Glucose breath test and Crohn's disease: Diagnosis of small intestinal bacterial overgrowth and evaluation of therapeutic response. (November 2015)

• Record Type: Journal Article
• Authors: Greco, Anna; Caviglia, Gian Paolo; Brignolo, Paola; Ribaldone, Davide Giuseppe; Reggiani, Stefania; Sguazzini, Carlo; Smedile, Antonina; Pellicano, Rinaldo; Resegotti, Andrea; Astegiano, Marco; Bresso, Francesca
• Is Part Of: Scandinavian journal of gastroenterology. Volume 50:Number 11(2015)
• Page Start: 1376
• Page End: 1381
• Publication Date: 2015-11
• Subjects: Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; 616.33
• Languages: English
• ISSNs: 0036-5521

Abstract

<abstract> <title>Abstract</title> <p> <bold> <italic>Objective.</italic> </bold> Small intestinal bacterial overgrowth (SIBO) is characterized by an abnormal proliferation of bacterial species in the small bowel. It has been shown that patients with Crohn's disease (CD) have a higher risk of SIBO development. The aim of the present study was to investigate SIBO prevalence in CD patients, possible clinical predictors of SIBO development and response to antibiotic therapy. <bold><italic>Material and methods.</italic></bold> Sixty-eight patients (42 male, 26 female; mean age 49.3 ± 12.8 years) with CD reporting abdominal complaints were prospectively evaluated for SIBO with H<sub>2</sub>/CH<sub>4</sub> glucose breath test (GBT). <bold><italic>Results.</italic></bold> Of the 68 patients enrolled, 18 (26.5%) tested positive for SIBO. Patients with SIBO exhibited increased stool frequency and significant reduction of stool solidity (<italic>p</italic> = 0.014), were older than patients tested negative to GBT (54.3 ± 13.0 years vs. 47.5 ± 12.3 years, <italic>p</italic> = 0.049), reported a longer history of CD (21.2 ± 10.3 years vs. 15.7 ± 10.2 years, <italic>p</italic> = 0.031) and showed a significant higher frequency of prior surgery (<italic>p</italic> = 0.001), revealing an association of number of surgical procedures (OR = 2.8315, 95% CI = 1.1525–6.9569, <italic>p</italic> = 0.023) with SIBO. Breath test normalization occurred in 13/15 patients evaluated after antibiotic and probiotic therapy. Although vitamin B12 levels were lower in patients with SIBO (<italic>p</italic> = 0.045) and a significant improvement was found after treatment (<italic>p</italic> = 0.011), this could be due to the heterogeneity, regarding vitamin B12 treatment, in our cohort. <bold><italic>Conclusion.</italic></bold> SIBO is a frequent but underestimated condition in CD, which often mimics acute flare, effectively identified with GBT and could be treated with a combined antibiotic and probiotic therapy.</p> </abstract>