Breath test for differential diagnosis between small intestinal bacterial overgrowth and irritable bowel disease: An observation on non-absorbable antibiotics

Esposito, Giovanni; Leone,; Di, Di; Gregório,; Giaquinto,; Magistris,; Ferrieri,; Riegler,

doi:10.3748/wjg.13.6016

Cited by 42 publications

(39 citation statements)

References 20 publications

(23 reference statements)

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“…Effect of other antibiotics in IBS patients have been reported 15,20 also in randomized placebo-controlled trials, [16][17][18][19] and a possibility of a real (non-placebo) effect of treatment exists.…”

Section: Discussionmentioning

confidence: 96%

“…Irritable bowel syndrome can develop after acute gastroenteritis (so-called post-infectious IBS). 8,9 Some studies have shown alterations in quantity and composition of the gut microbiota in IBS patients compared with controls [10][11][12][13] and both probiotics 14 and antibiotics [15][16][17][18][19][20][21][22] have been reported relieving symptoms of IBS. Therefore, the microbiota of IBS patients is under scrutiny.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of Dientamoeba fragilis in Patients with Irritable Bowel Syndrome

Engsbro

Stensvold²,

Nielsen³

et al. 2012

The American Journal of Tropical Medicine and Hygiene

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Abstract. The role of Dientamoeba fragilis in irritable bowel syndrome (IBS) is incompletely known. We aimed to investigate whether eradication of D. fragilis alleviates symptoms in IBS. Twenty-five D. fragilis-positive IBS patients were treated with Metronidazole (MZ) or Tetracycline. The patients were mostly female (89%), and mean age (SD) was 35.1 (8.2) years. Microbiological response, evaluated 2 weeks post-treatment, was observed in 15 of 25 patients (60%), all by MZ. Clinical response, defined as adequate relief of symptoms, was observed in 7 of 22 patients (32%), all by MZ. In a logistic regression analysis, we found no significant association between clinical and microbiological response. This case study did not support our hypothesis of a simple association between D. fragilis and IBS. Some D. fragilis-infections were insufficiently treated by MZ. Further studies into the prevalence and effect of eradication of D. fragilis in IBS and into efficient treatments of D. fragilis are warranted.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Treatment of Dientamoeba fragilis in Patients with Irritable Bowel Syndrome

Engsbro

Stensvold²,

Nielsen³

et al. 2012

The American Journal of Tropical Medicine and Hygiene

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“…The presence of SIBO in NASH patients has been linked to increased intestinal permeability [19], which predisposes to bacterial translocation and translocation of bacterial byproducts such as LPS. In patients with NASH, SIBO has been associated with increased levels of LPS binding protein and up-regulation of the LPS ligand toll-like receptor 4 (TLR-4), which correlated with increased plasma levels of inflammatory markers such as interleukin (IL)-8 and hepatic expression of tumor necrosis factor (TNF)-α [16,17]. The latter has been shown to induce liver fibrosis and insulin resistance [20,21].…”

Section: Discussionmentioning

confidence: 99%

“…above basal value or H 2 and/or CH 4 increase >12 p.p.m. between minimal and maximal values after glucose ingestion [16].…”

Section: Diagnosis Of Sibomentioning

confidence: 99%

Small Intestinal Bacterial Overgrowth Is Associated with Non- Alcoholic Fatty Liver Disease

Fialho

André

Thota

et al. 2016

JGLD

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Background: Changes in gut bacteria play a role in type 2 diabetes mellitus (DM) and hepatic steatosis. There is a lack of studies evaluating the frequency and risk factors for non-alcoholic fatty liver disease (NAFLD) in patients tested for small intestinal bacterial overgrowth (SIBO). Aim: To evaluate the frequency of NAFLD and associated risk factors in patients tested for SIBO. Methods: In this case-control study, 372 eligible patients submitted to glucose hydrogen/methane breath test for SIBO who also had an abdominal imaging study were included. Patients were divided into SIBO-positive and SIBO-negative groups. Clinical, demographic and laboratory variables were evaluated in addition to the presence of NAFLD on abdominal imaging. Results: Of the 372 eligible patients, 141 (37.9%) were tested positive for SIBO (study group) and 231 (62.1%) were negative for it (control group). NAFLD occurred in 45.4% (64/141) of the study group compared to 17.3% (40/231) of the control group (p<0.001). Patients in the study group were found to have higher rates of elevated aspartate aminotransferase (AST) (20.6% vs. 11.3%; p=0.034) and alanine aminotransferase (ALT) levels (56.0% vs. 40.7%; p= 0.039), type 2 diabetes (23.4% vs. 13.9%; p=0.041), hypertension (54.6% vs. 40.3%; p=0.046) and metabolic syndrome (78.0% vs. 60.2%; p=0.020). In the multivariate analysis, SIBO (odds ratio [OR]: 1.95; 95% confidence interval [CI]: 1.14-3.31; p=0.014), type 2 DM (OR: 3.04; 95%CI: 1.57-5.90; p=0.001) and obesity (OR: 3.58; 95%CI: 1.70-7.54; p=0.001) remained associated with NAFLD.Conclusion: Patients with SIBO have an increased risk for hepatic steatosis and may benefit from aggressive control of the risk factors for NAFLD including metabolic syndrome. Abbreviations: ALT: alanine aminotransferase; AST: aspartate aminotransferase; BMI: body mass index; CTE: computed tomography enterography; DM: diabetes mellitus; ETOH: ethanol; IL: interleukin; LPS: lipopolysaccharide; NAFLD: non-alcoholic fatty liver disease; NASH: non-alcoholic steatohepatitis; PPI: proton pump inhibitor; SIBO: small intestinal bacterial overgrowth; TLR-4: toll-like receptor 4; TMAO: trimethylamine-N-oxide (TMAO); TNF-α: tumor necrosis factor alpha.

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“…The occurrence of SIBO has been associated with abnormalities in small intestinal motor function (73) and its eradication with symptomatic relief (68,69,72,(74)(75)(76)(77). These striking results have been the target of much criticism on several grounds (78)(79)(80)(81)(82)(83)(84)(85).…”

Section: Qualitative or Quantitative Changes In The Enteric Flora (Mimentioning

confidence: 99%

Irritable bowel syndrome; update on pathophysiology and management

Quigley¹,

Craig²

2012

Turk J Gastroenterol

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The functional gastrointestinal disorders (FGID) are symptom-based disorders that cannot be currently explained by definable structural or biochemical causes (1). These disorders are common: the presence of at least one functional GI disorder was identified in 70% of participants in a large US householder survey (2). An associated co-morbid psychiatric condition such as anxiety, mood or panic disorder is seen in up to 60% of those attending gastroenterology outpatient clinics with a functional compliant (3). Functional GI disorders are associated with significant impairment of quality of

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Breath test for differential diagnosis between small intestinal bacterial overgrowth and irritable bowel disease: An observation on non-absorbable antibiotics

Abstract: AIM:To estimate the prevalence of small intestine bacterial overgrowth (SIBO) among patients with an earlier diagnosis of irritable bowel disease (IBS) in our geographical area, and to collect information on the use of locally acting non-absorbable antibiotics in the management of SIBO.

Cited by 42 publications

References 20 publications

Treatment of Dientamoeba fragilis in Patients with Irritable Bowel Syndrome

Treatment of Dientamoeba fragilis in Patients with Irritable Bowel Syndrome

Small Intestinal Bacterial Overgrowth Is Associated with Non- Alcoholic Fatty Liver Disease

Irritable bowel syndrome; update on pathophysiology and management

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