Dynamic Changes in Small-Intestinal Bacterial Overgrowth Following Stricture-Directed Interventions in Patients With Crohn’s Disease: A Prospective Cohort Study
- 1Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University Niigata Japan
Abstract
Background/Aims: Prospective data regarding small-intestinal bacterial overgrowth (SIBO) in patients with Crohn’s disease (CD) are limited, and the influence of small-bowel strictures on SIBO as well as the effects of stricture-directed interventions remain unclear.
Methods: Patients with CD were classified into stricture and non-stricture groups on the basis of the findings of double-balloon enteroscopy or cross-sectional imaging. Healthy controls (HCs) were included. All participants underwent glucose hydrogen–methane breath testing, and SIBO was diagnosed according to the North American Consensus criteria. Primary analyses used pre-intervention tests, whereas secondary analyses assessed changes after endoscopic balloon dilation (EBD) or surgery.
Results: Hydrogen-type SIBO (H-SIBO) was not detected in HCs (0/33) but was observed in 3 of 32 patients with CD (9.4%; P = 0.114). H-SIBO was observed in patients with strictures (3/17) but not in those without strictures (0/15; P = 0.229). Three patients who initially showed negative results for H-SIBO showed positive results after EBD of the ileum or ileal surgery; thus, H-SIBO was observed in 6/32 CD cases (18.8%; P = 0.011 vs. HCs; sensitivity analysis including post-intervention tests). Methane-type SIBO was detected in one HC participant (1/33) but was not observed in patients with CD before or after the intervention.
Conclusions: In this prospective cohort study, the prevalence of H-SIBO in Japanese patients with CD appeared to be lower than that reported previously. Severe small-bowel strictures may cause false-negative glucose breath-test results, and stricture-directed interventions may reveal previously undetectable bacterial overgrowth. These findings indicate dynamic changes in SIBO status following such interventions, although the results should be interpreted with caution given the limited sample size and methodological constraints.
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BibTeX
@article{igarashi2026dynamic,
title = {{Dynamic Changes in Small-Intestinal Bacterial Overgrowth Following Stricture-Directed Interventions in Patients With Crohn’s Disease: A Prospective Cohort Study}},
author = {Takanori Igarashi and Kentaro Tominaga and Kunihiko Yokoyama and Takuya Wakabayashi and Hanako Yamazaki and Shun Yamazaki and Yuichi Kojima and Yuzo Kawata and Kazuya Takahashi and Hiroki Sato and Akira Sakamaki and Shuji Terai},
journal = {Journal of Neurogastroenterology and Motility},
year = {2026},
month = oct,
doi = {10.5056/jnm26085},
url = {https://doi.org/10.5056/jnm26085},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Dynamic Changes in Small-Intestinal Bacterial Overgrowth Following Stricture-Directed Interventions in Patients With Crohn’s Disease: A Prospective Cohort Study
AU - Takanori Igarashi
AU - Kentaro Tominaga
AU - Kunihiko Yokoyama
AU - Takuya Wakabayashi
AU - Hanako Yamazaki
AU - Shun Yamazaki
AU - Yuichi Kojima
AU - Yuzo Kawata
AU - Kazuya Takahashi
AU - Hiroki Sato
AU - Akira Sakamaki
AU - Shuji Terai
PY - 2026
DA - 2026/10/31
JO - Journal of Neurogastroenterology and Motility
DO - 10.5056/jnm26085
UR - https://doi.org/10.5056/jnm26085
AB - Background/Aims: Prospective data regarding small-intestinal bacterial overgrowth (SIBO) in patients with Crohn’s disease (CD) are limited, and the influence of small-bowel strictures on SIBO as well as the effects of stricture-directed interventions remain unclear. Methods: Patients with CD were classified into stricture and non-stricture groups on the basis of the findings of double-balloon enteroscopy or cross-sectional imaging. Healthy controls (HCs) were included. All participants underwent glucose hydrogen–methane breath testing, and SIBO was diagnosed according to the North American Consensus criteria. Primary analyses used pre-intervention tests, whereas secondary analyses assessed changes after endoscopic balloon dilation (EBD) or surgery. Results: Hydrogen-type SIBO (H-SIBO) was not detected in HCs (0/33) but was observed in 3 of 32 patients with CD (9.4%; P = 0.114). H-SIBO was observed in patients with strictures (3/17) but not in those without strictures (0/15; P = 0.229). Three patients who initially showed negative results for H-SIBO showed positive results after EBD of the ileum or ileal surgery; thus, H-SIBO was observed in 6/32 CD cases (18.8%; P = 0.011 vs. HCs; sensitivity analysis including post-intervention tests). Methane-type SIBO was detected in one HC participant (1/33) but was not observed in patients with CD before or after the intervention. Conclusions: In this prospective cohort study, the prevalence of H-SIBO in Japanese patients with CD appeared to be lower than that reported previously. Severe small-bowel strictures may cause false-negative glucose breath-test results, and stricture-directed interventions may reveal previously undetectable bacterial overgrowth. These findings indicate dynamic changes in SIBO status following such interventions, although the results should be interpreted with caution given the limited sample size and methodological constraints.
SN - 2093-0879
SN - 2093-0887
ER -