P.39 HIGH FREQUENCY OF SMALL INTESTINE BACTERIAL OVERGROWTH IN PATIENTS WITH EARLY POSITIVE LACTOSE H2-BREATH TEST

ABSTRACT BACKGROUND Small intestine bacterial overgrowth is a heterogeneous syndrome characterized by an increase in the number and/or the presence of atypical microbiota in the small intestine. The symptoms of small intestine bacterial overgrowth are unspecific, encompassing abdominal pain/distension, diarrhea and flatulence. Due to the increased cost and complexity for carrying out the jejunal aspirate, the gold standard for diagnosis of the syndrome, routinely the hydrogen (H 2 ) breath test has been used, utilizing glucose or lactulose as substrate, which is able to determine, in the exhaled air, the H 2 concentration produced from the intestinal bacterial metabolism. However, due to a number of individuals presenting a methanogenic microbiota, which does not produce H 2 , the testing on devices capable of detecting, concurrently, the concentration of exhaled H 2 and methane (CH 4 ) is justified. OBJECTIVE This study aimed to determine the prevalence of small intestine bacterial overgrowth in patients with digestive symptoms, through a comparative analysis of breath tests of H 2 or H 2 and CH 4 associated, using glucose as substrate . METHODS A total of 200 patients of both sexes without age limitation were evaluated, being directed to a Breath Test Laboratory for performing the H 2 test (100 patients) and of exhaled H 2 and CH 4 (100 patients) due to gastrointestinal complaints, most of them patients with gastrointestinal functional disorders. RESULTS The results indicated a significant prevalence of small intestine bacterial overgrowth in the H 2 test and in the test of exhaled H 2 and CH 4 (56% and 64% respectively) in patients with gastrointestinal symptoms, and higher prevalence in females. It found further that methane gas was alone responsible for positivity in 18% of patients. CONCLUSION The data found in this study is consistent with the findings of the current literature and underscores the need for using devices capable of capturing the two gases (exhaled H 2 and CH 4 ) to improve the sensitivity and hence the accuracy of small intestine bacterial overgrowth diagnosis in daily medical practice.

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Comparison of the one-gramd-[14C]xylose breath test to the [14C]bile acid breath test in patients with small-intestine bacterial overgrowth

Digestive Diseases and Sciences ◽

10.1007/bf01312733 ◽

1980 ◽

Vol 25 (1) ◽

pp. 53-58 ◽

Cited By ~ 46

Author(s):

Charles E. King ◽

Phillip P. Toskes ◽

Tomas R. Guilarte ◽

Erhard Lorenz ◽

Susan L. Welkos

Keyword(s):

Small Intestine ◽

Bile Acid ◽

Breath Test ◽

Bacterial Overgrowth ◽

Small Intestine Bacterial Overgrowth ◽

The One

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Treatment of Small Intestine Bacterial Overgrowth with Rifaximin, a Non-Absorbable Rifamycin

Journal of International Medical Research ◽

10.1177/030006058801600410 ◽

1988 ◽

Vol 16 (4) ◽

pp. 312-316 ◽

Cited By ~ 32

Author(s):

G. R. Corazza ◽

M. Ventrucci ◽

A. Strocchi ◽

M. Sorge ◽

L. Pranzo ◽

...

Keyword(s):

Small Intestine ◽

Side Effects ◽

Small Bowel ◽

Therapeutic Efficacy ◽

Breath Test ◽

Bacterial Overgrowth ◽

Hydrogen Breath Test ◽

Small Bowel Bacterial Overgrowth ◽

Small Intestine Bacterial Overgrowth ◽

Lactulose Hydrogen Breath Test

In twelve patients affected by small bowel bacterial overgrowth, diagnosed by means of the lactulose hydrogen breath test, the therapeutic efficacy of a non-absorbable derivative of rifamycin, rifaximin, was evaluated. This study showed that this drug has a satisfactory therapeutic efficacy in contaminated small bowel syndrome and, at the doses tested, is free of side-effects.

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Small intestine bacterial overgrowth is frequent in cystic fibrosis: combined hydrogen and methane measurements are required for its detection.

Acta Biochimica Polonica ◽

10.18388/abp.2009_2495 ◽

1970 ◽

Vol 56 (4) ◽

Cited By ~ 1

Author(s):

Aleksandra Lisowska ◽

Jerzy Wójtowicz ◽

Jarosław Walkowiak

Keyword(s):

