S2103 Elevated Risk of Developing Small Intestinal Bacterial Overgrowth Following COVID-19 Infection: A Global Population-Based Study

Introduction: Coronavirus disease 2019 (COVID-19) is associated with gastrointestinal (GI) symptoms, potentially due to disturbances in gut microbiota or dysfunction of the renin-angiotensin system. Small intestinal bacterial overgrowth (SIBO) is emerging as a significant GI sequela post-COVID-19 infection. However, large-scale real-world data assessing SIBO risk post-COVID-19 infection across different age groups are limited. This study aimed to evaluate the prevalence and incidence of SIBO post-COVID-19 infection in a global population-based cohort and identify key associated risk factors. Methods: A retrospective study was conducted with the TriNetX database, encompassing over 275 million de-identified patient records. Adult patients (≥18 years) diagnosed with SIBO post COVID-19 infection after January 1, 2022, to May 30, 2024, were included to align with the global adoption of SIBO diagnostic coding time and a 12-month follow-up period. Patients with prior SIBO, concurrent viral infections including influenza, prior surgeries of the GI tract, and inflammatory bowel disease were excluded. Propensity score matching (PSM; 1:1) was adjusted for demographics and SIBO risk factors. Kaplan-Meier survival analysis and univariate Cox proportional hazards models were used to assess the incidence of SIBO within 12 months. Results: A total of 1,660,092 COVID-19 patients and 42,322,017 controls were analyzed. SIBO was diagnosed in 353 COVID-19 patients and 3,368 controls without hydrogen breath tests (BT), and in 78 COVID-19 patients and 871 controls using BT. Overall, COVID-19 infection significantly increased the risk of developing SIBO within 12 months post-infection compared to non-infected controls. Specifically, COVID-19 patients aged 60–69 and 70–79 years had the highest SIBO risk at 12 months (0.011% vs 0.004–0.005% in controls). Elevated SIBO risks were also significant in younger groups at 12 months: ages 30–39 (odds ratio [OR] 2.7; 95% confidence interval [CI] 1.3–5.8; P = 0.002) and 40–49 (OR 2.4; 95% CI 1.1–5.0; P< 0.0001). Additionally, COVID-19 patients had significantly higher rates of GI comorbidities, chronic opioid use, proton pump inhibitor therapy, and antidiarrheal medication use. Conclusion: COVID-19 significantly increases the risk of SIBO within 12-month post-infection, particularly among older adults and patients with specific GI comorbidities or chronic medication use. Prospective studies are warranted to explore underlying mechanisms and develop effective interventions for SIBO prevention and treatment.