Intestinal Bacterial Overgrowth In Patients Research Articles

Rediscover the clinical value of small intestinal bacterial overgrowth in patients with intestinal Behçet's disease.

Many patients with intestinal Behçet's disease (BD) still suffer from gastrointestinal symptoms despite the disease being in endoscopic or radiological remission. Previous studies report that small intestinal bacterial overgrowth (SIBO) can be associated with inflammatory bowel disease. However, there have been no reports about SIBO in patients with intestinal BD. We sought to identify the frequency of SIBO in patients with inactive intestinal BD by hydrogen breath test (HBT) and to investigate the efficacy of rifaximin as a treatment for SIBO. Twenty-five patients with intestinal BD who had gastrointestinal symptoms even in endoscopic or radiological remission status were enrolled between January 2012 and January 2016. The patients filled out a questionnaire regarding their subjective gastrointestinal symptoms and took an HBT. Patients with positive HBT results were recommended to take 800-mg rifaximin daily for 14days. Nine patients (9/25, 36%) had a positive HBT test. Eight (8/9, 88.9%) were women, and their mean age was 48.7years. The most common symptom was abdominal distension (8/9, 88.9%), followed by abdominal discomfort (6/9, 66.7%). Rifaximin was prescribed to the nine patients with positive HBT, but two patients refused to take the medication. Four weeks later, six of the seven patients taking rifaximin (85.7%) reported symptom improvement, and none of them reported adverse events. More than one-third of the patients with inactive intestinal BD who had gastrointestinal symptoms were accompanied by SIBO using HBT. Rifaximin might be an effective and safe drug to treat these patients.

Prevalence and clinical significance of small intestinal bacterial overgrowth in patients with chronic liver disease

Prevalence and clinical significance of small intestinal bacterial overgrowth in patients with chronic liver disease

Small intestinal bacterial overgrowth in patients with systemic sclerosis

Small intestinal bacterial overgrowth (SIBO) is common in patients with systemic sclerosis (SSc) yet often goes underrecognized in clinical practice. In patients with SSc, untreated SIBO may result in marked morbidity and possible mortality. The pathogenesis of SIBO is multifactorial and relates to immune dysregulation, vasculopathy, and dysmotility. This article reviews various diagnostic approaches and therapeutic options for SIBO. Treatment modalities mainly include prokinetics, probiotics, and antibiotics.

Frequency of small intestinal bacterial overgrowth in patients with chronic pancreatitis detected by different methods

Frequency of small intestinal bacterial overgrowth in patients with chronic pancreatitis detected by different methods

Lubiprostone Accelerates Intestinal Transit and Alleviates Small Intestinal Bacterial Overgrowth in Patients With Chronic Constipation

BackgroundLubiprostone is an effective treatment for chronic constipation (CC). The mechanism of action of lubiprostone is through increasing fluid secretion and lubrication of the intestinal lumen. The effects of lubiprostone on gastrointestinal transit and small intestinal bacterial overgrowth (SIBO) have not been adequately explored. The current study was designed to investigate whether lubiprostone (1) alters gastrointestinal transit and (2) affects SIBO in patients with constipation. MethodsA total of 29 female patients (mean age = 39 years; range: 19-64) with CC received 2 weeks of lubiprostone (24mcg b.i.d., P.O.). Stool consistency based on Bristol stool scale and the frequency of bowel movements (BMs) were recorded. Gastric emptying time, small bowel transit time, colon transit time (CTT), combined small and large bowel transit time (SLBTT) and whole gut transit time were measured using wireless motility capsule. The SIBO status was assessed by the lactulose breath test. Data were analyzed using Wilcoxon rank, Mann-Whitney U, Spearman׳s rank correlation and Chi-square tests. ResultsLubiprostone significantly softened the stool and increased the frequency of BM from median of 2 to 4times per week. The CTT and SLBTT were significantly shorter in responders to lubiprostone (i.e., those with ≥ 2 times increase in the number of their weekly BM) compared with nonresponders. The higher frequency of BM after treatment was significantly correlated with the acceleration of CTT, SLBTT and whole gut transit time. In all, 17 out of 25 (68%) patients, who were tested for SIBO at baseline, were positive. In addition, 7 out of 17 (41%) SIBO-positive patients became SIBO-negative after lubiprostone treatment (P < 0.05). ConclusionsIn CC, lubiprostone improves the frequency of BMs, softens the stool, accelerates intestinal transit and decreases accompanying SIBO. The improvement of SIBO could be explained by the cleansing effect of increased intestinal fluid and mucus combined with enhanced intestinal motility with lubiprostone.

