Tu1815 Acid-Stable Fungal Enzymes Improve Food Digestion and Nutrient Release in a Dynamic Human Stomach Model System

Abstract

INTRODUCTION Chronic abdominal pain and steatorrhea are common complications of chronic pancreatitis (CP). Among possible multifactorial etiologies, small intestinal bacterial overgrowth (SIBO) is suspected. The prevalence and the factors promoting SIBO in CP patients are poorly known in the literature. AIM : To determine the prevalence of SIBO in patients with CP. METHODS : Prospective case-control study conducted at Centre Hospitalier de l'Universite de Montreal (Quebec, Canada) from January to September 2013. Inclusion criterias: age 18 to 75 yo, clinical and radiological diagnosis of CP. Exclusion criterias: history of gastric, pancreatic or intestinal surgery, significant clinical gastroparesis. The presence of SIBO was detected using a standard breath test (ingestion of 10 g of lactulose followed by measurements of concentrations of hydrogen and methane in breath every 15 minutes for 3 hours). Positivity criterias validated in the literature and in force at CHUM are baseline H2> 20 ppm, peak of 20 ppm or two consecutive peaks of H2 or CH4 of 13 ppm during the first 90 minutes. Patients should not have taken antibiotics in the 30 days before and were asked to stop prokinetics and laxatives seven days before the test. Patients and controls were also asked to complete a standardized medical history questionnaire scoring the severity of different symptoms. The CP patients group was compared to a healthy control group. RESULTS: 31 patients (mean age 53.8 SD 14.1 years; 29% of female) and 40 controls (mean age 38.7 SD 12.1 years; 87% of female) were included. The prevalence of SIBO was significantly higher in patients than in controls (38.7% vs. 2.5%; p < 0.01). Women showed higher prevalence of SIBO than men (66.6 vs. 27.3%, p = 0.05). Among patients with CP, there were no differences between the subgroups with and without SIBO in terms of age, lifestyle, body mass index, etiology of the CP, use of opiates, pancreatic enzymes, PPI use or severity of symptoms. CONCLUSION : The prevalence of SIBO is high among patients with CP. We have shown no association between clinical features and the risk of SIBO except for gender. SIBO should be sought in all symptomatic patients with CP.