Prevalence Of Small Intestinal Bacterial Overgrowth In Patients Research Articles

Small Intestinal Bacterial Overgrowth in Patients with Gallbladder Polyps: A Cross-Sectional Study.

There is probably a high prevalence of small intestinal bacterial overgrowth (SIBO) in patients with gallbladder polyps (GBPs). To date, no study has evaluated the occurrence of SIBO in patients with GBPs. The aim of this study was to investigate the prevalence of SIBO in patients with GBPs and explore the possible association between these two conditions. The hydrogen-methane breath test was used to diagnose SIBO, and patients were divided into GBPs and control groups based on whether GBPs were found under ultrasound. Clinical and paraclinical factors were compared between the two groups. A total of 297 subjects were included in this study. The prevalence of SIBO was significantly higher in the GBPs group than in the control group (50.0% vs.30.8%, p<0.01). Multivariate logistic regression analysis showed that male (OR=2.26, 95% CI=1.12-4.57, p=0.023), SIBO (OR=3.21, 95% CI=1.69-6.11, p<0.001), fatty liver (OR=2.91, 95% CI= 1.50-5.64, p=0.002) and BMI (OR=1.13, 95% CI=1.01-1.26, p=0.035) were independently associated with GBPs. And by subgroup analysis, we found that the association between SIBO and GBPs was stronger in females than in males (p for interaction< 0.001). In addition, SIBO (OR=5.11, 95% CI=1.42-18.36, p=0.012) and fasting glucose (OR=3.04, 95% CI=1.27-7.28, p=0.013) were found to be associated with solitary polyps. SIBO was highly prevalent in patients with GBPs, and this association seemed to be stronger among females.

Risk factors for small intestinal bacterial overgrowth in patients with acute ischaemic stroke.

Introduction. The intestinal flora has become a promising new target in acute ischaemic stroke (AIS), and small intestinal bacterial overgrowth (SIBO) is a common pathological condition of the intestinal flora. Recently, the lactose hydrogen-methane breath test has emerged as a non-invasive and economical method for the detection of SIBO in AIS patients. Exploring the prevalence of SIBO and its associated risk factors will provide a clinical basis for the association between intestinal flora and AIS.Hypothesis/Gap Statement. Given that the prevalence of SIBO and its risk factors in patients with AIS remain to be studied, there is a need to investigate them.Aim. This study aimed to investigate the prevalence and risk factors of SIBO in patients with AISMethodology. Eighty patients tested for SIBO using the lactulose hydrogen-methane breath test were evaluated. Patients were divided into SIBO-positive and SIBO-negative groups according to the presence or absence of SIBO, respectively. The baseline characteristics and clinical biochemical indicators of the patients were compared between the two groups. The independent risk factors and predictive value of SIBO in AIS patients were determined using multivariate logistic regression and receiver operating characteristic (ROC) curve analyses.Results. Of the 80 consecutive patients with AIS, 23 (28.8 %) tested positive for SIBO. Triglyceride (TG) and homocysteine (Hcy) levels were identified as independent risk factors for SIBO in patients with AIS using multivariate logistic regression analysis (P<0.005). ROC curve analysis showed that the area under the curve (AUC) of TG was 0.690 (95 % CI 0.577-0.789, P=0.002). The sensitivity, specificity and optimal cut-off values were 95.7 %, 35.1 % and 1.14 mmol l-1, respectively. The AUC of Hcy was 0.676 (95 % CI 0.562-0.776, P=0.01). The sensitivity, specificity and optimal cut-off values were 73.9 %, 59.7 % and 14.1 µmol-1, respectively. When TG and Hcy levels were combined, the AUC increased to 0.764 (95 % CI 0.656-0.852, P<0.001). The specificity and sensitivity were 61.4 and 82.6 %, respectively. This showed that the combined detection of TG and Hcy levels had a higher predictive valueConclusion. The prevalence of SIBO in patients with AIS was 28.8 %. TG and Hcy levels are independent risk factors for SIBO in patients with AIS. Both markers had good predictive value for the occurrence of SIBO. In the future, we should actively utilize these indicators to prevent intestinal flora imbalance and the occurrence of SIBO.

