Rational Use of Antibiotics in the Treatment of Functional Bowel Disorders

Michele Di Stefano,Roberta Fasulo,Gino Roberto Corazza

doi:10.3390/ph3082380

Michele Di Stefano, Roberta Fasulo + Show 1 more

Open Access

https://doi.org/10.3390/ph3082380

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Journal: Pharmaceuticals	Publication Date: Jul 26, 2010
Citations: 21	License type: CC BY 3.0

Affiliation: University of Pavia

Abstract

Functional gastrointestinal symptoms such us bloating, fullness, flatulence, diarrhea, and constipation due to irritable bowel syndrome (IBS) were recently attributed to small bowel bacterial overgrowth, a condition depending on the presence of an increased number of bacteria in the small bowel. However, the methodology used to describe this association may be harshly criticized, since it has already been shown to be quite inaccurate. As a result an inappropriate use of antibiotics was consequently generated. In fact, antibiotics could be effective in the treatment of functional complaints, but only in a limited subgroup of patients, characterized by an increase of fermentation at colonic level. In this review, we have examined the papers suggesting a pathophysiological link between IBS and small bowel bacterial overgrowth, underlining its inappropriateness, and put forth our personal view on the rationale for antibiotic use in IBS.

Highlights

It has been estimated that functional bowel disorders are characterized by a high prevalence in the general population [1] and they represent a very frequent cause for gastroenterological outpatient consultation [2]
Small Intestine Bacterial Overgrowth (SIBO) is a condition defined by the presence of pathological amounts or types of bacteria at the small bowel level, responsible for a malabsorption syndrome, clinically evident through a spectrum of symptoms such as diarrhea, flatulence, abdominal pain, bloating, and, in more severe cases, anaemia, weight and bone loss [19,20]
Two major criticisms may be raised against these results: first, jejunal aspirate was performed through the central channel of a manometric catheter, without adopting methods that could exclude a possible contamination by oro-pharyngeal flora, that may be responsible for a descending contamination; second, no study is available showing that the presence of 103 CFU/mL in jejunal aspirate causes an alteration of small bowel intraluminal micro-environment, responsible for malabsorption and symptom onset

Summary

Introduction

It has been estimated that functional bowel disorders are characterized by a high prevalence in the general population [1] and they represent a very frequent cause for gastroenterological outpatient consultation [2]. Apart from pain and the modification of bowel habit, patients with irritable bowel. Pharmaceuticals 2010, 3 syndrome (IBS) present a wide range of symptoms and co-morbidities, recently extensively reviewed as regards both prevalence and pathophysiology [3,4,5]. Bloating may represent a very bothersome symptom and may be present in up to 80-90% of patients [6,7,8,9,10]. Another annoying symptom is flatulence, very frequent in patients with IBS [11] and not always associated with bloating

Intestinal Gas and Symptoms

Clinical Overlap between Small Intestine Bacterial Overgrowth and IBS

The Inaccuracy of the Lactulose Breath Test to Diagnose SIBO

The Rationale for the Use of Antibiotics in IBS

Findings

Conclusions