Dysmotility and proton pump inhibitor use are independent risk factors for small intestinal bacterial and/or fungal overgrowth. Issue 11 (10th April 2013)

• Record Type: Journal Article
• Authors: Jacobs, C.; Coss Adame, E.; Attaluri, A.; Valestin, J.; Rao, S. S. C.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 37:Issue 11(2013)
• Page Start: 1103
• Page End: 1111
• Publication Date: 2013-04-10
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.12304
• Languages: English
• ISSNs: 0269-2813

Abstract

<abstract abstract-type="main" id="apt12304-abs-0001"> <title>Summary</title> <sec id="apt12304-sec-0001" sec-type="section"> <title>Background</title> <p>Whether intestinal dysmotility and the use of a proton pump inhibitor (PPI) either independently or together contributes to small intestinal bacterial overgrowth (SIBO), and/or small intestinal fungal overgrowth (SIFO) is not known.</p> </sec> <sec id="apt12304-sec-0002" sec-type="section"> <title>Aim</title> <p>To investigate the role of dysmotility and PPI use in patients with persistent gastrointestinal complaints.</p> </sec> <sec id="apt12304-sec-0003" sec-type="section"> <title>Methods</title> <p>Patients with unexplained gastrointestinal symptoms and negative endoscopy/radiology tests completed a validated symptom questionnaire and underwent 24‐h ambulatory antro‐duodeno‐jejunal manometry (ADJM). Simultaneously, duodenal aspirate was obtained for aerobic, anaerobic and fungal culture. Dysmotility was diagnosed by (>2): absent phase III MMC, absent/diminished postprandial response, diminished amplitude of antral/intestinal phasic activity, impaired antro‐duodenal coordination. Bacterial growth ≥10<sup>3</sup> CFU/mL or fungal growth was considered evidence for SIBO/SIFO. PPI use was documented. Correlation of symptoms with presence of SIBO or SIFO was assessed.</p> </sec> <sec id="apt12304-sec-0004" sec-type="section"> <title>Results</title> <p>One hundred and fifty subjects (M/F = 47/103) were evaluated; 94/150 (63%) had overgrowth: 38/94 (40%) had SIBO, 24/94 (26%) had SIFO and 32/94 (34%) had mixed SIBO/SIFO. SIBO was predominately due to <italic>Streptococcus, Enterococcus, Klebsiella</italic> and <italic>E. coli</italic>. SIFO was due to <italic>Candida</italic>. Eighty of 150 (53%) patients had dysmotility and 65/150 (43%) used PPI. PPI use (<italic>P </italic>= 0.0063) and dysmotility (<italic>P</italic> = 0.0003) were independent significant risk factors (<italic>P</italic> < 0.05) for overgrowth, but together did not pose additional risk. Symptom profiles were similar between those with or without SIBO/SIFO.</p> </sec> <sec id="apt12304-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Dysmotility and PPI use were independent risk factors for SIBO or SIFO and were present in over 50% of subjects with unexplained gastrointestinal symptoms. Diagnosis of overgrowth requires testing because symptoms were poor predictors of overgrowth.</p> </sec> </abstract>