Effect of probiotics on small intestinal bacterial overgrowth in patients with gastric and colorectal cancer.

Small intestinal bacterial overgrowth (SIBO) may be related to the presence of gastrointestinal cancer. The exact link, however, between SIBO and cancer prevalence as well as cancer symptoms remains unclear, especially in Asian populations. In addition, there is a paucity of data documenting the influence of probiotic treatment of SIBO on cancer symptoms. Here, the aims were to correlate the presence of SIBO with cancer prevalence and cancer symptoms, as well as to investigate the effect of probiotic intervention on SIBO and cancer symptoms. Employing a case-control design, 112 gastric and 88 colorectal cancer patients were evaluated. Questionnaires were used to assess gastrointestinal symptoms and a glucose-H2-breath test (GHBT) was used to determine SIBO status. Patients with SIBO were administered Bifidobacterium triple viable capsule therapy or placebo. Subsequently, SIBO status and gastrointestinal symptom scores were reanalyzed. In our study group, 63.0% of patients versus 16.3% of controls was tested positive for SIBO. In patients with cancer, SIBO was associated with proton pump inhibitor (PPI) use. Bifidobacterium triple viable capsule was effective in combating SIBO and was associated with a significant improvement in gastrointestinal cancer-related symptoms. In a Chinese cohort, SIBO is associated with gastrointestinal cancer. Based on the preliminary intervention study, we conclude that probiotic intervention combats SIBO in patients with gastrointestinal cancer and alleviates its symptoms.

Su1583 The Prevalence of Delayed Orocecal Transit Time and Small Intestinal Bacterial Overgrowth in Patients With Functional Constipation

Su1583 The Prevalence of Delayed Orocecal Transit Time and Small Intestinal Bacterial Overgrowth in Patients With Functional Constipation

Mo1323 A Systematic Review of Antibiotic Treatment of Small Intestinal Bacterial Overgrowth in Patients with Systemic Sclerosis

Mo1323 A Systematic Review of Antibiotic Treatment of Small Intestinal Bacterial Overgrowth in Patients with Systemic Sclerosis

Small Intestinal Bacterial Overgrowth in Patients with Irritable Bowel Syndrome: Clinical Characteristics, Psychological Factors, and Peripheral Cytokines.

Small intestinal bacterial overgrowth (SIBO) has been implicated in the pathogenesis of irritable bowel syndrome (IBS). Psychosocial factors and low-grade colonic mucosal immune activation have been suggested to play important roles in the pathophysiology of IBS. In total, 94 patients with IBS and 13 healthy volunteers underwent a 10 g lactulose hydrogen breath test (HBT) with concurrent 99mTc scintigraphy. All participants also completed a face-to-face questionnaire survey, including the Hospital Anxiety and Depression Scale, Life Event Stress (LES), and general information. Serum tumour necrosis factor-α, interleukin- (IL-) 6, IL-8, and IL-10 levels were measured. The 89 enrolled patients with IBS and 13 healthy controls had no differences in baseline characteristics. The prevalence of SIBO in patients with IBS was higher than that in healthy controls (39% versus 8%, resp.; p = 0.026). Patients with IBS had higher anxiety, depression, and LES scores, but anxiety, depression, and LES scores were similar between the SIBO-positive and SIBO-negative groups. Psychological disorders were not associated with SIBO in patients with IBS. The serum IL-10 level was significantly lower in SIBO-positive than SIBO-negative patients with IBS.

