Evaluation of small intestine bacterial overgrowth in patients with functional dyspepsia through H2 breath test

Costa, Michelle; Azeredo, Itaciron Luz; Marciano, Ricardo; Caldeira, Luciana Morelli; Boiocchi, Mauro

doi:10.1590/s0004-28032012000400009

Cited by 33 publications

(30 citation statements)

References 12 publications

(15 reference statements)

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“…There is contradictory evidence on the role in functional dyspepsia of small-intestinal bacterial overgrowth, a condition in which the bacterial population in the small intestine is greater than the physiological state and composed of species that are typical of the colon microbiota 98,99 . One study has linked the composition of the faecal microbiota to abdominal pain, and enterotypes (that is, types of gut microbiota populations) in which bacteria of the Prevotella genus were predominant corre lated with less-intense pain 100 .…”

Section: Intestinal Microbiotamentioning

confidence: 99%

Functional dyspepsia

Enck¹,

Azpiroz

Boeckxstaens

et al. 2017

Nat Rev Dis Primers

235

223

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| Functional dyspepsia is one of the most prevalent functional gastrointestinal disorders. Functional dyspepsia comprises three subtypes with presumed different pathophysiology and aetiology: postprandial distress syndrome (PDS), epigastric pain syndrome (EPS) and a subtype with overlapping PDS and EPS features. Functional dyspepsia symptoms can be caused by disturbed gastric motility (for example, inadequate fundic accommodation or delayed gastric emptying), gastric sensation (for example, sensations associated with hypersensitivity to gas and bloating) or gastric and duodenal inflammation. A genetic predisposition is probable but less evident than in other functional gastrointestinal disorders, such as irritable bowel syndrome (IBS). Psychiatric comorbidity and psychopathological state and trait characteristics could also play a part, although they are not specific to functional dyspepsia and are less pronounced than in IBS. Possible differential diagnoses include Helicobacter pylori infection and peptic ulceration. Pharmacological therapy is mostly based on the subtype of functional dyspepsia, such as prokinetic and fundus-relaxing drugs for PDS and acid-suppressive drugs for EPS, whereas centrally active neuromodulators and herbal drugs play a minor part. Psychotherapy is effective only in a small subset of patients, whereas quality of life can be severely affected in nearly all patients. Future therapies might include novel compounds that attempt to treat the underlying gastric and duodenal inflammation. NATURE REVIEWS | DISEASE PRIMERS VOLUME 3 | ARTICLE NUMBER 17081 | 1 PRIMER © 2 0 1 7 M a c m i l l a n P u b l i s h e r s L i m i t e d , p a r t o f S p r i n g e r N a t u r e . A l l r i g h t s r e s e r v e d .standard therapy for gastro -oesophageal reflux disease. Paediatric dyspeptic symptoms are being addressed in a separate classification effort 10 . This Primer covers functional dyspepsia in adults only, although we sporadically refer to paediatric functional dyspepsia when similarities exist. EpidemiologyThe population prevalence of functional dyspepsia is quite variable across the globe, with overall high numbers (10-40%) in Western countries and low numbers (5-30%) in Asia, independent of the respective functional dyspepsia definitions 11 . A large-scale health and nutrition survey from France 12 (which involved >35,000 people) identified that 15% of individuals had suspected functional dyspepsia, 28% had irritable bowel syndrome (IBS) and 6% had both. The population of patients who are affected by both IBS and functional dyspepsia has been reported to range between 10% and 27% in previous studies 13 and to approach 30% in popu lation samples; it could be even higher in specific populations 14,15 . This observation has given rise to the term 'overlap syndrome' (REF. 13), which calls into question the sensitivity and specificity of the Rome criteria, at least for IBS and functional dyspepsia. This argument is also supported by the observation that patients with functional dyspepsia m...

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Section: Intestinal Microbiotamentioning

confidence: 99%

Functional dyspepsia

Enck¹,

Azpiroz

Boeckxstaens

et al. 2017

Nat Rev Dis Primers

235

223

View full text Add to dashboard Cite

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“…14,15 SIBO is characterized by various gastrointestinal symptoms such as abdominal pain, bloating, distention, and diarrhea, which are found in patients with FGID, and may be associated with excessive gas in the small intestine due to the presence of a large number of hydrogen-producing bacteria. Indeed, it has been demonstrated that patients experiencing functional dyspepsia (FD) or irritable bowel syndrome (IBS) have a higher prevalence of abnormal microbial fermentation in the small intestine as compared with healthy controls, [16][17][18] with the prevalence reported to be 56.5% in patients with FD 16 and ranging from 2-84% in those with IBS. [19][20][21] These results support the hypothesis that SIBO may play a role in FGID.…”

Section: Introductionmentioning

confidence: 99%

Small Intestinal Bacterial Overgrowth in Patients with Refractory Functional Gastrointestinal Disorders