Lactase Deficiency Diagnosed by Endoscopic Biopsy-based Method is Associated With Positivity to Glucose Breath Test

Lactase deficiency, which has many similarities with small intestinal bacterial overgrowth (SIBO), causes various gastrointestinal symptoms. We estimate the prevalence of SIBO in patients with intestinal symptoms from dairy products and investigate the association between lactase deficiency (LD) and SIBO. This prospective study included patients with functional intestinal symptoms from dairy product indigestion. A questionnaire on gastrointestinal symptoms, a hydrogen (H2)-methane glucose breath test (GBT) for SIBO, and lactose intolerance quick test (LQT) for LD using upper gastrointestinal endoscopy were performed. A total of 88 patients, 29 (33.0%) with severe and 36 (40.9%) with mild LD were included. Sixteen patients (18.2%) were GBT positive. Patients with LQT negativity indicating severe LD showed a higher positivity to GBT or GBT (H2) than the historic controls (27.6% vs 6.7%, P = 0.032). There was no difference in the items on the symptom questionnaire according to the presence of LD or SIBO, except for higher symptom scores for urgency in GBT-positive patients. There were more LQT-negative patients in the GBT (H2)-positive group than in the other groups (27.6% vs 10.2%, P = 0.036). Moreover, only GBT (H2)-positivity was significantly associated with a higher risk of LQT negativity in multivariate analysis (OR, 4.19; P = 0.029). SIBO producing H2 is common in patients with severe LD suspected lactose intolerance. SIBO may be a new therapeutic target for managing intestinal symptoms in patients with lactose intolerance.

Prevalence of small intestinal bacterial overgrowth syndrome among patients with inflammatory bowel disease and its impact on nutritional status and clinical manifestations

Background. In recent years, there has been high interest in the prevalence of small intestinal bacterial overgrowth (SIBO) syndrome in various populations. Chronic inflammatory bowel disease (IBD) is known to be a heterogeneous group of disorders, with a high degree of geographical variability in terms of symptoms, nature of progression, clinical manifestations, or combination with other types of pathologies. Since the involvement of the intestinal microbiome plays an important role in the etiopathogenesis of inflammatory bowel disease, the combination of SIBO and IBD is increasingly being considered and studied recently. Since the symptoms of both pathological conditions are significantly echoed, and therefore exacerbated by the combination, the manifestations of malnutrition become more pronounced, which negatively affects the nutritional status of patients with IBD. The purpose of the study is to determine the frequency of SIBO in patients with IBD depending on the nosological forms and to investigate its effect on clinical and laboratory indicators of nutritional status and clinical manifestations. Materials and methods. We examined 100 patients with IBD, aged 19 to 79 years, on average (42.54 ± 1.50) years, including 70 patients with ulcerative colitis (UC), and 30 — with Crohn’s disease (CD). All patients underwent general clinical examination, anthropometric measurements, general and biochemical blood tests (with the determination of total protein, albumin, prealbumin). To characterize the state of the small intestine microbiota (presence of SIBO), all patients underwent a hydrogen breath test with glucose loading using a Gastro+ Gastrolyzer gas analyzer from Bedfont Scientific Ltd (UK). Results. The analysis of SIBO frequency showed the changes in the state of the small intestinal microflora in 45 % of patients with IBD. The prevalence of SIBO was higher in the group of patients with CD — 53.3 % (16) than in the group with UC — 41.4 % (29). The presence of SIBO in the group of patients with UC had statistical significance and a direct correlation with the duration of the disease — (9.3 ± 6.2) versus (2.9 ± 3.1) years (p = 0.001, r = 0.55). There was a decrease in weight and body mass index (BMI) in patients with SIBO, especially in patients with Crohn’s disease, and accounted for (19.8 ± 3.5) kg/m2. There was a significant difference between the levels of total protein in patients with SIBO and without it, both in the basic group and in the group of UC: (65.8 ± 8.4) vs. (70.2 ± 8.2) g/l (p=0.009, r = –0.232) and (66.5 ± 8.3) vs. (70.7 ± 7.4) g/l (p = 0.029), respectively, and albumin levels were reduced in both nosological groups. No relationship was found between the severity of abdominal pain and the presence of SIBO. When SIBO was detected, the manifestations of flatulence significantly prevailed in patients with UC — 75.8 % (n=22), and diarrheal syndrome in patients with CD — 75 % (n = 12). Conclusions. The obtained results indicate a high prevalence of SIBO in patients with IBD. Patients with CD suffered from SIBO more often (53.3 %) than patients with UC (41.4%) (with a predominance of patients with severe disease). A direct correlation of SIBO with the disease duration in patients with UC (r = 0.55, р &lt; 0.05) was revealed, which is explained by the violation of physiological barriers that prevent the emergence of SIBO, due to more episodes of exacerbation, long-term use of drugs and concomitant pathology with time. The negative impact of SIBO on nutritional status manifested in weight loss, reduced BMI and other anthropometric (mid-upper arm circumference, mid-arm muscle circumference, triceps skinfold) and laboratory (total protein, albumin, prealbumin) parameters in these patients. The most common symptoms in patients with IBD with SIBO were abdominal pain, diarrhea, and flatulence that reflected the typical clinical picture of SIBO.

