng/mL)	0.1475 (0.02-2.45)
12	Serum LDH (U/L)	270 (186-830)
13	Serum amylase (U/L)	1237 (233-7235)
14	Serum lipase (U/L)	987 (310-8076)
15	PT (seconds)	10 (1-17)
16	INR	1.03 (0.8-1.5)
17	Urea (mg/dL)	26.1 (9-66)
18	Creatinine (mg/dL)	0.8 (0.4-1.6)
19	Sodium (mEq/L)	139 (129-151)
20	Potassium (mEq/L)	4.1 (3.3-5.5)
21	Serum Calcium (mg/dL)	8.9 (7.7-11.6)
22	Serum Phosphorous (mg/dL)	2.55 (1.1-4.9)
23	Total Bilirubin (mg/dL)	1.3 (0.2-9.6)
24	SGOT (IU/L)	65 (15-1040)
25	SGPT (IU/L)	64.5 (10-790)
26	ALP (IU/L)	182.5 (31-512)
27	Total protein (g/dL)	6.95 (4.6-8.5)
28	Albumin (g/dL)	3.55 (2.3-5.4)
29	Globulin (g/dL)	3 (1.9-4.6)
30	TG (mg/dL)	141 (23-272)
31	HDL (mg/dL)	36 (17-73)
32	Cholesterol (mg/dL)	154.5 (77-289)
1 g: CT based parameters in AP
1	No necrosis	19 (63.3)
2	0-30% necrosis	3 (10.0)
3	> 30% necrosis	8 (26.6)
4	CTSI score	2 (1-10)

AKI: Acute kidney injury; ALI: Acute lung injury; ALP: Alkaline phosphatase; ANC: Acute necrotic collection; AP: Acute pancreatitis; APFC: Acute peripancreatic fluid collection; BMI: Body mass index; CT: Computed tomography; CTSI: Computed tomography severity index; Hb: Hemoglobin; HDL: High-density lipoprotein; HsCRP: High-sensitivity C-reactive protein; INR: International normalized ratio; LDH: Lactate dehydrogenase; NLR: Neutrophil-to-lymphocyte ratio; PT: Prothrombin time; SGOT: Serum Glutamic-oxaloacetic transaminase; SGPT: Serum Glutamic-pyruvic transaminase; SVT: Splanchnic venous thrombosis; TLC: Total leukocyte count; TG: Triglycerides.

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Table 2 Characteristics of glucose hydrogen breath test among cases and controls

No	Values	Cases (n = 30)	Control (n = 60)	P value
1	H2 - baseline	3 (0-6)	3 (0-10)	0.282
2	H2 - peak	5 (3-131)	5 (1-64)	0.294
3	Predominant methane producers	12 (40.0%)	8 (13.3%)	0.004
4	Methane - baseline	5 (3-22)	4 (0-12)	0.019
5	Methane - peak	6 (4-19)	5 (1-15)	0.001
6	Symptoms during GHBT	9 (30.0%)	0 (0%)	0.001

GHBT: Glucose hydrogen breath test.

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Table 3 Univariate analysis of predictors of small intestinal bacterial overgrowth among acute pancreatitis cases

