Treatment Of Small Intestinal Bacterial Overgrowth Research Articles

Small intestinal bacterial overgrowth (SIBO) - Therapy, nutrition, microbiome

SIBO (small intestinal bacterial overgrowth) is defined by bacterial overgrowth or colonization of the small intestine in combination with gastrointestinal symptoms such as bloating, nausea, pain, diarrhoea, malabsorption and food intolerance. SIBO can be caused by various mechanisms such as reduced intestinal motility, altered gastrointestinal anatomy, reduced gastric acid or pancreatic enzyme production, altered bile acid metabolism, or immune defects. Accordingly, SIBO often develops secondary to different underlying diseases.Diet has a fundamental influence on the composition of the intestinal microbiome and is therefore also a potential pathomechanism in SIBO. Furthermore, food intolerances are common in SIBO patients. However, both aspects have so far been insufficiently investigated. Nevertheless, elemental diets, carbohydrate-reduced diets, as well as pre- and probiotics are potential therapy options.This article provides a summary of current knowledge on the pathophysiology, diagnosis and treatment of SIBO, with particular emphasis on the role of nutrition and the microbiome.

Proton Pump Inhibitors. Investigating Their Role in Small Intestinal Bacterial Overgrowth

Proton pump inhibitors (PPIs) are widely used medications known for their effectiveness in reducing gastric acid production and their overall safety profile. Despite being valued for these properties, concerns have been raised regarding potential adverse effects associated with their long-term use. Various studies indicate a higher prevalence of small intestinal bacterial overgrowth (SIBO) in patients on prolonged PPI therapy, with symptoms ranging from bloating and diarrhea to malabsorption and nutrient deficiencies. Diagnosing SIBO primarily involves non-invasive breath tests that measure hydrogen and methane levels produced by bacterial fermentation after ingesting a carbohydrate substrate, such as lactulose or glucose. Direct aspiration and culture of small intestinal fluid offer a more definitive diagnosis but are invasive and less commonly performed. Treatment of SIBO focuses on reducing bacterial overgrowth by using antibiotics.This review aims to inform clinicians about the possible risks of PPI therapy and the importance of suspecting SIBO in patients with nonspecific gastrointestinal symptoms.

Small intestinal bacterial overgrowth – current, novel and possible future methods of treatment and diagnosis

Small intestinal bacterial overgrowth (SIBO) is a prevalent issue, frequently overlooked in clinical practice. Its prevalence is unknown because SIBO requires diagnostic testing, however, in most studies, SIBO has been detected anywhere from <2% to 22% of healthy controls. Breath tests, which detect the presence of hydrogen in exhaled air, are the most used diagnostic method. However, their low sensitivity and specificity indicate the need for research into new more accurate methods. The standard treatment is antibiotic therapy with rifaximin. After antibiotic therapy, there is a risk of recurrence and the emergence of multidrug-resistant bacterial strains. Recurrence ratio after antibiotic therapy have been documented in 12.6% of patients after 3 months, 27.5% after 6 months and 43.7% after 9 months. There are promising results from studies on the use of probiotics and herbal preparations in treatment, but these studies have been conducted on relatively small groups of patients. This indicates the need for multicentre randomised trials with large numbers of patients to develop effective methods for the diagnosis and treatment of SIBO.

Small Intestinal Bacterial Overgrowth in Various Specialties of Medical Practice (Literature Review and Expert Council Resolution)

