S1564 Association of SIBO Symptoms with Breath-Test Results and Response to Treatment

Abstract

Introduction: Small intestinal bowel overgrowth (SIBO) is a common gastrointestinal disorder caused by excessive microbial growth in the small intestine, leading to a wide range of symptoms such as abdominal distention, bloating, nausea, vomiting, diarrhea, constipation, steatorrhea, and weight loss. We aimed to explore the association between patients' presenting SIBO symptoms to their breath-test results and response to treatment to determine whether the symptoms could potentially be used as a predictive tool for aiding in the diagnosis and treatment of SIBO. Methods: A retrospective analysis was performed on a single-center study population from 2019 to 2021. The study population consisted of patients who had tested positive for SIBO for the first time. Chi-squared test and Fisher’s exact test were the statistical analyses used to assess for any associations between symptoms and breath test results and associations between symptoms and response to treatment. This study received IRB approval. Results: 174 patients tested positive for SIBO. The most common presenting symptom was bloating/distention (79.9%), followed by pain/discomfort (66.7%), diarrhea (48.9%), constipation (36.8%), nausea/vomiting (28.2%), weight loss (16.1%), flatulence (13.8%), and steatorrhea (6.9%). Breath tests were positive for hydrogen, methane, and both gases in 76.5%, 18.4%, and 5.2% of patients respectively. Most patients were treated with rifaximin (69%), followed by rifaximin + neomycin combination (6.9%), metronidazole (4.6%), ciprofloxacin (4.6%), amoxicillin-clavulanate (4.6%), and other (2.3%). The P-values for the associations between symptoms and breath-test positivity (hydrogen or methane) and the associations between symptoms and response to therapy are outlined in our Table. None of the associations had a P-value < 0.05. Response to treatment using rifaximin + neomycin combination vs rifaximin alone had a P-value = 0.5. Conclusion: There was no statistically significant relationship between symptoms and breath-test positivity. There was also no statistically significant relationship between symptoms and response to therapy. In addition, there does not appear to be an increased efficacy of using rifaximin + neomycin combination compared to rifaximin alone. Table 1. - P-values for the association between symptom and breath test positivity (hydrogen or methane) and the association between symptom and response to therapy Symptoms Association with breath-test results (hydrogen/methane) Association with response to therapy Bloating/distention P = 0.08 P = 0.20 Pain/discomfort P = 0.37 P = 0.52 Diarrhea P = 0.60 P = 0.099 Constipation P = 0.35 P = 0.37 Nausea/vomiting P = 0.20 P = 0.57 Weight loss P = 0.22 P = 0.60 Flatulence P = 0.19 P = 1.0 Steatorrhea P = 0.95 P = 0.68