AB0657 Small intestinal bacterial overgrowth in relation to gastrointestinal symptoms in systemic sclerosis

Abstract

BackgroundAutonomic dysfunction, smooth muscle fibrosis and vascular damage lead to small intestinal bacterial overgrowth (SIBO) in Systemic Sclerosis (SSc). SIBO is characterized by diarrhea, abdominal pain, bloating, malabsorption and malnutrition.ObjectivesTo evaluate by NIH PROMIS® gastrointestinal symptoms scales and SIBO by hydrogen breath test (HBT) in patients with SSc.MethodsWe include 68 patients with SSc (ACR-EULAR 2015) who signed informed consent. NIH PROMIS®questionarie was applied to evaluated gastrointestinal symptoms and classified in not symptomatic, least, mildy, moderately and most symptomatic. Glucose HBT was applied after 14 hours fast, oral hygiene and 30 days free of antibiotics. Patients who has a negative HBT with symptoms associated to glucose ingestion we repeat test with lactulose.ResultsWe applied questionnaire to 58 SSc patients, age 52 (26–75)years, 65 (96%) female and 3 (4%) males, disease duration 13 (1–40) years, limited SSc 41 (59%) and diffuse 27 (41%), body mass index 24 (12–39).They are using prednisone (28%), micofenolate (14%), methotrexate (19%), azatioprin (5%), amlodipine or nifedipine (33%). Patients had continuous and very high increase of parts per millon (ppm) of exhaled Hydrogen: min0: 13 ppm (5–21), min15:17 ppm (5–43), min30:17 (3–49), min45:18ppm (7–103), min 60:22ppm (8–145), min90:18ppm (2–250), min120:25ppm (3–212), min150:71ppm (3–235). Normal values: <10 ppm during total test (Figure1).Frequency of gastrointestinal symptoms were flatulence (87.5vs81.2%), nausea/vomiting (72.7vs37.6%), constipation (65.6vs40%), diarrhea (45.2vs33.4%), abdominal pain %) and incontinence (39.4vs31.3%) respectively between SCB (+) positive and negative.Hyperproduction of hydrogen in breath had a direct correlation to severity of their symptoms (p≤0.05). The severity of diarrhea was in close relation to the severity of its rectal incontinence (r=0.73,p=0.001), and greater abdominal pain with flatulence (r=72, p=0.001).ConclusionsGastrointestinal symptoms are common in SSc regardless of whether they have SIBO. However, a higher Row Score SGI or moderate severe status (NIH PROMIS) correlates with high H scores from the 30th minute, therefore, the questionnaire is useful within the SSc assessment.Disclosure of InterestNone declared

Small Intestinal Bacterial Overgrowth Complicating Gastrointestinal Manifestations of Systemic Sclerosis: A Systematic Review and Meta-analysis

“…This data was reported in 3 studies. 36 , 37 , 44 There was substantial heterogeneity noted in the analysis (I 2 = 82.00%, P = 0.001). Although data could be extracted from only limited studies, SSc-patients who were SIBO positive as compared to those who were SIBO negative, there was significant difference in prevalence of symptoms like bloating 37 , 44 (84.8% [95% CI, 73.9-92.4] vs 60.4% [95% CI, 46.0-73.5]), dyspepsia 29 , 36 (63.2% [95% CI, 38.3-83.7] vs 22.2% [95% CI, 14.1-32.2]), and abdominal pain 37 (86.4% [95% CI, 65.1-97.1] vs 31% [95% CI, 15.2-50.8]) but no significant difference was noted in regard to prevalence of dysphagia 36 (66.7% [95% CI, 34.8-90.1] vs 37.7% [95% CI, 26.8-49.4]) and weight loss 24 , 29 (53.3% [95% CI, 16.5-78.7] vs 13.8% [95% CI, 3.8-31.6]).…”

“…1 ) identified 28 studies suitable for this systematic review and the subsequent meta-analysis. Eleven out of 28 studies 22 - 32 were case-control studies while 17 33 - 49 were prevalence studies. The specifics of these studies in relation to methodology for the diagnosis of SIBO and the characteristics of the patient cohorts are provided in Table 2 and Supplementary Tables 2 and 3 .…”

“…9 ) with moderate heterogeneity (I 2 = 44.40%, P = 0.126) in the analysis. 23 , 24 , 29 , 33 , 36 , 37 , 44 Further subgroup analysis regarding other GI symptoms could not be performed, however the descriptive results are summarized below.…”

“…This data was reported in 3 studies. 36,37,44 There was substantial heterogeneity noted in the analysis (I 2 = 82.00%, P = 0.001). Although data could be extracted from only limited studies, SSc-patients who were SIBO positive as compared to those who were SIBO negative, there was significant difference in prevalence of symptoms like bloating 37,44 (84.8% [95% CI, 73.9-92.4] vs 60.4% [95% CI, 46.0-73.5]), dyspepsia 29…”