Aim: to discuss current views on the clinical significance, diagnostic opportunities, and therapeutic approaches in the treatment of small intestinal bacterial overgrowth (SIBO) as an important component in the gut microbiota function assessment, to assess the awareness of physicians and the opportunities in the diagnosis and treatment of this disease in patients in the Federal districts of the Russian Federation, as well as to present the proceedings of the Expert Council held on December 16, 2023 in Moscow.Key points. SIBO is a common syndrome often associated with irritable bowel syndrome, liver cirrhosis, asthma, and congestive heart failure, being also a predictor of early death in the elderly. Today, in many regions of the Russian Federation, there are limitations for instrumental diagnosis of this disease — lack of awareness among doctors, unavailability of gas analyzers for diagnosing SIBO, lack of information about the need to diagnose SIBO in the standards of compulsory health insurance. Rifaximin is the first-line treatment due to the highest therapeutic efficacy. One of the ways to increase the efficacy of SIBO treatment is to include strain-specific probiotics in the treatment regimen. Saccharomyces boulardii CNCM I-745 is thought to be the most studied, promising probiotic. The review also presents statistical data on the issues in the diagnosis and treatment of SIBO in the regions of the Russian Federation.Conclusion. Optimization of approaches to the diagnosis and treatment of SIBO, the development of domestic gas analyzers, increasing the awareness of physicians in all regions of the Russian Federation, as well as the development and optimization of clinical recommendations appear to be necessary measures to increase the effectiveness of medical care, the duration and quality of life of the Russian population. These goals can be achieved within the framework of Federal programs under the supervision of specialized reference centers of the Ministry of Health of the Russian Federation.

The relationship between small intestinal bacterial overgrowth and constipation in children - a comprehensive review.

Small intestinal bacterial overgrowth (SIBO) is characterized by an increase in the bacterial population of the small intestine due to an imbalance between the amount of bacteria and the intestinal barrier. Pediatric SIBO presents with a wide spectrum of symptoms, ranging from mild gastrointestinal complaints to malabsorption or malnutrition. Breath tests are commonly used as noninvasive diagnostic tools for SIBO, but a standardized methodology is currently unavailable. Intestinal flora produces methane which slows intestinal transit and increases the contractile activity of small intestine. Emerging literature suggests a correlation between overgrowth of methanogenic bacteria in the intestines and constipation. Treatment of SIBO involves administration of antibacterial therapy in addition to management of underlying conditions and optimal dietary adjustments. However, research on antibiotic treatment for pediatric patients with constipation and SIBO is limited and has yielded conflicting results. In the current review, we summarize the state-of-the-art of the field and discuss previous treatment attempts and currently used regimens for SIBO patients with constipation, with a focus on pediatric populations.

Probiotic Formulations Containing Fixed and Essential Oils Ameliorates SIBO-Induced Gut Dysbiosis in Rats.

Dysbiosis of the gut microbiota is associated with the pathogenesis of intestinal diseases such as inflammatory bowel disease, irritable bowel syndrome (IBS), small intestinal bacterial overgrowth (SIBO), and metabolic disease states such as allergies, cardiovascular diseases, obesity, and diabetes. SIBO is a condition characterized by an increased number (>1 × 103 CFU) of abnormal bacterial species in the small intestine. Interest in SIBO has gained importance due to increased awareness of the human microbiome and its potential relationships with human health and disease, which has encouraged new work in this area. In recent years, standard antibiotic regimens (rifaximin and metronidazole) have been used to treat SIBO, but solo antibiotics or their derivatives are insufficient. In this study, the therapeutic effects of the probiotic form, which contains coconut oil and traces of peppermint-lemon-patchouli essential oil, were evaluated on the Dysbiosis-Based Rat SIBO Model. There are significant differences between sick and healthy rats (p = 0.014), between sick rats and rats treated with the oil mix plus probiotic mix protocol (p = 0.026), and between rats treated with only the probiotic and only oil protocols (p = 0.030) in the evaluation of TNF-α levels. Histologically, villi distortion and loss of crypts, epithelial shedding and necrotic changes in the apical regions of the villi, and inflammatory cell infiltrations extending to the lamina propria and submucosa were observed in sick rats. Mitotic figures in villus epithelium and crypts were observed in rats treated with 9.2 × 109 CFU/1000 mg/coconut oil + trace amounts of peppermint-lemon-patchouli essential oil and a probiotic mixture (oil + probiotic mix protocol). A regression of inflammatory reactions and an increase in goblet cells were observed. A decrease was observed in inflammation markers in sick rats. On the other hand, the oil plus probiotic mix protocol recovered digestive system defects in the animals caused by dysbiosis. In the future, these treatment approaches can be effective in the treatment of SIBO.