Assessment of small intestinal bacterial overgrowth in chronic pancreatitis patients using jejunal aspirate culture and glucose hydrogen breath test

Background A subset of chronic pancreatitis patients respond poorly to pancreatic enzyme replacement therapy. Small intestinal bacterial overgrowth (SIBO) is considered to be one of the major reasons for this poor response. Previous studies have reported a wide range of prevalence of SIBO in patients with chronic pancreatitis. We aimed to assess the prevalence of SIBO in chronic pancreatitis using quantitative jejunal aspirate culture and glucose hydrogen breath test (GHBT). The sensitivity and specificity of GHBT for the diagnosis of SIBO in chronic pancreatitis were also estimated. Methods Newly diagnosed chronic pancreatitis patients were recruited into the study. A detailed history and relevant laboratory tests were done. All patients underwent an endoscopy and jejunal fluid aspiration for bacterial cultures and GHBT to detect SIBO. The results of GHBT were compared with jejunal fluid aspirate culture. Results The jejunal aspirate culture was positive in 18/48 (37.5%) patients while the GHBT showed that 14/48 (29%) patients had SIBO. The sensitivity, specificity, positive and negative predictive value of GHBT in our study was 44.4, 80, 57.14 and 70.59%, respectively. Conclusions SIBO is not uncommon in chronic pancreatitis patients. One-third of our study population had SIBO. GHBT has low sensitivity but had high specificity in the diagnosis of SIBO in chronic pancreatitis.

1188 The Effects of Probiotics on Parenteral Nutrition-Related Complications: A Prescriber’s Dilemma

INTRODUCTION: Parenteral nutrition (PN) is a life-saving modality that carries risks for potentially life-threatening complications. The gut microbiome, which is often impaired in patients receiving PN, plays an integral role in intestinal wall integrity and immune function. Hence, restoration of a healthy microbiome may theoretically protect against various infections. Therefore, we aimed in our study to investigate the effect of probiotics on parenteral nutrition-related infectious complications. METHODS: We identified a cohort of patients with intestinal failure who received PN for &gt;2 weeks at our center for human nutrition between January 2005 and August 2016. We excluded patients &lt; 18 years of age, patients who used probiotics for &lt; 30 days, and those who had long-term antibiotic use ( &gt;30 days). Seventy-eight patient received probiotics, among them, 48% used it for small intestinal bacterial overgrowth (SIBO) treatment, 42% for SIBO prophylaxis in high-risk patients (history of recurrent SIBO, resection of the ileocecal valve, and surgically created blind loops), and 10% of the patients used non-prescription over-the-counter probiotics. Patients characteristics and other variables were determined by manual chart review. RESULTS: A total of 282 patients who received prolonged parenteral support were included. Eighty-five percent of our sample received PN, while the remaining received intravenous fluids (IVF). A total of 78 (27.7%) patients used probiotics. (Table 1) One hundred and six (37.6%) patients were diagnosed with SIBO, 31(11%) patients had at least one episode of catheter-related infection, and 88(31.2%) patients had at least one documented episode of sepsis. The prevalence of SIBO in patients who used prophylactic probiotic was 22 % vs. 30 % in patients who did not use probiotics, P = 0.5. Compared to non-users, the prevalence of sepsis and catheter-related infection among probiotics users were (26.9% vs. 32.8%; P = 0.33 and 7.7% vs. 12.3%; P = 0.27, respectively) (Figure 1) CONCLUSION: Although there was a non-significant trend toward less SIBO, sepsis and catheter-related infections among patients using probiotics, our findings don’t support the routine use of probiotics to prevent or treat PN-related complications. Interestingly, this study revealed-despite the lack of evidence- a quarter of our included patients received a medical prescription for probiotics to prevent or treat SIBO.