Nutrition status and small intestinal bacterial overgrowth in patients with virus-related cirrhosis.

Malnutrition and small intestinal bacterial overgrowth (SIBO) is frequently present in patients with liver cirrhosis (LC). However, the direct relationship between SIBO and nutrition status in the LC patients has not been elucidated. The aim of this study was to investigate whether there was an association between nutrition status, evaluated by the subjective global assessment (SGA) and SIBO in patients with Hepatitis B virus (HBV) or hepatitis C virus (HCV) related cirrhosis. A total of 120 patients with HBV or HCV-related cirrhosis and 30 healthy controls were included. Nutritional status was determined according to SGA and anthropometry. All patients and healthy controls underwent a glucose hydrogen breath test for SIBO. The prevalence of malnutrition for the patients with HBV or HCV related cirrhosis ranged 19.4%-60% in China. The highest prevalence of malnutrition was detected by SGA, the lowest by triceps skinfold thickness. The frequency of SIBO was significantly higher in the malnourished (SGA-B/C) than in the well-nourished (SGA-A) patients with HBV or HCV related cirrhosis [41/72 (56.9%) vs 12/48 (25.0%) (p=0.001)]. Univariate analysis showed that SIBO, ascites, and Child-Turcotte-Pugh (CTP) class were associated with malnutrition. Multivariate analysis demonstrated that SIBO [odds ratio (OR) 8.10; p=0.002] and ascites (OR 4.56; p=0.022) were independently associated with the occurrence of malnutrition (SGA-B/C) in the same subjects. SIBO is independently related to the occurrence of malnutrition (SGA-B/C) in patients with HBV or HCV cirrhosis. We deduce that SIBO may play an important role in nutrition status in patients with HBV or HCV cirrhosis.

Upper gastrointestinal dysmotility and small intestinal bacterial overgrowth in patients with functional constipation

Upper gastrointestinal dysmotility and small intestinal bacterial overgrowth in patients with functional constipation

Small Intestinal Bacterial Overgrowth in Patients with Refractory Functional Gastrointestinal Disorders.

Background/AimsSmall intestinal bacterial overgrowth (SIBO) is considered to be involved in the pathogenesis of functional gastrointestinal disorders (FGID). However, the prevalence and clinical conditions of SIBO in patients with FGID remain to be fully elucidated. Here, we examined the frequency of SIBO in patients with refractory FGID.MethodsWe prospectively enrolled patients with refractory FGID based on Rome III criteria. A glucose hydrogen breath test (GHBT) was performed using a gas analyzer after an overnight fast, with breath hydrogen concentration measured at baseline and every 15 minutes after administration of glucose for a total of 3 hours. A peak hydrogen value ≥ 10 ppm above the basal value between 60 and 120 minutes after administration of glucose was diagnosed as SIBO.ResultsA total of 38 FGID patients, including 11 with functional dyspepsia (FD), 10 with irritable bowel syndrome (IBS), and 17 with overlapping with FD and IBS, were enrolled. Of those, 2 (5.3%) were diagnosed with SIBO (one patient diagnosed with FD; the other with overlapping FD and IBS). Their symptoms were clearly improved and breath hydrogen levels decreased to normal following levofloxacin administration for 7 days.ConclusionsTwo patients initially diagnosed with FD and IBS were also diagnosed with SIBO as assessed by GHBT. Although the frequency of SIBO is low among patients with FGID, it may be important to be aware of SIBO as differential diagnosis when examining patients with refractory gastrointestinal symptoms, especially bloating, as a part of routine clinical care.

Small intestinal bacterial overgrowth in patients with chronic pancreatitis.