Probiotics and Prebiotics in Subclinical Hypothyroidism of Pregnancy with Small Intestinal Bacterial Overgrowth

Evaluating efficacy of probiotics combined with prebiotics in small intestinal bacterial overgrowth (SIBO) in subclinical hypothyroidism (SCH) in the second trimester. We collected data from 78 pregnant women with SCH (SCH group) and 74 normal pregnant women (control group) in second trimester, compare the differences in high sensitivity C-reactive protein (hsCRP), result of lactulose methane-hydrogen breath test and gastrointestinal symptoms assessed by GSRS scale between two groups. In SCH group, 32 patients with SIBO were selected as intervention group. Treatment with probiotics + prebiotics for 21 days; The differences of lipid metabolism, hsCRP, thyroid function level, methane-hydrogen breath test results and GSRS scores before and after treatment were compared to evaluate the therapeutic effect. (1) The positive rate of SIBO and methane, hsCRP levels in SCH group were higher than those in control group (P < 0.05), the total score of GSRS scale, mean score of indigestion syndrome, and constipation syndrome in SCH group were higher (P < 0.05). (2) The mean abundance of hydrogen and methane were higher in SCH group. (3) After treatment, serum levels of thyrotropin(TSH), total cholesterol(TC), triglyceride(TG), low-density lipoprotein (LDL), and hsCRP in intervention group were decreased, and high-density lipoprotein (HDL) was increased compared with before treatment (P < 0.05). (4) After treatment, methane positive rate, total score of GSRS scale, mean score of diarrhea syndrome, dyspepsia syndrome, and constipation syndrome were decreased (P < 0.05). (5) The average abundance of methane and hydrogen were lower. Probiotics combined with prebiotics are effective in the treatment of SIBO in pregnant SCH patients.Clinical Trial Registration Number: ChiCTR1900026326.

Efficacy of an Irritable Bowel Syndrome Diet in the Treatment of Small Intestinal Bacterial Overgrowth: A Narrative Review.

Small intestinal bacterial overgrowth (SIBO) is highly prevalent in irritable bowel syndrome (IBS). The eradication of bacterial overgrowth with antibiotics is the first-line treatment. However, focusing only on the antimicrobial effects without taking care to improve lifestyle factors, especially dietary patterns, may predispose patients to intestinal microbiota dysfunction. The objective of this study is to determine whether the current recommendations regarding nutrition in IBS are suitable for patients with SIBO. A narrative literature review was carried out using databases, including PubMed, ScienceDirect and Google Scholar. Recent studies indicate that dietary manipulation may have a role in alleviating SIBO gastrointestinal symptoms. A low FODMAP diet proposed for IBS may promote a negative shift in the gut microbiota and deepen the existing state of dysbiosis in SIBO patients. Supplementation with soluble fiber can lessen the symptoms in IBS and SIBO. Targeted probiotic therapy may also increase the effectiveness of antibiotic treatment and regulate bowel movements. Therefore, optimal dietary patterns play a key role in the treatment of SIBO. Based on currently available literature, the potential efficacy of the IBS diet in SIBO is largely hypothetical. Future research is needed to characterize a specific diet for the treatment of SIBO.

Practical Recommendation of the Scientific Сommunity for Human Microbiome Research (CHMR) and the Russian Gastroenterological Association (RGA) on Small Intestinal Bacterial Overgrowth in Adults

Aim. To optimize the choice of treatment strategies by physicians and gastroenterologists to improve treatment and prevention of small intestinal bacterial overgrowth (SIBO) in adults.Key points. SIBO is a condition characterized by an increased amount and/or abnormal composition of the microbiota in the small intestine. Clinically, the syndrome is manifested by nonspecific gastroenterological complaints and the development of malabsorption syndrome. Most often, SIBO is associated with various chronic non- infectious diseases (both diseases of the gastrointestinal tract, and the cardiovascular system and the neuromuscular apparatus) and can affect the severity of their symptoms. Specific methods for diagnosing SIBO are the culture method and breath tests. The main approaches to the treatment of SIBO include the elimination of the underlying cause of its occurrence, the use of antibacterial drugs and adherence to dietary recommendations (elemental diet).Conclusion. Small intestinal bacterial overgrowth is common in patients with various diseases, but has non-specific manifestations, so proper diagnosis of this condition is required. SIBO therapy involves prescription of antibacterial agents, the most studied of which is the non-absorbable antibiotic rifaximin-α.