503 Small Intestinal Bacterial Overgrowth (SIBO) in Functional Dyspepsia (FD): Does Dyspeptic Symptom Pattern Make a Difference?

INTRODUCTION: FD is a common gastrointestinal disorder with poorly understood pathophysiology. Patients with FD and SIBO frequently overlap symptomatically. The prevalence of SIBO in patients with FD is not well studied, particularly in relation to the predominant FD symptom profile. We aimed to evaluate the prevalence of SIBO diagnosed by glucose breath test (GBT) in patients with FD and compare the SIBO prevalence in FD subtypes - Postprandial Distress Syndrome (PDS), Epigastric Pain Syndrome (EPS) or both (PDS+EPS). METHODS: Retrospective, tertiary center, study of patients fulfilling Rome criteria for FD, who completed GBT (2018-2019). Demographics, history, medications, and GBT findings were reviewed. Patients with documented structural disease (eg. neoplasm) were excluded. GI symptoms (including mid upper abdominal pain or burning, early satiety and postprandial fullness) were prospectively collected from all patients at the time of their GBT. Based on these responses, patients were classified into: 1. FD-PDS, 2. FD-EPS and 3. FD-PDS+EPS. A priori variables associated with SIBO were analyzed including: presence of diabetes, GERD, and gastroparesis; history of small bowel surgery or gastric bypass; use of opioids or proton pump inhibitors. Prior to GBT, patients had low carbohydrate diet (2 days), no antibiotics (30 days) and no tobacco (12 hrs). Positive GBT for SIBO was defined by ≥20 ppm H2 increase over basal within 90 min and/or ≥10 ppm CH4 increase at any time. Statistical methods included chi-square and t test. RESULTS: 737 consecutive patients were studied (mean age=51.6±17.6 years, 70% female, 88% Caucasian, mean BMI=28.4±7.1). No differences in demographic or a priori SIBO-associated variables were found between the 3 subgroups of FD patients (P = NS). 31.4% of patients fulfilling criteria for FD had a GBT positive for SIBO. Individual gas (H2, CH4, or both) excretion responsible for a positive glucose HBT in each of the FD subgroups is shown on Table 1. There was no statistically significant difference in the prevalence of SIBO (by either H2, CH4 or both) between the three FD patient subtypes. There was borderline significant difference for slower H2 peak depicting a positive GBT in FD-PDS compared to FD-EPS and FD-EPS+PDS (83.8 vs. 70.7 vs. 65.7 minutes, P = 0.05). CONCLUSION: SIBO diagnosed by GBT is common in patients with FD regardless of the predominant symptomatic pattern. The prevalence of SIBO was similar in the three FD subtypes.

High occurrence of small intestinal bacterial overgrowth in primary biliary cholangitis.

Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease affecting mainly middle-aged women. An alteration in intestinal motility has been well documented in cirrhosis predisposing to small intestinal bacterial overgrowth (SIBO). Patients with PBC frequently complain of various gastrointestinal symptoms compatible with SIBO. No study has specifically been published to this day to determine the occurrence of SIBO in PBC. Our objective was to determine the prevalence of SIBO in patients with PBC. Retrospective study from 2010 to 2018. All patients diagnosed with PBC during this period had a systematic screening for SIBO in their diagnostic workup. The diagnosis of SIBO was made by a carbohydrate breath test (lactulose and/or glucose). Clinical and paraclinical factors of patients were compared with a control group of healthy subjects. Ninety-eight subjects were included in the study (mean age 49, range 21-88years) including 58 patients with PBC and 40 healthy subjects. The PBC group was older than the control group (mean age 56, range 31-88 vs 39, range 21-62years; P<.001), but identical for gender and body mass index. The prevalence of SIBO was higher in PBC versus controls (32.8% vs 2.5%; P<.001). The PBC group with SIBO had significantly more diarrhea (78.9% vs 35.9%; P<.05) than the PBC group without SIBO, but the prevalence of abdominal pain and bloating was similar. The high occurrence of SIBO in PBC may explain some of the frequently reported gastrointestinal symptoms. This study justifies the systematic screening for SIBO in PBC.