To assess the prevalence of small intestinal bacterial overgrowth (SIBO) in chronic pancreatitis (CP), and analyze factors related with SIBO in CP. SIBO is to be considered a factor that worsens symptoms and nutritional status in patients with CP. However, the few studies evaluating the rate of SIBO in CP patients used nonuniform and nonstandardized procedures, and reported a wide range of positivity (0% to 92%). Those studies often investigated CP patients with previous resection surgery (cause of SIBO per se). CP patients and controls evaluated for SIBO by the H2 glucose breath test with a standard protocol. For CP patients, the relationship between test results, abdominal symptoms, and clinical and biochemical variables was analyzed. A total of 43 CP patients and 43 controls were enrolled. Of the CP patients, 8 had advanced disease (defined by M-ANNHEIM index) and none had undergone previous surgery. The glucose breath test positivity rate was higher in the CP patients than in the controls (21% vs. 14%), albeit without a significant difference (P=0.57). Mean fasting H2 excretion and mean H2 excretion at 120 minutes also had a trend toward higher levels in CP patients. There were no clinical differences between CP patients with or without SIBO, but there were nutritional differences for lower levels of vitamin D and higher levels of folate in these patients with SIBO. Our findings suggest that SIBO is not uncommon in uncomplicated CP patients. The lack of a significant difference compared with controls might be due to the study being underpowered. SIBO in CP patients does not seem to be related to peculiar clinical features, but it might affect nutritional status.

Rifaximin for small intestinal bacterial overgrowth in patients without irritable bowel syndrome.

BackgroundRifaximin is a minimally absorbed antibiotic with high luminal activity, used to treat various gastrointestinal diseases. Although rifaximin has been proposed as first line treatment for small intestinal bacterial overgrowth (SIBO), few data are available regarding its efficacy in non-IBS subjects. We aimed to assess the ability of rifaximin to normalize lactulose-H2 breath tests in non-IBS subjects with symptoms suggestive of SIBO.Materials and methodsConsecutive non-IBS patients presenting with bloating and flatulence were prospectively recruited and submitted to lactulose-H2 breath testing (LBT). Patients who had a positive result were offered rifaximin 1200 mg daily for 10 days. Breath testing was repeated two weeks after treatment completion in all patients in order to assess for response.ResultsA total of 19 patients with a positive result received rifaximin and repeated the breath test (7 (36.8%) males, age 56.5 ± 17.6 years). The mean peak hydrogen excretion was 13.7 ± 2.8 and 10.3 ± 7.3 ppm at baseline and following rifaximin treatment, respectively (t = 1.98, p = 0.06). LBT normalized in 8/19 (42.1%) subjects. No patients reported symptom resolution. No adverse events were reported.DiscussionStrengths include the study's prospective design. Limitations include the small sample size and open label design.ConclusionRifaximin was not effective in normalizing LBT in our cohort of non-IBS subjects with symptoms suggestive of SIBO.

Difficulties in diagnostics of small intestinal bacterial overgrowth in patients with chronic pancreatitis

s / Pancreatology 14 (2014) S1eS129 S42 extracted and pooled to estimate sensitivity, specificity and diagnostic odds ratios using Bayesian Hierarchical Summary ROC methods. Data are presented as portions s(95% Confidence Intervals). Results: Of 1373 studies, 55 were suitable for inclusion (37 cohort studies, 18 case-control) evaluating 27 different tests. Forty-five percent (2453/5441) of individuals had a diagnosis of CP; the prevalence of CP within cohort studies ranged from 0.12 to 0.94. Diagnostic sensitivity ranged from 0.12 to 1 and specificity from 0.16 to 1. Endoscopic ultrasound (EUS) was the most extensively evaluated diagnostic test being the focus of 16 studies, using different diagnostic models; however, EUS showed the highest pooled sensitivity at 0.90 (0.78,0.96). The accuracy of MR was improved by the addition of secretin: sensitivity 0.81 (0.66,0.9) vs. 0.83 (0.56,0.95); specificity 0.8 (0.61,0.91) vs. 0.89 (0.76,0.96). Conclusion: A wide range of tests for CP have been evaluated in heterogeneous populations making comparison challenging. EUS and secretin MR show good sensitivity and specificity, but specific diagnostic parameters have to be defined to ensure optimum diagnostic utility.

