Efficacy of antibiotherapy for treating flatus incontinence associated with small intestinal bacterial overgrowth: A pilot randomized trial

Abstract

AimAn increase in intestinal gas production due to small intestinal bowel overgrowth (SIBO) is a contributing factor for flatus incontinence. The aims of our study were to assess the efficacy of metronidazole in a select population of patients with flatus incontinence associated with SIBO and to compare its efficacy with that of a combination of simethicone and activated charcoal (SC; Carbosylane) in randomized experimental arms.MethodsAdult patients suffering from flatus incontinence associated with SIBO diagnosed by a glucose breath test were enrolled in the study. They were given metronidazole or Carbosylane (SC) for 10 days. The reduction in the mean daily number of gas leakages reported in a 3-day diary before and at the end of the treatment was used as the primary endpoint.ResultsOf 52 consecutive subjects with flatus incontinence, 23 (44%) had SIBO, 16 (33%) of whom were included in and completed the study. The relative reduction in flatus incontinence episodes was significantly higher in the metronidazole than in the SC group (66.8±34.8% vs. 25±50%, P = 0.03), decreasing by more than 50% in 7 (87.5%) of the subjects in the metronidazole group compared with only 1 (12.5%) in the SC group (odds ratio 1.9, 95% confidence interval 0.9–56.9, P = 0.06).ConclusionOur results show a promising trend indicating that metronidazole might significantly improve flatus incontinence associated with SIBO and might be more successful in treating flatus incontinence than gas absorbents.

Small intestinal bacterial overgrowth as a cause of protracted wound healing and vitamin D deficiency in a spinal cord injured patient with a sacral pressure sore: a case report

“…In principle, antibiotics should be chosen based on the results of an antimicrobial susceptibility test, but this approach cannot address the great diversity in microbiota of the digestive tract [ 26 , 27 ]. Metronidazole is a first-line choice for SIBO [ 28 ], with other choices being rifaximin, ciprofloxacin, norfloxacin, amoxicillin/clavulanate, trimethoprim, sulfamethoxazole, cephalexin, or their combination [ 6 ]. However, these antibodies are selected based on custom rather than scientific evidence [ 27 ].…”

Preparation and characterization of steam and CO2 activated carbon from Brazil nut shell

“…The activation also provides an increasement on the porosity of the conventional carbon, which enables it to several uses, such as in health care (Vaziri et al 2013;Ali et al 2014;Melchior et al 2017), skin care (Kulkarni et al 2018), filtering (Nowicki et al 2015) and others.…”