Small intestinal bacterial overgrowth in Alzheimer's disease

J Neural Transm (Vienna). 2022 Jan;129(1):75-83. doi: 10.1007/s00702-021-02440-x. Epub 2021 Nov 19.


The results of animal studies and clinical data support the gut microbiota contribution to the pathogenesis of Alzheimer's disease (AD). The aim of this pilot study was to evaluate the prevalence of small intestinal bacterial overgrowth (SIBO) and fecal markers of intestinal inflammation and permeability in AD patients. The study was conducted in 45 AD patients and 27 controls. Data on comorbidities, pharmacotherapy, and gastrointestinal symptoms were acquired from medical records and a questionnaire. SIBO was evaluated using lactulose hydrogen breath test. Fecal calprotectin and zonulin levels were assessed by ELISA assays. The positive result of SIBO breath test was found in 49% of the AD patients and 22% of the controls (p = 0.025). The comparative analysis between SIBO-positive and SIBO-negative AD patients with respect to the degree of cognitive impairment, comorbidities and used medications did not reveal any statistically significant difference, except for less common heartburn in SIBO-positive AD patients than in SIBO-negative ones (9 vs 35%, p = 0.038). The median fecal calprotectin and zonulin levels in the AD group compared to the control group amounted to 43.1 vs 64.2 µg/g (p = 0.846) and 73.5 vs 49.0 ng/ml (p = 0.177), respectively. In the AD patients there was no association between the presence of SIBO and fecal calprotectin level. Patients with AD are characterized by higher prevalence of SIBO not associated with increased fecal calprotectin level that may be related to anti-inflammatory effect of cholinergic drugs used in the treatment of AD.

Keywords: Alzheimer’s disease; Brain–gut–microbiota axis; Calprotectin; Small intestinal bacterial overgrowth.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Alzheimer Disease* / epidemiology
  • Alzheimer Disease* / pathology
  • Humans
  • Intestine, Small / microbiology
  • Lactulose
  • Leukocyte L1 Antigen Complex / analysis
  • Pilot Projects


  • Leukocyte L1 Antigen Complex
  • Lactulose