Small intestinal bacterial overgrowth in patients with progressive familial intrahepatic cholestasis.

To date, no studies concerning the presence of small intestinal bacterial overgrowth in patients with progressive familial intrahepatic cholestasis were published. Based upon characteristic of progressive familial intrahepatic cholestasis one can expect the coexistence of small intestinal bacterial overgrowth. The aim of the study was to assess the incidence of small intestinal bacterial overgrowth in patients with progressive familial intrahepatic cholestasis. 26 patients aged 8 to 25 years with progressive familial intrahepatic cholestasis were included in the study. Molecular analysis of ABCB11 gene was performed in the vast majority of patients. In all patients Z-score for body weight and height, biochemical tests (bilirubin, bile acid concentration, fecal fat excretion) were assessed. In all patients hydrogen-methane breath test was performed. On the basis of first hydrogen-methane breath test, diagnosis of small intestinal bacterial overgrowth was confirmed in 9 patients (35%), 5 patients (19%) had borderline results. The second breath test was performed in 10 patients: in 3 patients results were still positive and 2 patients had a borderline result. The third breath test was conducted in 2 patients and positive results were still observed. Statistical analysis did not reveal any significant correlations between clinical, biochemical and therapeutic parameters in patients with progressive familial intrahepatic cholestasis and coexistence of small intestinal bacterial overgrowth. Our results suggest that small intestinal bacterial overgrowth is frequent in patients with progressive familial intrahepatic cholestasis. Moreover, it seems that this condition has the tendency to persist or recur, despite the treatment.

Breath Testing for Small Intestinal Bacterial Overgrowth: Maximizing Test Accuracy

The diagnosis of small intestinal bacterial overgrowth (SIBO) has increased considerably owing to a growing recognition of its association with common bowel symptoms including chronic diarrhea, bloating, abdominal distention, and the irritable bowel syndrome. Ideally, an accurate and objective diagnosis of SIBO should be established before initiating antibiotic treatment. Unfortunately, no perfect test exists for the diagnosis of SIBO. The current gold standard, small-bowel aspiration and quantitative culture, is limited by its high cost, invasive nature, lack of standardization, sampling error, and need for dedicated infrastructure. Although not without shortcomings, hydrogen breath testing provides the simplest noninvasive and widely available diagnostic modality for suspected SIBO. Carbohydrates such as lactulose and glucose are the most widely used substrates in hydrogen breath testing, with glucose arguably providing greater testing accuracy. Lactose, fructose, and sorbitol should not be used as substrates in the assessment of suspected SIBO. The measurement of methane in addition to hydrogen can increase the sensitivity of breath testing for SIBO. Diagnostic accuracy of hydrogen breath testing in SIBO can be maximized by careful patient selection for testing, proper test preparation, and standardization of test performance as well as test interpretation.

Small intestine bacterial overgrowth in patients with chronic pancreatitis

Small intestine bacterial overgrowth in patients with chronic pancreatitis

Evaluation of small intestine bacterial overgrowth in patients with functional dyspepsia through H2 breath test

