P262 Diagnosis and management of small intestinal bacterial overgrowth (SIBO): current practice across England

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Introduction Despite causing multiple gastrointestinal symptoms, a diagnosis of small intestinal bacterial overgrowth (SIBO) can be difficult to establish due to the lack of a standardised diagnostic test. Current BSG guidelines advise empirical antibiotic treatment in high probability cases,1 although evidence for which antibiotic to use first line and duration of treatment is lacking.2 As a result of these factors, we suspect that current practice in the diagnosis and management of SIBO may vary considerably between gastroenterologists across the country and aimed to assess this. Methods A brief survey was created to collect data on the diagnosis and treatment of SIBO, as well as the methodology used for hydrogen/methane breath testing (HMBT) in comparison with recent UK guidelines.3 The survey was emailed to 607 gastroenterologists (consultants/registrars) who’s email addresses were obtained through an existing database or via the nhs.net email server. Results There were 57 (9%) respondents from 31 different hospitals. Recent UK guidelines3 advise that best practice for HMBT should measure methane excretion in addition to hydrogen and have both lactulose and glucose substrates available for testing, but this was only done in 7/31 (22%) and 11/31 (35%) hospitals respectively. Rifaximin (26), followed by metronidazole (10), co-amoxiclav (10) and ciprofloxacin (9) were the most commonly used antibiotics for SIBO treatment, with antibiotics usually given between 10 – 14 days (44/57, 77%), although length of treatment prescribed varied from 5 – 21 days (see figure 1). Most gastroenterologists (61%) would initially give antibiotic treatment for a suspected high probability case of SIBO but request a breath test first (65%) if the patient was only felt to have a moderate probability of SIBO. Conclusion Best practice guidelines on HMBT are not followed in many hospitals in England and there is considerable variation among gastroenterologists between first-line antibiotic choice and duration of treatment. Improving standards of HMBT would increase accuracy of testing, while greater evidence for choice and duration of antibiotic therapy in SIBO would improve consistency of treatment among clinicians, resulting in cost-savings and fewer side effects to patients from unnecessarily long or repeated courses of antibiotics. References Arasaradnam et al. Guidelines for the investigation of chronic diarrhoea in adults: British Soceity of Gastroenterology, 3rd edition. Gut 2018;0:1–20 Shah S, et al. Meta-analysis: antibiotic therapy for small intestinal bacterial overgrowth. Aliment Pharmacol Ther 2013; October; 38(8): 925–934 Sweis, et al. New AGIP recommendations of best practice in hydrogen/methane breath testing for SIBO and carbohydrate malabsorption. New Wave 2019; February:7–10