Abstract
Duodenal aspirates are not commonly collected, but they can be easily used in detection of small intestinal bacterial overgrowth (SIBO). Proton pump inhibitor (PPI) use has been proposed to contribute to the development of SIBO. We aimed to determine the yield of SIBO-positive cultures detected in duodenal aspirates, the relationship between SIBO and PPI use, and the clinical outcomes of patients identified by this method. In a retrospective study, we analyzed electronic medical records from 1263 consecutive patients undergoing upper endoscopy at a tertiary medical center. Aspirates were collected thought out the third and fourth portions of the duodenum, and cultures were considered to be positive for SIBO if they produced more than 100,000 cfu/mL. Culture analysis of duodenal aspirates identified SIBO in one-third of patients. A significantly higher percentage of patients with SIBO use PPIs than patients without SIBO, indicating a possible association. Similar proportions of patients with SIBO improved whether or not they received antibiotic treatment, calling into question the use of this expensive therapy for this disorder.
Highlights
Small intestinal bacterial overgrowth (SIBO) is a clinical entity that may be responsible for a constellation of symptoms that include bloating, abdominal distension, pain, and diarrhea
There is controversy regarding the association between pump inhibitor (PPI) therapy and SIBO, a recent meta-analysis has suggested a positive association only when the diagnosis of SIBO is based on aspiration cultures [3, 4]
Multivariant analysis was performed for the patients who had positive cultures and among all groups distributed by symptoms, diarrhea was the only variable statistically significant associated with clinical improvement
Summary
Small intestinal bacterial overgrowth (SIBO) is a clinical entity that may be responsible for a constellation of symptoms that include bloating, abdominal distension, pain, and diarrhea. The diagnosis requires a positive culture defined as >100,000 colony forming units per mL (cfu/mL) in aspirates obtained from the small bowel [1]; some have used the less frequent and not as reliable cutoff of 10,000 cfu/mL [2]. We sought to evaluate a cohort of patients undergoing EGD with duodenal aspirates to determine the diagnostic yield of cultures, clinical response to antibiotic treatment and the risk factors associated with SIBO. There is controversy regarding the association between PPI therapy and SIBO, a recent meta-analysis has suggested a positive association only when the diagnosis of SIBO is based on aspiration cultures [3, 4]. We hypothesized that PPI use would be associated with higher rates of positive duodenal aspirate culture in our population
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