Cystic Fibrosis ◽

Small Intestine ◽

Breath Test ◽

Gastrointestinal Symptoms ◽

Bacterial Overgrowth ◽

Additional Measurement ◽

Hydrogen Breath Test ◽

Small Intestine Bacterial Overgrowth ◽

Comparative Group ◽

Methane Measurement

Hydrogen breath test (BT) is commonly used as a diagnostic tool for the detection of small intestine bacterial overgrowth (SIBO). It was reported that colonic methane production is far more frequent in cystic fibrosis (CF) patients than in other subjects. Therefore, measuring exclusively hydrogen in the diagnostic breath test for diagnosing SIBO might be of limited value. We aimed to assess the usefulness of combined measurement of hydrogen and methane expiration for the diagnosis of SIBO in CF. The study comprised 62 CF patients aged 5 to 18 years. Three-hundred-ninety subjects assessed due to gastrointestinal symptoms for the presence of SIBO served as a comparative group. In all subjects hydrogen/methane BT using glucose was performed. A positive BT was defined as fasting hydrogen > or = 20 ppm or fasting methane > or = 10 ppm or a rise of > or = 12 ppm hydrogen or > or = 6 ppm methane over baseline during the test. In 23 (37.1%) CF patients and in 52 (13.3%) subjects from the comparative group abnormal BT results were found. In seven (11.3%) CF patients and 29 (7.4%) of the other subjects studied methane measurement allowed diagnosis of SIBO. Small intestine bacterial overgrowth is frequent in cystic fibrosis. For its detection in cystic fibrosis and other gastrointestinal patients, combined hydrogen and methane measurement instead of hydrogen breath test should be applied. Without the additional measurement of methane a significant percentage of SIBO will be missed.

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Su1041 Non-Alcoholic Fatty Liver Disease (NAFLD) and Metabolic Syndrome Are Associated With Small Intestine Bacterial Overgrowth

Gastroenterology ◽

10.1016/s0016-5085(15)33571-x ◽

2015 ◽

Vol 148 (4) ◽

pp. S-1047

Author(s):

Andre Fialho ◽

Andrea Fialho ◽

Prashanthi N. Thota ◽

Arthur J. McCullough ◽

Bo Shen

Keyword(s):

Metabolic Syndrome ◽

Small Intestine ◽

Liver Disease ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Bacterial Overgrowth ◽

Alcoholic Fatty Liver ◽

Small Intestine Bacterial Overgrowth ◽

Alcoholic Fatty Liver Disease

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PWE-050 Does small intestine bacterial overgrowth cause neurodysmotility in IBS and coeliac disease?

Gut ◽

10.1136/gutjnl-2012-302514d.50 ◽

2012 ◽

Vol 61 (Suppl 2) ◽

pp. A317.1-A317 ◽

Cited By ~ 1

Author(s):

K Evans ◽

E Lunn ◽

S Raza ◽

D S Sanders ◽

S Higham

Keyword(s):

Small Intestine ◽

Coeliac Disease ◽

Bacterial Overgrowth ◽

Small Intestine Bacterial Overgrowth

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Small Intestine Bacterial Overgrowth and Environmental Enteropathy in Bangladeshi Children

mBio ◽

10.1128/mbio.02102-15 ◽

2016 ◽

Vol 7 (1) ◽

Cited By ~ 34

Author(s):

Jeffrey R. Donowitz ◽

Rashidul Haque ◽

Beth D. Kirkpatrick ◽

Masud Alam ◽

Miao Lu ◽

...

Keyword(s):

Small Intestine ◽

Systemic Inflammation ◽

Linear Growth ◽

Developing World ◽

Diarrheal Disease ◽

Intestinal Inflammation ◽

Bacterial Overgrowth ◽

Environmental Enteropathy ◽

Small Intestine Bacterial Overgrowth ◽

Chronic Intestinal Inflammation

ABSTRACT Recent studies suggest small intestine bacterial overgrowth (SIBO) is common among developing world children. SIBO’s pathogenesis and effect in the developing world are unclear. Our objective was to determine the prevalence of SIBO in Bangladeshi children and its association with malnutrition. Secondary objectives included determination of SIBO’s association with sanitation, diarrheal disease, and environmental enteropathy. We performed a cross-sectional analysis of 90 Bangladeshi 2-year-olds monitored since birth from an impoverished neighborhood. SIBO was diagnosed via glucose hydrogen breath testing, with a cutoff of a 12-ppm increase over baseline used for SIBO positivity. Multivariable logistic regression was performed to investigate SIBO predictors. Differences in concomitant inflammation and permeability between SIBO-positive and -negative children were compared with multiple comparison adjustment. A total of 16.7% (15/90) of the children had SIBO. The strongest predictors of SIBO were decreased length-for-age Z score since birth (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.03 to 0.60) and an open sewer outside the home (OR, 4.78; 95% CI, 1.06 to 21.62). Recent or frequent diarrheal disease did not predict SIBO. The markers of intestinal inflammation fecal Reg 1β (116.8 versus 65.6 µg/ml; P = 0.02) and fecal calprotectin (1,834.6 versus 766.7 µg/g; P = 0.004) were elevated in SIBO-positive children. Measures of intestinal permeability and systemic inflammation did not differ between the groups. These findings suggest linear growth faltering and poor sanitation are associated with SIBO independently of recent or frequent diarrheal disease. SIBO is associated with intestinal inflammation but not increased permeability or systemic inflammation. IMPORTANCE A total of 165 million children worldwide are considered stunted, which is associated with increased risk of death prior to age 5 years and cognitive disability. Stunting has, in part, been attributed to the presence of environmental enteropathy. Environmental enteropathy is a poorly understood condition leading to chronic intestinal inflammation. It has been postulated that small intestine bacterial overgrowth contributes to the pathogenesis of environmental enteropathy as overgrowth has been associated with intestinal inflammation and micronutrient malabsorption when it develops in other clinical contexts. This study confirms the finding that overgrowth occurs at high rates in the developing world. This is the first study to show that overgrowth is associated with intestinal inflammation and linear growth delay in this setting and is the first to examine why children with no known gastrointestinal dysfunction develop overgrowth from the developing world environment.

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