Systematic review with meta-analysis: the prevalence of small intestinal bacterial overgrowth in inflammatory bowel disease.

Current data on small intestinal bacterial overgrowth (SIBO) in patients with inflammatory bowel diseases (IBD) are controversial. To conduct a systematic review and meta-analysis to determine the prevalence of SIBO in patients with ulcerative colitis (UC) and Crohn's disease (CD). Electronic databases were searched up to May 2018 for studies reporting prevalence of SIBO in IBD patients. The prevalence rate of SIBO among IBD patients and the odds ratio (OR) and 95% CI of SIBO in IBD patientscompared with controls were calculated. The final dataset included 11 studies (1175 adult patients with IBD and 407 controls), all utilising breath test for diagnosis of SIBO. The proportion of SIBO in IBD patients was 22.3% (95% CI 19.92-24.68). The OR for SIBO in IBD patients was 9.51 (95% CI 3.39-26.68) compared to non-IBD controls, and high in both CD (OR=10.86; 95% CI 2.76-42.69) and UC (OR=7.96; 95% CI 1.66-38.35). In patients with CD, subgroup analysis showed the presence of fibrostenosing disease (OR=7.47; 95% CI 2.51-22.20) and prior bowel surgery (OR=2.38; 95% CI 1.65-3.44), especially resection of the ileocecal valve, increased the odds of SIBO. Individual studies suggest that combined small and large bowel disease but not disease activity may be associated with SIBO. Overall, there is a substantial increase in the prevalence of SIBO in IBD patients compared to controls. Prior surgery and the presence of fibrostenosing disease are risk factors for SIBO in IBD.

The Prevalence of Depression in Small Intestinal Bacterial Overgrowth

Introduction: Many patients who seek care for gastrointestinal symptoms have an associated affective disorder. Gastrointestinal diseases including food allergies, H. Pylori infection, irritable bowel syndrome (IBS), and small intestinal bacterial overgrowth, have all been shown to have an increased probability of depression. The gastrointestinal disease most widely studied in its association with psychiatric disease is irritable bowel syndrome (IBS). There is significant overlap between irritable bowel syndrome and small intestinal bacterial overgrowth (SIBO). The prevalence of SIBO in patients meeting Rome II criteria for IBS was 4-64%. Moreover, ninety-two percent of patients with IBS complain of bloating and abdominal pain, which are also symptoms of SIBO. Thus, we hypothesize that patients with small intestinal bacterial overgrowth will have an increased prevalence of depression as compared to the general population. Methods: 67 subjects were referred for hydrogen breath test to evaluate for small intestinal bacterial overgrowth at Montefiore Medical Center. Data was collected from July 2016 to May 2017. 15 patients were excluded from the study because of: previous treatment of small intestinal bacterial overgrowth, prior rifaximin use, prior gastrointestinal surgery, prior gastrointestinal cancer, or pregnancy. The remaining 52 were provided with validated depression (Patient Health Questionnaire 9) and anxiety (Generalized Anxiety Disorder 7) surveys. Results: Subjects were on average 54 years old, 83% of minority race, 63% female, 37% obese, and 42% had a prior history of depression. Mean Patient Health Questionnaire-9 (PHQ-9) score was 7, with 46% meeting criteria for depression. Thirty patients (58%) tested positive and twenty-two patients (42%) tested negative for small intestinal bacterial growth by hydrogen breath test. Of the patients who tested positive for SIBO, 15 (50%) tested positive for depression and 11 (37%) tested positive for anxiety. Of the patients who tested negative for SIBO, 9 (41%) tested positive for depression and 7 (32%) tested positive for anxiety. There was no significant difference in rate of depression between the SIBO positive and negative cohorts. Conclusion: Although patients with small intestinal bacterial overgrowth had more depression and anxiety in this study, this was not found to be of statistical significance.

