Common Gastrointestinal Symptoms Do Not Predict the Results of Glucose Breath Testing in the Evaluation of Suspected Small Intestinal Bacterial Overgrowth Presidential Poster

Abstract

Introduction: Given the variability in the presentation of small intestinal bacterial overgrowth, it remains unknown if specific gastrointestinal symptoms are predictive of this condition. To assess the prevalence of gastroesophageal reflux disease (GERD), dyspeptic, and irritable bowel syndrome (IBS) symptoms in adults with a positive glucose breath test (GBT) compared with those demonstrating a negative GBT. Methods: A retrospective analysis was performed on all patients presenting to a large US medical center for glucose breath testing for suspected small intestinal bacterial overgrowth. Each patient reported on the presence or absence of ten specific gastrointestinal symptoms at the time of breath testing including heartburn, regurgitation, chest pain, nausea, vomiting, abdominal pain, bloating, gas, diarrhea and constipation. Heartburn, regurgitation and/or chest pain were grouped as GERD symptoms. Abdominal pain, nausea, vomiting, and/or bloating in the absence of diarrhea or constipation were grouped as dyspeptic symptoms. Abdominal pain and/or bloating in association with either diarrhea and/or constipation were grouped as IBS symptoms. Comparisons of dichotomous variables were performed using a chi-square test. Results: Data was collected and analyzed on 5045 patients (mean age 50.9 years, 70% female, 87% Caucasian). 1680 patients (33.3%) had a positive GBT indicating small intestinal bacterial overgrowth. The percentage of patients with a positive GBT reporting individual symptoms of heartburn, regurgitation, chest pain, nausea, abdominal pain, bloating, gas, diarrhea and constipation was no different than those with a negative GBT (table 1). Vomiting was reported by more patients with a positive GBT, 39% versus 33% in those with a negative GBT. For patients with a positive GBT, 32.7 % reported one or more GERD symptoms compared to 34.5% reporting no GERD symptoms; 33.1 % reported one or more dyspeptic symptoms compared to 36.3% reporting no dyspeptic symptoms; and 33.3% reported two or more IBS symptoms compared to 33.9% reporting no IBS symptoms. Conclusion: Common GERD, dyspeptic and IBS symptoms do not predict the presence or absence of small intestinal bacterial overgrowth as assessed by the GBT. These findings underscore the importance of GBT in the assessment of suspected small intestinal bacterial overgrowth.Table 1: Percentage of Patients Reporting Gastrointestinal Symptoms Based on Glucose Breath Test Results