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Small intestinal bacterial overgrowth is associated with irritable bowel syndrome and is independent of proton pump inhibitor usage.

Giamarellos-Bourboulis EJ, Pyleris E, Barbatzas C, Pistiki A, Pimentel M - BMC Gastroenterol (2016)

Bottom Line: Current knowledge suggests that small intestinal overgrowth participates in the pathogenesis of irritable bowel syndrome.It is questionable if this association is modulated by intake of proton pump inhibitors (PPIs).Multiple logistic regression analysis found that factors independently associated with SIBO were age above or equal to 60 years (OR: 2.36), body mass index more than or equal to 22 kg/m(2) (OR: 0.60), presence of IBS (OR: 6.29), type 2 diabetes mellitus (OR: 1.59) and gastritis (OR: 0.47).

View Article: PubMed Central - PubMed

Affiliation: 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece. egiamarel@med.uoa.gr.

ABSTRACT

Background: Current knowledge suggests that small intestinal overgrowth participates in the pathogenesis of irritable bowel syndrome. It is questionable if this association is modulated by intake of proton pump inhibitors (PPIs).

Methods: In a prospective study, quantitative cultures of duodenal aspirates were performed for aerobic species in 897 consecutive patients undergoing upper GI tract endoscopy. SIBO was defined as equal to or more than 10(3) cfu/ml. The effect of PPI intake on the relationship between SIBO and IBS was the primary endpoint.

Results: Analysis among patients without any history of PPI intake (n = 713) showed that odds ratio (OR) for IBS in the event of SIBO was 5.63 (3.73-8.51, p < 0.0001); this was 4.16 (1.91-9.06) when analysis was done among patients with history of PPI intake (n = 184, p: 0.498 between patients without and with PPI intake). Multiple logistic regression analysis found that factors independently associated with SIBO were age above or equal to 60 years (OR: 2.36), body mass index more than or equal to 22 kg/m(2) (OR: 0.60), presence of IBS (OR: 6.29), type 2 diabetes mellitus (OR: 1.59) and gastritis (OR: 0.47).

Conclusions: The association between IBS and SIBO was completely independent from PPI intake. Although gastritis was protective against SIBO, results show that PPI intake cannot prime SIBO.

No MeSH data available.


Related in: MedlinePlus

Study flow chart. Abbreviations: GI; gastrointestinal; SIBO: syndrome of intestinal bacterial overgrowth
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Fig1: Study flow chart. Abbreviations: GI; gastrointestinal; SIBO: syndrome of intestinal bacterial overgrowth

Mentions: Fully available data were missing in seven patients and analysis was done in a total of 897 patients (Fig. 1). From the total analysed patients, 184 (20.5 %) had a history of recent PPI intake. The overall frequency of SIBO was 17.6 % when the ≥103 cfu/ml diagnostic cut-off was used; it was 15.6 % when the ≥104 cfu/ml diagnostic cut-off was used; and it was 10.6 % when the ≥105 cfu/ml diagnostic cut-off was used. Comparative characteristics between patients with SIBO and patients without SIBO are shown in Table 1. Overall, endoscopic findings were negative for 410 patients. No differences were found between the two groups of patients regarding history of PPI intake. However, patients with SIBO were older, they had a greater frequency of IBS, of type 2 diabetes mellitus (T2DM) and of anemia and a lower frequency of endoscopic presence of gastritis.Fig. 1


Small intestinal bacterial overgrowth is associated with irritable bowel syndrome and is independent of proton pump inhibitor usage.

Giamarellos-Bourboulis EJ, Pyleris E, Barbatzas C, Pistiki A, Pimentel M - BMC Gastroenterol (2016)

Study flow chart. Abbreviations: GI; gastrointestinal; SIBO: syndrome of intestinal bacterial overgrowth
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940948&req=5

Fig1: Study flow chart. Abbreviations: GI; gastrointestinal; SIBO: syndrome of intestinal bacterial overgrowth
Mentions: Fully available data were missing in seven patients and analysis was done in a total of 897 patients (Fig. 1). From the total analysed patients, 184 (20.5 %) had a history of recent PPI intake. The overall frequency of SIBO was 17.6 % when the ≥103 cfu/ml diagnostic cut-off was used; it was 15.6 % when the ≥104 cfu/ml diagnostic cut-off was used; and it was 10.6 % when the ≥105 cfu/ml diagnostic cut-off was used. Comparative characteristics between patients with SIBO and patients without SIBO are shown in Table 1. Overall, endoscopic findings were negative for 410 patients. No differences were found between the two groups of patients regarding history of PPI intake. However, patients with SIBO were older, they had a greater frequency of IBS, of type 2 diabetes mellitus (T2DM) and of anemia and a lower frequency of endoscopic presence of gastritis.Fig. 1

Bottom Line: Current knowledge suggests that small intestinal overgrowth participates in the pathogenesis of irritable bowel syndrome.It is questionable if this association is modulated by intake of proton pump inhibitors (PPIs).Multiple logistic regression analysis found that factors independently associated with SIBO were age above or equal to 60 years (OR: 2.36), body mass index more than or equal to 22 kg/m(2) (OR: 0.60), presence of IBS (OR: 6.29), type 2 diabetes mellitus (OR: 1.59) and gastritis (OR: 0.47).

View Article: PubMed Central - PubMed

Affiliation: 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece. egiamarel@med.uoa.gr.

ABSTRACT

Background: Current knowledge suggests that small intestinal overgrowth participates in the pathogenesis of irritable bowel syndrome. It is questionable if this association is modulated by intake of proton pump inhibitors (PPIs).

Methods: In a prospective study, quantitative cultures of duodenal aspirates were performed for aerobic species in 897 consecutive patients undergoing upper GI tract endoscopy. SIBO was defined as equal to or more than 10(3) cfu/ml. The effect of PPI intake on the relationship between SIBO and IBS was the primary endpoint.

Results: Analysis among patients without any history of PPI intake (n = 713) showed that odds ratio (OR) for IBS in the event of SIBO was 5.63 (3.73-8.51, p < 0.0001); this was 4.16 (1.91-9.06) when analysis was done among patients with history of PPI intake (n = 184, p: 0.498 between patients without and with PPI intake). Multiple logistic regression analysis found that factors independently associated with SIBO were age above or equal to 60 years (OR: 2.36), body mass index more than or equal to 22 kg/m(2) (OR: 0.60), presence of IBS (OR: 6.29), type 2 diabetes mellitus (OR: 1.59) and gastritis (OR: 0.47).

Conclusions: The association between IBS and SIBO was completely independent from PPI intake. Although gastritis was protective against SIBO, results show that PPI intake cannot prime SIBO.

No MeSH data available.


Related in: MedlinePlus