Small intestinal bacterial overgrowth in adult patients with type 1 diabetes: its prevalence and relationship with metabolic control and the presence of chronic complications of the disease.

INTRODUCTION Gastrointestinal symptoms may occur in 50% to 70% of patients with diabetes. OBJECTIVES The aim of this study was to evaluate the prevalence of small intestinal bacterial overgrowth(SIBO) in patients with diabetes, as well as the relationship between SIBO and metabolic controlof diabetes and the presence of chronic complications of the disease. PATIENTS AND METHODS The study group included 148 patients with type 1 diabetes, treated in the years2013-2015. The control group consisted of 41 healthy volunteers. The presence of SIBO was assessedwith a noninvasive breath test using 20 g of lactulose suspended in 200 ml of water, with the assessmentof exhaled hydrogen concentrations. The measurements were performed at 15-minute intervals in thefirst hour and at 30-minute intervals in the second hour of the test. A positive result was considered as the output value of exhaled hydrogen of 20 parts per million (ppm) or higher or an increase in the outputvalue of the exhaled hydrogen of 12 ppm during the first 60 minutes of the test. RESULTS We observed a lower prevalence of SIBO in the study group in comparison with controls (56patients [37.8%] vs 30 healthy volunteers [73%]; P = 0.006). In the logistic regression model, this associationwas independent of age, sex, body mass index, cigarette smoking, serum C-reactive protein concentrations, and estimated glomerular filtration rate (odds ratio, 0.26; 95% confidence interval,0.10-0.68; P = 0.006). CONCLUSIONS The prevalence of SIBO in patients with type 1 diabetes is lower than that in healthysubjects. One of the possible causes might be the beneficial effect of nutritional therapy in patientswith diabetes.

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.

Prevalence of Small Intestinal Bacterial Overgrowth among Chronic Pancreatitis Patients: A Case-Control Study.

Background. Patients with chronic pancreatitis (CP) exhibit numerous risk factors for the development of small intestinal bacterial overgrowth (SIBO). Objective. To determine the prevalence of SIBO in patients with CP. Methods. Prospective, single-centre case-control study conducted between January and September 2013. Inclusion criteria were age 18 to 75 years and clinical and radiological diagnosis of CP. Exclusion criteria included history of gastric, pancreatic, or intestinal surgery or significant clinical gastroparesis. SIBO was detected using a standard lactulose breath test (LBT). A healthy control group also underwent LBT. Results. Thirty-one patients and 40 controls were included. The patient group was significantly older (53.8 versus 38.7 years; P < 0.01). The proportion of positive LBTs was significantly higher in CP patients (38.7 versus 2.5%: P < 0.01). A trend toward a higher proportion of positive LBTs in women compared with men was observed (66.6 versus 27.3%; P = 0.056). The subgroups with positive and negative LBTs were comparable in demographic and clinical characteristics, use of opiates, pancreatic enzymes replacement therapy (PERT), and severity of symptoms. Conclusion. The prevalence of SIBO detected using LBT was high among patients with CP. There was no association between clinical features and the risk for SIBO.

Small Intestinal Bacterial Overgrowth (SIBO) and Fungal Overgrowth (SIFO): A Frequent and Unrecognized Complication of Colectomy: ACG Category Award: Presidential Poster