Current and Future Approaches for Diagnosing Small Intestinal Dysbiosis in Patients With Symptoms of Functional Dyspepsia.

The development and application of next generation sequencing technologies for clinical gastroenterology research has provided evidence that microbial dysbiosis is of relevance for the pathogenesis of gastrointestinal and extra-intestinal diseases. Microbial dysbiosis is characterized as alterations of diversity, function, and density of the intestinal microbes. Emerging evidence suggests that alterations of the gastrointestinal microbiome are important for the pathophysiology of a variety of functional gastrointestinal conditions, e.g., irritable bowel syndrome (IBS) and functional dyspepsia (FD), also known as disorders of brain-gut axis interaction. Clinicians have for many years recognized that small intestinal bacterial overgrowth (SIBO) is typified by a microbial dysbiosis that is underpinned by abnormal bacterial loads in these sites. SIBO presents with symptoms which overlap with symptoms of FD and IBS, point toward the possibility that SIBO is either the cause or the consequence of functional gastrointestinal disorders (FGIDs). More recently, new terms including “intestinal methanogen overgrowth” and “small intestinal fungal overgrowth” have been introduced to emphasize the contribution of methane production by archea and fungi in small intestinal dysbiosis. There is emerging data that targeted antimicrobial treatment of SIBO in patients with FD who simultaneously may or may not have IBS, results in symptom improvement and normalization of positive breath tests. However, the association between SIBO and FGIDs remains controversial, since widely accepted diagnostic tests for SIBO are lacking. Culture of jejunal fluid aspirate has been proposed as the “traditional gold standard” for establishing the diagnosis of SIBO. Utilizing jejunal fluid culture, the results can potentially be affected by cross contamination from oropharyngeal and luminal microbes, and there is controversy regarding the best cut off values for SIBO diagnosis. Thus, it is rarely used in routine clinical settings. These limitations have led to the development of breath tests, which when compared with the “traditional gold standard,” have sub-optimal sensitivity and specificity for SIBO diagnosis. With newer diagnostic approaches–based upon applications of the molecular techniques there is an opportunity to characterize the duodenal and colonic mucosa associated microbiome and associated gut microbiota dysbiosis in patients with various gastrointestinal and extraintestinal diseases. Furthermore, the role of confounders like psychological co-morbidities, medications, dietary practices, and environmental factors on the gastrointestinal microbiome in health and disease also needs to be explored.

Eradication of small intestinal bacterial overgrowth in irritable bowel syndrome using herbal therapy: A case report

Small intestinal bacterial overgrowth (SIBO) is a common pathology in irritable bowel syndrome (IBS). Symptoms include bloating, excessive belching, flatulence, epigastric and abdominal pain, nausea, early satiety, fatigue and altered bowel habits. Given the high incidence of IBS globally, SIBO needs to be investigated in IBS using hydrogen and methane breath testing. Adherence to the North American Consensus 2017 or the updated guidelines from the Association of Gastrointestinal Physiology (AGIP) committee of the British Society of Gastroenterology 2019 is necessary to ensure that testing and diagnosis are standardised. The treatment of SIBO with antibiotics, most commonly rifaximin, may restore gastrointestinal function and reduce the symptoms of IBS. A number of herbal and nutraceutical supplements are known to exert antimicrobial effects. There is increasing awareness amongst the public regarding these herbal and nutraceutical supplements, and there is an increased demand for their use. The present study describes the case of a patient with severe IBS symptoms, scoring in the extreme category on a quality of life questionnaire validated for IBS and functional digestive disorders. The patient tested positive for SIBO, which was then eradicated using a herbal formulation containing garlic, berberine, oregano, grapefruit seed extract and caprylic acid, while following a diet low in fermentable oligo‑, di‑, mono‑saccharides and polyols (FODMAP). The patient's quality of life assessment markedly improved following treatment and the remaining symptoms improved at the 3‑month follow‑up performed by verbal confirmation.

