1182 Small Intestinal Bacterial Overgrowth (SIBO) Is Common in Patients With Ehlers-Danlos Syndrome (EDS)

Abstract

INTRODUCTION: EDS is a group of rare connective tissue disorders caused by defects in collagen synthesis. EDS patients frequently have chronic gastrointestinal (GI) symptoms. Delayed gastric emptying and colonic transit time are common in EDS, suggesting underlying GI dysmotility. The relationship between SIBO and EDS has not been studied. In this study, we aimed to assess the prevalence of SIBO by glucose hydrogen breath test (GBT) in EDS patients with GI symptoms. We also characterized the risk factors for SIBO in these patients. METHODS: This was a retrospective cohort study of adults with EDS from specialty clinics at University of Michigan (2000-2019) who completed GBT for suspected SIBO. Demographics, history, medications, and GBT findings were reviewed. Patients with documented structural disease (eg. neoplasm) were excluded. GI symptoms were prospectively collected from all patients at their GBT. A priori variables associated with SIBO were analyzed including: presence of diabetes, GERD, and gastroparesis; history of small bowel surgery or gastric bypass; use of opioids or proton pump inhibitors. Positive GBT for SIBO was defined as breath H2 rise ≥20 ppm within 90 min and/or CH4 rise ≥10 ppm at any time after glucose ingestion. Statistical methods included chi-square and t test. Univariate regression analysis assessed the relationship between tested variables and GBT outcome. RESULTS: A total of 600 EDS patients were identified and 327 (54.5%) had at least one GI symptom. GBT was performed in 39 patients (mean age 37.6 ± 12.9; 94.8% female; 92.3% Caucasian) for suspected SIBO. Common symptomatic indications in these patients are shown in Table 1. 15 patients (38.5%) had positive GBT by either H2 (n = 11; 28.2%) and/or CH4 (n = 7; 17.9%). There were no significant differences in demographic factors between EDS patients with positive and negative GBT. Symptomatically, the presence of bloating was associated with a positive GBT (P = 0.04) but there was no significant association between any other GI symptom and the GBT outcome. Diagnosis of GERD was significantly associated with a positive GBT (P = 0.04) and there was a trend towards significant association between IBS and positive GBT (P = 0.07). None of other tested variables predicted the GBT outcome. CONCLUSION: SIBO diagnosed by GBT is common in EDS patients with chronic GI symptoms. Our preliminary results suggest that SIBO should be particularly considered in EDS patients with bloating and GERD. Further study is needed to delineate this relationship.