Introduction: Following subtotal colectomy, approximately 40% of patients report abdominal pain and diarrhea, and this is associated with poor quality of life. Its cause is unknown and many are labeled as IBS. In a pilot study, we observed a high incidence of bacterial overgrowth in post-colectomy patients. Our aim was to determine the prevalence of SIBO/SIFO in patients with unexplained GI symptoms following colectomy (> 1 year). Methods: Patients seen between January 2012 to March 2015 with chronic GI complaints and a history of colectomy and negative GI evaluation (endoscopy, blood tests, CT scan) other than post-op changes were assessed and underwent testing for SIBO with either 75 g glucose breath test (GBT) and/or distal duodenal aspiration (DDA). The DDA was performed using aseptic technique with a sterile 6F Liguory nasobiliary catheter, and cultures were obtained for aerobic, anaerobic, and fungal organisms. Bacterial concentrations≥103 cfu/mL was defined as SIBO positive. Results: 50 patients (F/M =41/9; mean age 52.32 years) with prior colectomy were assessed. Of these, 48/50 patients underwent GBT alone, 33 underwent GBT and DDA, and 2 underwent DDA alone. We found that 31/50 patients(62%) had SIBO. 16 subjects with SIBO had aerobic flora (streptococcus and klebsiella spp.), and 11 had anaerobic flora (bacteroides veillonella, and peptostreptococcus spp). In this subgroup 12/31(39%) had concurrent SIFO and 2/50(4%) had SIFO alone—all grew candida. Abdominal pain, gas, bloating, diarrhea, and nausea are common and severe (table1). Patients with SIBO/SIFO had greater symptoms than those without. The indication for subtotal colectomy was constipation(36%), diverticular disease(8%), bowel obstruction(8%), colorectal carcinoma(8%), polyps(6%), other (26%), or not documented (8%). The prevalence of SIBO in patients with history of constipation was 10/18(56%) compared to 22/32(69%) in patients without constipation. Conclusion: Overall 62% of patients with previous colectomy and chronic GI symptoms had undiagnosed SIBO and 39% had concurrent SIFO. SIBO and SIFO are important, frequent, and unrecognized complications following colectomy that explain their persistent gas, bloating, and pain. This occurs either because of small intestinal colonization by colonic flora by translocation through a widely patent ileocolonic anastomosis and/or dysmotility. SIBO/SIFO should be identified and treated in patients with persistent GI symptoms after colectomy, and not mislabeled as IBS.Table 1: Symptom prevalence and severity in patients with SIBO, Mixed SIBO and SIFO, SIFO and no overgrowth

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

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.

OP0131 Prevalence and Predictors of Small Intestinal Bacterial Overgrowth in Systemic Sclerosis

BackgroundGastro-Intestinal (GI) involvement is a well-known complication of Systemic Sclerosis (SSc). Small intestinal bacterial overgrowth (SIBO) is part of such involvement. It can compromise the patient quality of life and...

Role of small intestinal bacterial overgrowth and delayed gastrointestinal transit time in cirrhotic patients with minimal hepatic encephalopathy

Minimal hepatic encephalopathy (MHE) is the mildest form in the spectrum of hepatic encephalopathy. This cross-sectional study was carried out to elucidate the role of bacterial overgrowth of the small intestine and delayed intestinal transit among patients with MHE. Two-hundred-thirty patients with cirrhosis were screened; 102 patients (44.4%) who met the eligibility criteria were included in the study. MHE was diagnosed when the psychometric hepatic encephalopathy score was ≤-5. All patients underwent a glucose breath test for small intestinal bacterial overgrowth (SIBO) and lactulose breath test for oro-cecal transit time (OCTT). Fifty-seven (55.9%) patients with cirrhosis had MHE. Among these patients with MHE, 22 (38.6%) had SIBO, while 4 (8.9%) without MHE had SIBO (p = 0.001). The prevalence of SIBO was higher in patients with CTP classes B and C (69.2%) compared to those in CTP class A (30.8%); p = 0.054. OCTT was significantly prolonged in patients who had SIBO than in those who did not have SIBO (p<0.0001). Univariate analysis demonstrated that increased age, female gender, low educational status, low albumin, presence of SIBO, and prolonged OCTT were associated with the presence of MHE. Multivariate analysis demonstrated SIBO as the only factor associated with MHE. Our study conclusively demonstrates high prevalence of SIBO in patients with cirrhosis with MHE. This study gives the rationale of treatment directed against SIBO and gut dysmotility, which may include non-absorbable antibiotics such as rifaximin, probiotics, and prokinetics.