No	Parameters	SIBO present (n = 12)	SIBO absent (n = 18)	P value
Demographic parameters and symptoms
1	Age in years	32.5 (24-60)	35 (27-60)	1.000
2	Gender (M/F)	9/3	8/10	0.141
3	Abdominal bloating	12 (100.0%)	1 (5.6%)	< 0.001
4	Flatulence	3 (25.0%)	0 (0.0%)	0.054
5	Belching	3 (25.0%)	1 (5.6%)	0.274
6	Vomiting	10 (83.3%)	15 (83.3%)	1.000
7	Hiccups	1 (8.3%)	1 (5.6%)	0.765
8	Obstipation	8 (66.7%)	3 (16.7%)	0.009
9	Jaundice	4 (33.3%)	2 (11.1%)	0.184
10	Oliguria	2 (16.7%)	0 (0.0%)	0.152
Etiology, duration, severity, and complications of pancreatitis
1	Etiology of pancreatitis (ethanol/biliary/idiopathic/ethanol + biliary)	4/5/1/2	6/10/2/0	0.343
2	Duration of pancreatitis (days)	6.5 (3-23)	5 (1-15)	0.134
3	Severe pancreatitis	4 (33.3%)	0 (0.0%)	0.018
4	APFC	1 (8.3%)	2 (11.1%)	0.804
5	ANC	9 (75.0%)	0 (0.0%)	< 0.001
6	Ileus	9 (75.0%)	2 (11.1%)	0.001
7	AKI	2 (16.7%)	0 (0.0%)	0.152
8	Sepsis	2 (16.7%)	0 (0.0%)	0.152
9	Presence of SIRS	10 (83.3%)	3 (16.7%)	0.001
Laboratory parameters
1	NLR	11.71 (2.28-23.5)	4.95 (1.75-8.8)	0.001
2	Urea (mg/dL)	36.5 (12-50)	24 (9-66)	0.113
3	Creatinine (mg/dL)	0.9 (0.5-1.6)	0.65 (0.4-1.4)	0.012
4	Amylase (U/L)	1327.5 (371-4009)	1184.5 (233-7235)	0.819
5	Lipase (U/L)	947.5 (310-6800)	1162.5 (383-8076)	0.267
6	Total bilirubin (mg/dL)	2.2 (0.2-9.6)	0.95 (0.2-3.8)	0.325
7	Total protein (g/dL)	6.45 (4.6-8.5)	7 (5.2-8)	0.573
8	Albumin (g/dL)	3.6 (2.3-5.4)	3.5 (2.7-4.7)	0.917
9	TG (mg/dL)	147.5 (75-272)	135 (23-218)	0.491
10	Cholesterol (mg/dL)	165.5 (77-289)	151 (113-231)	0.884
11	hsCRP (mg/dL)	61 (2.8-338)	21.5 (1.6-204)	0.004
12	Procalcitonin (ng/mL)	0.332 (0.02-2.45)	0.136 (0.02-1.28)	0.305
13	CTSI score	8 (2-10)	2 (1-6)	< 0.001
14	Basal hydrogen (ppm)	2.5 (1-5)	3 (0-6)	0.285
15	Basal methane (ppm)	5 (3-11)	5 (3-22)	0.632
16	Predominant methane producer	4 (33.3%)	8 (44.4%)	0.709

AKI: Acute kidney injury; ANC: Acute necrotic collection; APFC: Acute peripancreatic fluid collection; CTSI: Computed tomography severity index; SIBO: Small intestinal bacterial overgrowth; SIRS: Systemic inflammatory response syndrome; hsCRP: High-sensitivity C-reactive protein; NLR: Neutrophil-to-lymphocyte ratio; TG: Triglyceride; M: Male; F: Female.

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Table 4 Univariate association of variables with small intestinal bacterial overgrowth after least absolute shrinkage and selection operator logistic regression-based selection and collinearity exclusion

No	Variable	GHBT positive (n = 12)	GHBT negative (n = 18)	P value
1	Abdominal bloating	12 (100.0%)	1 (5.6%)	< 0.001^a
2	Ileus	9 (75.0%)	2 (11.1%)	0.001^a
3	NLR	11.71 (2.28-23.5)	4.95 (1.75-8.8)	0.001^a
4	CTSI score	8 (2-10)	2 (1-6)	< 0.001^a
5	Obstipation	8 (66.7%)	3 (16.7%)	0.009
6	Creatinine (mg/dL)	0.9 (0.5-1.6)	0.65 (0.4-1.4)	0.012

^aP < 0.001, statistically significant after Bonferroni correction (α = 0.05/6 = 0.0083).

GHBT: Glucose hydrogen breath test; CTSI: Computed tomography severity index; NLR: Neutrophil-to-lymphocyte ratio.

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Citation: Kumbar C, Vaithiyam V, Reddy RT, Mehta K, Ahuja A, Kumar A, Dalal A, Sachdeva S. Frequency and predictors of small intestinal bacterial overgrowth in acute pancreatitis. World J Gastrointest Pharmacol Ther 2026; 17(2): 118784
URL: https://www.wjgnet.com/2150-5349/full/v17/i2/118784.htm
DOI: https://dx.doi.org/10.4292/wjgpt.v17.i2.118784

Kumbar C, Vaithiyam V, Reddy RT, Mehta K, Ahuja A, Kumar A, Dalal A, Sachdeva S. Frequency and predictors of small intestinal bacterial overgrowth in acute pancreatitis. World J Gastrointest Pharmacol Ther 2026; 17(2): 118784 [DOI: 10.4292/wjgpt.v17.i2.118784]

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