The effectiveness of rotating versus single course antibiotics for small intestinal bacterial overgrowth.

BackgroundSmall intestinal bacterial overgrowth treatment is usually based on antibiotics with no guidelines available.ObjectiveThis study aimed to investigate the efficacy of different antibiotics to treat small intestinal bacterial overgrowth.MethodsConsecutive patients referred to our tertiary center and diagnosed with intestinal bacterial overgrowth were retrospectively included. Patients were diagnosed using a 75 g glucose breath test. Patients were treated either with a single antibiotic (quinolone or azole) or rotating antibiotics (quinolone and azole, one after the other) for 10 consecutive days per month for 3 months. A negative glucose breath test after antibiotic treatment was considered as remission. Quality of life (GIQLI) and gastrointestinal severity (IBS‐SSS) were assessed before and after antibiotic treatment. Symptomatic evaluation was realized in simple blind of glucose breath test result: patients were unaware of their results.ResultsBetween August 2005 and February 2020, 223 patients were included in the analysis (female 79.8%, mean age 50.2 ± 15.7 years). Remission was observed in 119 patients (53.4%) after one course of antibiotics and was more frequent in patients receiving rotating antibiotics than in patients receiving a single antibiotic (70.0% vs. 50.8%, p = 0.050). Remission was associated with a significant improvement in quality of life (p = 0.035) and in bloating (p = 0.004).ConclusionIn this study, the treatment of small intestinal bacterial overgrowth using rotating antibiotics was more effective than treatment using a single course of antibiotic. Remission was associated with improvement in both quality of life and bloating.

Chinese herbal medicine for the treatment of small intestinal bacterial overgrowth (SIBO): A protocol for systematic review and meta-analysis.

Background:Chinese medicine has a unique theory and the Chinese herbal medicine treatment is based on the integral concepts and syndrome differentiation of the Traditional Chinese Medicine system. Although antibiotics remain the mainstay of SIBO treatment, various alternative or adjunctive therapies are available, including prokinetic agents, dietary interventions, probiotics, and herbal combinations. There is accumulating evidence demonstrating the antimicrobial properties of a growing number of herbs including garlic, black cumin, cloves, cinnamon, thyme, all-spices, bay leaves, mustard, and rosemary. This has prompted an interest in herbal therapy for the treatment of SIBO. Currently, there is no systematic review focusing on efficacy of CHM in the treatment of SIBO with PCOS, so our meta-analysis aims to comprehensively explore it. Meanwhile we will provide high-quality evidence to help patients, clinicians as well as health policymakers select better treatment strategy of PCOS.Methods:We will search the following sources without restrictions for date, language, or publication status: PubMed, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL) Cochrane Library, EMBASE and China National Knowledge Infrastructure. We will apply a combination of Medical Subject Heading (MeSH) and free-text terms incorporating database-specific controlled vocabularies and text words to implement search strategies. We will also search the ongoing trials registered in the World Health Organization's International Clinical Trials Registry Platform. Besides, the previous relevant reviews conducted on CHM for SIBO and reference lists of included studies will also be searched.Results:This study will provide a reliable basis for the treatment of SIBO with CHM.Conclusions:The findings will be an available reference to evaluate the efficacy and safety of CHM in the treatment of SIBO.Registration number:INPLASY202080004.