A Retrospective Study of Small Intestinal Bacterial Overgrowth in Patients with Bloating

Purpose: Many patients (80–90%) with IBS consider bloating their most bothersome symptom. Recent studies suggest a link between abdominal bloating and/or irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO). The prevalence of SIBO in patients with bloating, with or without IBS, is unknown. We determined the prevalence of SIBO in patients referred for lactulose breath test (LBT) and response to treatment for SIBO in patients with bloating. Methods: Selection criteria for enrollment included; >18 years of age and LBT with bloating as a symptom at the UUHSC from Jan 2004 to May 2007. A chart review was performed to collect information including; indication for LBT, LBT results, presence or absence of IBS and treatment and response. SIBO was diagnosed by LBT. An LBT positive result was defined as an early rise (<90 min) in hydrogen (>20 ppm) or methane (>12 ppm). IBS was diagnosed clinically. A positive response was defined as moderate or greater improvement by patient or physician subjective criteria. Chi square or Fisher's exact test were used to make comparisons between groups. Results: A total of 255 breath tests were performed. There were 169 patients with bloating as a symptom (9 with no result). The mean age for patients with bloating was 47.6 years ± 15.8, 69% were female. The prevalence of positive SIBO in patients with bloating was 51% (82/160). The prevalence of positive SIBO was different between patients referred for bloating vs. referred for other reasons ((82/160 (51%) vs. 27/86 (31%), P= 0.004)). The prevalence of positive SIBO in patients with bloating and IBS was 22/42 (52%). There was no difference in the prevalence of SIBO in patients with and without IBS ((22/42 (52%) versus 62/118 (46%) P= NS)). 82% (28/34) of patients with bloating and positive LBT responded to antibiotic treatment vs. 33% (3/9) of patients with bloating and negative LBT (P= 0.008, OR = 9.3). Patients were followed for 10.4 ± 7.7 months for response. Conclusion: In patients with bloating referred for LBT, SIBO positivity was significantly higher than in patients referred for other reasons. In patients with bloating, SIBO positivity was not different in patients with and without IBS. Patients with bloating and positive SIBO by LBT are significantly more likely to respond to antibiotic Rx than patients with bloating and negative SIBO by LBT. Further investigation of factors associated with bloating, SIBO and response to antibiotic therapy is warranted.

Small intestinal bacterial overgrowth in patients with functional gastrointestinal diseases

Recent studies have described a high percentage of small intestinal bacterial overgrowth (SIBO) in patients with irritable bowel syndrome (IBS). However, the prevalence of SIBO has not been well established in other functional disorders. To evaluate the prevalence of SIBO in patients with different functional gastrointestinal disorders (FGID). Patients with FGID completed a self-administered questionnaire providing information to diagnose functional disorders on the basis of Rome II criteria. SIBO was assessed using a standardized lactulose breath test. A basal value of breath hydrogen (H2) >20 ppm and/or two lectures of HZ values >20 ppm during the first 60 minutes were considered suggestive of SIBO. We studied 367 patients with a mean age of 50 years (87% females). Of these, 225 had IBS (45 constipation predominant, 121 diarrhea predominant and 59 alternating type), 33 had functional constipation, 83 had functional bloating and 26 had functional diarrhea. SIBO was found in 76% of patients with IBS, 73% of those with functional constipation, 69% of those with functional diarrhea and 68% of those with functional bloating. This study confirms a high percentage of SIBO in patients with IBS and other FGID. The eradication of SIBO should be considered as a therapeutic tool in these patients.

Sobrecrecimiento bacteriano en trastornos funcionales del intestino

Recent studies have described a high percentage of small intestinal bacterial overgrowth (SIBO) in patients with irritable bowel syndrome (IBS). However, the prevalence of SIBO has not been well established in other functional disorders.To evaluate the prevalence of SIBO in patients with different functional gastrointestinal disorders (FGID).Patients with FGID completed a self-administered questionnaire providing information to diagnose functional disorders on the basis of Rome II criteria. SIBO was assessed using a standardized lactulose breath test. A basal value of breath hydrogen (H2) >20 ppm and/or two lectures of HZ values >20 ppm during the first 60 minutes were considered suggestive of SIBO.We studied 367 patients with a mean age of 50 years (87% females). Of these, 225 had IBS (45 constipation predominant, 121 diarrhea predominant and 59 alternating type), 33 had functional constipation, 83 had functional bloating and 26 had functional diarrhea. SIBO was found in 76% of patients with IBS, 73% of those with functional constipation, 69% of those with functional diarrhea and 68% of those with functional bloating.This study confirms a high percentage of SIBO in patients with IBS and other FGID. The eradication of SIBO should be considered as a therapeutic tool in these patients.