Abstract
Functional dyspepsia (FD) is associated with small intestinal bacterial overgrowth (SIBO). Several animal studies have reported that ursodeoxycholic acid (UDCA) has antibacterial and anti-inflammatory effects in the intestine. We hypothesized that UDCA may be effective against dyspeptic symptoms and SIBO in patients with FD. We conducted this randomized controlled trial to investigate the effects of UDCA in FD patients with SIBO. Twenty-four patients diagnosed with FD and SIBO based on lactulose breath test (LBT) were randomly assigned to either a UDCA treatment group or an untreated group. The treatment group received 100 mg of UDCA three times per day for two months; the untreated group was monitored for two months without intervention. After two months in both groups, we reevaluated LBT and FD symptoms using the Nepean dyspepsia index-K. FD symptoms in the UDCA-treated group were significantly reduced after two months compared with baseline and FD symptom scores between the UDCA-treated and untreated groups showed statistically significant differences after two months. In addition, the total methane gas levels for 90 minutes in LBT were significantly decreased after two months compared with baseline in the UDCA-treated group. In this preliminary exploratory study, we found that two months of UDCA treatment resulted in FD symptom improvement and reduced methane values during 90 minutes on the LBT, suggesting that methane-producing SIBO were associated with symptoms of dyspepsia and that UDCA was helpful in these patients. These findings need to be validated via large-scale controlled and well-designed studies.
Highlights
Functional dyspepsia (FD) is a functional digestive disorder characterized by one or more of the following symptoms: postprandial fullness, early satiation, epigastric pain and epigastric burning [1]
Treatment resulted in FD symptom improvement and reduced methane values during 90 minutes on the lactulose breath test (LBT), suggesting that methane-producing small intestinal bacterial overgrowth (SIBO) were associated with symptoms of dyspepsia and that Ursodeoxycholic acid (UDCA) was helpful in these patients
We hypothesize that treatment with UDCA improves upper gastrointestinal symptoms and SIBO in patients with FD. In this randomized controlled trial, we investigated whether dyspepsia symptoms and SIBO improved when FD patients whose SIBO was confirmed by a breath test were treated with UDCA
Summary
Functional dyspepsia (FD) is a functional digestive disorder characterized by one or more of the following symptoms: postprandial fullness, early satiation, epigastric pain and epigastric burning [1]. The causes of FD include Helicobacter pylori infection, visceral hypersensitivity and disturbed gastric motility [2,3,4,5], emerging evidence suggests that intestinal bacterial imbalance, small intestinal bacterial overgrowth (SIBO), may be one of the causes underlying. A shift in paradigm suggests that the role of SIBO is important in the development of FD. SIBO measured by hydrogen breath test was indicated for the clinical management of patients with suspected FD [8]. FD patients’ symptoms improved after two weeks of treatment with non-absorbing antibiotic rifaximin, which was effective in treating SIBO [9]. Ursodeoxycholic acid (UDCA) is one of the secondary bile acids secreted in the body and is used as a representative liver supplement. Primary bile acids (cholic and chenodeoxycholic acids)
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