Shimura

Ishimura

Mikami

et al. 2015

J Neurogastroenterol Motil

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Background/AimsSmall intestinal bacterial overgrowth (SIBO) is considered to be involved in the pathogenesis of functional gastrointestinal disorders (FGID). However, the prevalence and clinical conditions of SIBO in patients with FGID remain to be fully elucidated. Here, we examined the frequency of SIBO in patients with refractory FGID. MethodsWe prospectively enrolled patients with refractory FGID based on Rome III criteria. A glucose hydrogen breath test (GHBT) was performed using a gas analyzer after an overnight fast, with breath hydrogen concentration measured at baseline and every 15 minutes after administration of glucose for a total of 3 hours. A peak hydrogen value ≥ 10 ppm above the basal value between 60 and 120 minutes after administration of glucose was diagnosed as SIBO. ResultsA total of 38 FGID patients, including 11 with functional dyspepsia (FD), 10 with irritable bowel syndrome (IBS), and 17 with overlapping with FD and IBS, were enrolled. Of those, 2 (5.3%) were diagnosed with SIBO (one patient diagnosed with FD; the other with overlapping FD and IBS). Their symptoms were clearly improved and breath hydrogen levels decreased to normal following levofloxacin administration for 7 days. ConclusionsTwo patients initially diagnosed with FD and IBS were also diagnosed with SIBO as assessed by GHBT. Although the frequency of SIBO is low among patients with FGID, it may be important to be aware of SIBO as differential diagnosis when examining patients with refractory gastrointestinal symptoms, especially bloating, as a part of routine clinical care. (J Neurogastroenterol Motil 2016;22:60-68)

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“…Previously, it has been demonstrated that patients who complained of dyspeptic symptoms would have an increased risk of intestinal dysbiosis. 14,38,40 Further prospective evaluations are necessary to investigate whether patients with severe atrophic change would benefit on symptomatic improvement from H. pylori eradication. Altered gut microbiota have been considered as a main pathophysiology of IBS and manipulation of gut microbiota represents a new strategy for the treatment of IBS.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9][10][11][12] Increasing eosinophils of the duodenum secondary to the exposure of gastric acid or food allergens to the duodenum might correlate with FD, and it has been suggested that there is a correlation between eosinophils and low-grade inflammation. 13,14 Furthermore, it has been…”

Section: Introductionmentioning

confidence: 99%

IsHelicobacter pyloriAssociated Functional Dyspepsia Correlated With Dysbiosis?

Kim

Chung

Kim

et al. 2017

J Neurogastroenterol Motil

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Background/AimsTo assess the long-term effect of Helicobacter pylori eradication on symptomatic improvement according to the type of antibiotic and the duration of treatment in H. pylori-associated functional dyspepsia. MethodsWe searched Pubmed, Embase, CINAHL, and the Cochrane library databases for randomized controlled trials written in English and undertaken up to August 2016 that met our eligibility criteria. The search methodology used combinations of the following keywords: Helicobacter pylori OR H. pylori OR HP; dyspepsia OR functional dyspepsia OR non-ulcer dyspepsia; eradication OR cure OR treatment. The study outcome was the summary odds ratio (OR) for symptomatic improvement in H. pylori-associated functional dyspepsia with successful eradication therapy. Subgroup analyses were performed based on the type of antibiotic, and the duration of treatment, whether or not patients had symptoms of irritable bowel syndrome, and on race. ResultsSixteen randomized controlled trials met the inclusion criteria. The summary OR for symptomatic improvement in patients in our eradication group was 1.33 (95% confidence interval [CI], 1.16-1.54; P < 0.01). In a subgroup analysis on type of antibiotic, symptomatic improvement with metronidazole-containing regimen (OR, 1.87; 95% CI, 1.26-2.77) was better than treatment with clarithromycin (OR, 1.29; 95% CI, 1.11-1.50). H. pylori eradication therapy given for 10-14 days was the more effective for symptom improvement than 7-day therapy. When the studies excluding irritable bowel syndrome cases were analyzed, there were no therapeutic effects of H. pylori eradication on symptomatic improvement. ConclusionsIn the clinical setting, the most effective H. pylori eradication regimen for functional dyspepsia to provide relief of symptoms is a metronidazole-based treatment regimen for at least 10 days. The explanation for this is that H. pylori-associated functional dyspepsia could be associated with dysbiosis.

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Evaluation of small intestine bacterial overgrowth in patients with functional dyspepsia through H2 breath test

Cited by 33 publications

References 12 publications

Functional dyspepsia

Functional dyspepsia

Small Intestinal Bacterial Overgrowth in Patients with Refractory Functional Gastrointestinal Disorders

IsHelicobacter pyloriAssociated Functional Dyspepsia Correlated With Dysbiosis?

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