Functional dyspepsia is a condition in which symptoms are not related to organic underlying disease; its pathogenesis is not well known. The small intestinal bacterial overgrowth (SIBO) is characterized by the increase in the number and/or type of colonic bacteria in the upper gastrointestinal tract. The hypothesis of SIBO being associated to functional dyspepsia must be considered, since the impaired motility of the gastrointestinal tract is one of the main etiologic factors involved on both pathologies. To determine if there is SIBO in patients with functional dyspepsia. Case-control study, evaluating 34 patients: 23 functional dyspeptic and 11 non-dyspeptic (control group). Questionnaire applied based on Rome III criteria. The patients underwent H2-lactulose breath test, considered positive when: H2 peak exceeding 20 ppm, in relation to fasting, or two peaks exceeding 10 ppm sustained until 60 minutes. Of the 23 dyspeptic patients, 13 (56.5%) obtained positive results for SIBO trough the H2-lactulose breath test. On control group, SIBO was not observed. The association between the dyspeptic group and the control group regarding SIBO was statistically significant, with P = 0.0052. In the group of dyspeptic patients, 12 (52.2%) were using proton pump inhibitor; of these 9 (75%) were positive for SIBO. In the control group, none of the 11 patients used proton pump inhibitors and SIBO was not observed. The association of the dyspeptic group using proton pump inhibitor that were positive for SIBO and the control group was statistically significant, with P = 0.0011. It was found that, patients with functional dyspepsia presented SIBO, when they underwent to H2-lactulose breath test, compared to the non-dyspeptic. In addition, it was observed a higher prevalence of SIBO in dyspeptic patients that were using proton pump inhibitors, compared to control group.

Tu1483 Symptoms of Small Intestinal Bacterial Overgrowth in Patients With Gastroparesis

Background: Delayed gastric emptying is commonly seen in small intestinal bacterial overgrowth (SIBO), and is often proposed as a major risk factor for this condition. The 14C DXylose breath test (XBT) has been used to diagnose SIBO and based on our data has demonstrated excellent reliability as a diagnostic measure (King & Toskes Gastro 1986). Delayed gastric emptying affects the delivery of nutrients to the small intestine and therefore could impact the results of XBT. Objectives: We aim to evaluate (1) whether delayed gastric emptying affects the pattern of D-Xylose BT results, and (2) whether delayed gastric emptying increases the risk of SIBO. Methods: A retrospective chart review was conducted on 846 patients with XBT between 2005 and 2009, male: female 168:678 (ratio 1:4), median age 57 years (age range 20-88). All of the patients were referred by GI clinics for various GI symptoms to rule out SIBO. The XBT was obtained by measuring 14C at baseline, 30, 60 and 180 minutes as per our protocol. Positive XBT was defined as an increased value of 14C at any one or more time points. A delayed gastric emptying by gastric emptying scintigraphy (GES) was defined by T1/2 greater than 90 minutes after ingestion of a standard 254 calorie meal based on 2 hour continuous scanning. Results: Of 846 patients with XBT, 498 patients tested positive for SIBO. Of these patients positive for SIBO, 229 had GES completed and 41% (94/229) were found to have delayed gastric emptying. Of 348 patients with a negative XBT, 167 had GES with 45% (75/167) having delayed gastric emptying. The risk of delayed gastric emptying was similar in both XBT positive and the negative group, with a likelihood ratio of 0.7, p>0.2. Of 229 patients with a positive XBT, the proportion of patients with a positive D-Xylose BT at 30 and 60 minutes were similar in both the normal and abnormal GES groups. However, a significantly increased number of patients with delayed gastric emptying had a positive XBT at 180 minutes (72.7% vs 54.4%, likelihood ratio = 6, p<0.02). Conclusion: Delayed gastric emptying significantly delays XBT positivity to 180 minutes. Prolonged duration of XBT up to the 180-minute period would increase the sensitivity of the breath test in patients with underlying motility disorders such as gastroparesis or even small bowel dysmotility. Surprisingly, based on our retrospective analysis, delayed gastric emptying was not found to be an independent risk factor of SIBO. A well-designed prospective study in the future with standard GES would be indicated to assess the association of SIBO and gastroparesis. (Acknowledgment: This study was funded by University of Florida CTSI NIH Grant UL1RR029890, and UF KL2RR029888 Award to Baha Moshiree MD, MS)