Abstract
Background. Patients with chronic pancreatitis (CP) exhibit numerous risk factors for the development of small intestinal bacterial overgrowth (SIBO). Objective. To determine the prevalence of SIBO in patients with CP. Methods. Prospective, single-centre case-control study conducted between January and September 2013. Inclusion criteria were age 18 to 75 years and clinical and radiological diagnosis of CP. Exclusion criteria included history of gastric, pancreatic, or intestinal surgery or significant clinical gastroparesis. SIBO was detected using a standard lactulose breath test (LBT). A healthy control group also underwent LBT. Results. Thirty-one patients and 40 controls were included. The patient group was significantly older (53.8 versus 38.7 years; P < 0.01). The proportion of positive LBTs was significantly higher in CP patients (38.7 versus 2.5%: P < 0.01). A trend toward a higher proportion of positive LBTs in women compared with men was observed (66.6 versus 27.3%; P = 0.056). The subgroups with positive and negative LBTs were comparable in demographic and clinical characteristics, use of opiates, pancreatic enzymes replacement therapy (PERT), and severity of symptoms. Conclusion. The prevalence of SIBO detected using LBT was high among patients with CP. There was no association between clinical features and the risk for SIBO.
Highlights
Small intestinal bacterial overgrowth (SIBO) is defined as the presence of >105 bacteria/mL in the small bowel, most of which are enterobacteria from the colonic flora [1]
The main risk factors for small intestinal bacterial overgrowth (SIBO) include conditions associated with stasis of intestinal content due to structural abnormalities or dysmotility [1,2,3,4,5,6] as well as conditions associated with achlorhydria [1, 2]
It is hypothesized that pancreatic enzymes have antimicrobial properties and modify the intestinal chyme [12, 13] and that a deficiency leads to SIBO
Summary
Small intestinal bacterial overgrowth (SIBO) is defined as the presence of >105 bacteria/mL in the small bowel, most of which are enterobacteria from the colonic flora [1] Such overgrowth can cause malabsorption and maldigestion, which subsequently leads to diarrhea, steatorrhea, bloating, chronic pain, and vitamin B12 deficiency [1]. Many factors are associated with both CP and SIBO, especially alcohol and narcotic use, intestinal dysmotility, and pancreatic enzyme deficiency [11]. Patients with chronic pancreatitis (CP) exhibit numerous risk factors for the development of small intestinal bacterial overgrowth (SIBO). The proportion of positive LBTs was significantly higher in CP patients (38.7 versus 2.5%: P < 0.01). The subgroups with positive and negative LBTs were comparable in demographic and clinical characteristics, use of opiates, pancreatic enzymes replacement therapy (PERT), and severity of symptoms. There was no association between clinical features and the risk for SIBO
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