S0500 Intestinal Methanogen Overgrowth (IMO) in Parkinson's Disease: High Prevalence and Correlation With Constipation

INTRODUCTION: Recent ACG guidelines have defined intestinal methanogenic overgrowth (IMO) and described its clinical significance. The prevalences of small intestinal bacterial overgrowth (SIBO) and IMO in Parkinson's disease (PD) are unclear. SIBO in PD is linked to worse motor symptoms. Treatment of SIBO can improve motor function in PD. Our aim is to quantify the prevalence of SIBO and IMO in Parkinson's disease (PD) subjects with constipation compared to patients with unexplained GI symptoms undergoing glucose breath testing (GBT). METHODS: After an overnight fast and day of low-CHO diet, subjects brushed their teeth and rinsed their mouth with antiseptic mouthwash 2h before test. During GBT, 75 g of glucose dissolved in 250 mL water was administered. Breath samples were obtained at baseline and 15 min intervals for 2 h. Samples are collected in a bag (QuinTron Instrument Company, Inc.) and alveolar gas was analyzed for both H2 and CH4 levels by chromatography (QuinTron Micro Analyzer, QuinTron, Inc.). SIBO was defined as H2 rise of ≥20 ppm from baseline and/or CH4 rise of ≥10 ppm. IMO was defined as any measured CH4 ≥ 10 ppm. Daily bowel movements were assessed by prospective stool diary. Constipation was defined by <3 complete spontaneous bowel movements (CSBMs)/week. RESULTS: Nineteen patients with PD (68.2 ± 7.0 years, F/M = 6/13) underwent breath testing and compared to 158 subjects with unexplained GI symptoms (47.4 ± 15.3 years, F/M = 119/39). 31.6% (6/19) of PD subjects had SIBO versus 23.4% (37/158) of subjects with unexplained GI symptoms (P = 0.95), shown in Table 1. 52.6% (10/19) of PD subjects had IMO compared to 14.6% (23/158) subjects with unexplained GI symptoms (P < 0.001). 36.8% (7/19) had < 3 CSBMs per week. There was significant correlation between constipation and IMO, but not SIBO, Table 2. Higher maximum methane levels during GBT also significantly correlated with the presence of constipation. CONCLUSION: Rates of SIBO are similar between PD subjects with constipation and symptomatic patients undergoing GBT. More than half and significantly more PD subjects with constipation than symptomatic patients undergoing GBT have IMO. IMO and higher methane levels correlate with constipation in PD quantified by a stool diary. Methanogens may play a critical role in non-motor symptoms of PD patients such as constipation. ACKNOWLEDGEMENT: Parkinson's Foundation Translational Research Award.Table 1.: SIBO and IMO prevalence in subjects with PD vs unexplained GI symptomsTable 2.: Correlation between IMO, maximum methane level, and SIBO with constipation

PREVALENCE AND FACTORS ASSOCIATED WITH SMALL INTESTINAL BACTERIAL OVERGROWTH IN PATIENTS WITH CROHN'S DISEASE: A RETROSPECTIVE STUDY AT A REFERRAL CENTER.

Small intestinal bacterial overgrowth (SIBO) appears to be common in patients with Crohn's disease (CD). The rate of SIBO has been estimated at 25%-88% in this setting. However, different demographic, socioeconomic, and disease-related factors may exist between South American and North American or European populations that may limit the generalization of these findings, as the data are mainly derived from North American or European studies. We studied the prevalence and predictors of SIBO in CD outpatients. In this retrospective study, between June 2011 and June 2016, the medical records of 110 CD patients were assessed for presence of SIBO using the H2/CH4 glucose breath test. Univariate analysis was performed to investigate the potential association between SIBO and demographic, disease-related data, systemic markers of inflammation (C-reactive protein and erythrocyte sedimentation rate). The SIBO rate was high in CD patients (30%). Patients with and without SIBO were comparable according to demographics, systemic inflammatory biomarkers, and disease characteristics, except to the stricturing phenotype more common in the SIBO-positive CD patients (48.5% vs 19.5%, P=0.001). In Brazilian CD patients, SIBO is a highly prevalent condition. Stricturing phenotype demonstrated association with SIBO. An individualized screening plan followed by the timely treatment for SIBO should be carried out as part of quality of care improvement in CD individuals.

Small intestinal bacterial overgrowth as a cause of protracted wound healing and vitamin D deficiency in a spinal cord injured patient with a sacral pressure sore: a case report

BackgroundPressure sores are sometimes refractory to treatment, often due to malnutrition. Small intestinal bacterial overgrowth (SIBO) obstructs absorption in the digestive tract and causes malnutrition. However, little is known about the association between pressure sore wound healing and SIBO. Here, we report a case of a patient with a refractory sacral pressure sore and SIBO.Case presentationA 66-year-old woman who was spinal cord injured 14 years before visiting our hospital presented with the chief complaint of a sacral pressure sore, 10.0 × 6.5 cm in size, which was refractory to treatment. Physical examination showed abdominal distension and emaciation, with a body mass index of 15. Further examination revealed elevated serum alkaline phosphatase (1260 U/L), bilateral tibial fracture, multiple rib fracture, and osteoporosis. We diagnosed the patient with osteomalacia with vitamin D deficiency. Despite oral supplementation, serum levels of calcium, phosphorous, and vitamin D remained low. Also, despite concentrative wound therapy for the sacral pressure sore by plastic surgeons, no wound healing was achieved. Due to a suspicion of disturbances in nutrient absorption, we performed bacterial examination of collected gastric and duodenal fluid, which showed high numbers of bacteria in gastric content (104E. coli, 105Streptococcus species, and 105Neisseria species) and duodenal content (106E. coli, 104Candida glabrata). Therefore, we diagnosed the patient with SIBO and started selective decontamination of the digestive tract using polymyxin B sulfate and amphotericin B. After starting treatment for SIBO, the sacral pressure sore began to heal and was nearly healed after 285 days. The patient’s serum levels of calcium, phosphorous, vitamin D, and other fat-soluble vitamins also gradually increased after starting treatment for SIBO.ConclusionWe report a case of a patient with a refractory sacral pressure sore that healed after starting treatment for SIBO. We conclude that SIBO may be an overlooked cause of malnutrition and poor wound healing in patients with chronic pressure sores.

Minimal Hepatic Encephalopathy: Effect of H. pylori infection and small intestinal bacterial overgrowth treatment on clinical outcomes

The effect Helicobacter pylori (Hp) infection and small intestinal bacterial over growth (SIBO) in minimal hepatic encephalopathy (MHE) is not well understood. The aim of the study was to determine the effect of eradication of Hp infection and SIBO treatment on MHE in patients with cirrhosis. Patients with cirrhosis were enrolled and MHE was determined by psychometric tests and critical flicker frequency analysis. Hp infection and SIBO were assessed by urea breath and Hydrogen breath tests respectively in patients with cirrhosis and in healthy volunteers. Patients with Hp infection and SIBO were given appropriate treatment. At six weeks follow-up, presence of Hp infection, SIBO and MHE status was reassessed. Ninety patients with cirrhosis and equal number of healthy controls were included. 55 (61.1%) patients in the cirrhotic group were diagnosed to have underlying MHE. Among cirrhotic group, Hp infection was present in 28 with MHE (50.9%) vs. in 15 without MHE (42.8%) (p = 0.45). Similarly, SIBO was present in 17 (30.9%) vs. 11 (31.4%) (p = 0.95) in patients with and without MHE respectively. In comparison with healthy controls, patients with cirrhosis were more frequently harboring Hp and SIBO (47.7% vs. 17.7% (p < 0.001) and 31.1% vs. 4.4% (p < 0.001) respectively. On follow-up, all patients showed evidence of eradication of Hp and SIBO infection. Treatment of SIBO significantly improved the state of MHE in cirrhotics, however eradication of Hp infection did not improve MHE significantly. Additionally, patients with low Model for End-Stage Liver Disease (MELD) score and belonging to Child class B had significantly better improvement in MHE. A large number of patients with cirrhosis had either active Hp infection or SIBO with or without MHE, compared to healthy controls. Treatment of SIBO significantly improved MHE in patients with cirrhosis, whereas eradication of Hp did not affect the outcome of MHE in these patients.

The role of dietary diversity in the formation of syndrome intestinal bacterial overgrowth

Оne thousand twenty three patients with suspected SIBО were examined. Hydrogen-methane breath test with lactulose was performed in 973 patients, the results of which identified groups with SIBO-H2 (n=522), with SIBO-CH4 (n=340) and without signs of SIBO (n=108). Data on food intake was collected with 24 h recall from all participants. Dietary diversity was assessed using method of calculation of unique values (count base diversity) for 11 groups of food: cereals, meat and eggs, fish and non-fish seafood, fat containing products, dairy products, nuts, vegetables, fruits and berries, confectionery, drinks, sauces and spices. The pattern of food diversity for each patient was obtained by counting the items in each of the studied food groups. Comparison of the mean values of the number of items in each of the studied food groups was used to compare food diversity in patients with and without SIBО-H2. A comparison of nutritional diversity in patients with SIBO-H2 revealed a lower count base diversity in the groups of dairy products (2.70±1.37 vs 3.19±1.34, p<0.001), vegetables (5.50±2.22 vs 6.29±1.90, p<0.001), fruits (1.54± 1.38 vs 1.99±1.69, p=0.018) in compare with controls. Count base diversity in grains, meats, fishes, fat products, nuts and legumes and sweets did not demonstrate significant differences. Significant differences in the diversity of dietary patterns in patients with SIBО were found in dairy products, vegetables and fruits and berries. The obtained data may be used to develop diet for SIBO patients additionally to the treatment and prevention of its relapses.

Gut microbiome in systemic sclerosis: a potential therapeutic target.

IntroductionSystemic sclerosis (SSc) is a chronic, connective tissue disease characterized by inflammation, fibrosis and microcirculation disturbances. Gastrointestinal involvement and impaired gut motility observed in SSc promotes the small intestinal bacterial overgrowth (SIBO) defined as the increase in the number of bacteria to over 105 CFU/ml or as the presence of atypical flora.AimTo investigate the prevalence and characteristics of SIBO and to assess the efficacy of rifaximin in SIBO treatment in SSc patients.Material and methods40 SSc patients and 39 healthy individuals were enrolled in the study. All subjects completed UCLA SCTC GIT 2.0 questionnaire and query for gastrointestinal symptoms. The presence of SIBO was assessed by the lactulose hydrogen breath test (LHBT). Patients with SIBO received 1200 mg rifaximin daily for 10 days. The same diagnostic procedure was performed after completed treatment in order to evaluate SIBO eradication.ResultsThe prevalence of SIBO was higher in SSc patients compared with the control group (47.5% vs. 12.8%; p = 0.0008). SIBO eradication after rifaximin treatment was successful in 73.3% of SSc patients.ConclusionsThese data suggest that SIBO occurs more frequently in SSc patients than in controls. Eradication therapy with rifaximin is associated with satisfactory results and a high safety profile.

Infrequent small bowel intestinal bacterial overgrowth in malnourished Zambian children

There is evidence that children with malnutrition have an increased frequency of small intestinal bacterial overgrowth (SIBO) due to impaired gastric acidity, impaired intestinal motility, and dysbiosis. Children with malnutrition respond to antibiotic therapy but it is not clear if this effect is mediated by treatment of SIBO. We set out to determine the frequency of SIBO in children of varying nutritional status in a poor community in Lusaka, Zambia. Hydrogen breath testing, following a dose of 1g/kg oral glucose, was used to determine the presence of SIBO amongst the study participants. Forty nine children, 45 of whom had varying degrees of malnutrition, completed a full series of observations at 15, 30 and 60 minutes. Four children (8%) had a rise of 10ppm from baseline, consistent with SIBO. No correlation with nutritional status was observed. In this small study of Zambian children, SIBO was infrequent and unrelated to nutritional status.