Risk Factors for Small Bowel Bacterial Overgrowth in Cystic Fibrosis

Fridge, Jacqueline; Conrad, Carol; Gerson, Lauren B.; Castillo, Ricardo; Cox, Kenneth L.

doi:10.1097/mpg.0b013e31802c0ceb

Cited by 99 publications

(89 citation statements)

References 42 publications

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“…However, BIO also seems to be involved in other intestinal disorders, e.g., the irritable bowel syndrome [6,13,14]. Though an increased prevalence of BIO has already been described, even in children with cystic fibrosis (CF), further clinical studies confirming these findings are scarce [15,16]. Recently, Norkina et al [17] reported on the inflammatory effects of bacterial intestinal overgrowth in the cystic fibrosis mouse small intestine.…”

Section: Introductionmentioning

confidence: 93%

Application of the Glucose Hydrogen Breath Test for the Detection of Bacterial Overgrowth in Patients with Cystic Fibrosis––A Reliable Method?

et al. 2008

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Patients with cystic fibrosis (CF) have recently been deemed highly susceptible for bacterial intestinal overgrowth (BIO). We aimed to define the prevalence of BIO in children with CF by applying the H(2)-glucose breath test. Forty children with CF and ten healthy children received 1 g/kg D-glucose orally. Breath samples for H(2) content (ppm) were collected for 3 h. BIO was suspected if the breath hydrogen content increased by more than 20 ppm or if baseline concentrations topped 20 ppm. In 27 of 40 CF children (68%), breath hydrogen content exceeded 20 ppm. Whereas the breath hydrogen exhalation persisted above 20 ppm in almost all these children throughout the sampling period, none of the remaining children increased above this threshold. The high rate of CF children with elevated fasting hydrogen breath concentrations indicates that this phenomenon is less a sign of BIO rather than a consequence of global malabsorption and intestinal dysmotility.

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Section: Introductionmentioning

confidence: 93%

Application of the Glucose Hydrogen Breath Test for the Detection of Bacterial Overgrowth in Patients with Cystic Fibrosis––A Reliable Method?

et al. 2008

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“…Hydrogen and methane cannot be produced by host-cell metabolism but are the products of microbial fermentation; the magnitude of the gas levels is proportional to the concentration of bacteria. Using breath testing, SIBO has been found in about one-half of CF patients (Lewindon et al 1998;Fridge et al 2007;Lisowska et al 2009Lisowska et al , 2010. Also using breath testing, several studies have reported that orocecal transit is frequently slower in CF (Bali et al 1983;Escobar et al 1992;Murphy et al 1992;Lewindon et al 1998).…”

Section: Microbial Dysbiosismentioning

confidence: 99%

The Cystic Fibrosis Intestine

Lisle

Borowitz

2013

Cold Spring Harbor Perspectives in Medicine

173

203

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“…Laxativetreated CF mice apparently have less mucus accumulation and less dilation of the intestinal crypt lumen compared with liquid-fed mice (9), although this previously has not been quantitatively compared. PEG-based laxative is also used clinically to treat intestinal obstruction in CF patients (11), and its use is associated with a significant decrease in the occurrence of SIBO (18).…”

mentioning

confidence: 99%

Effects of laxative and N-acetylcysteine on mucus accumulation, bacterial load, transit, and inflammation in the cystic fibrosis mouse small intestine

Lisle¹,

Roach²,

Jansson³

2007

American Journal of Physiology-Gastrointestinal and Liver Physi

108

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De Lisle RC, Roach E, Jansson K. Effects of laxative and N-acetylcysteine on mucus accumulation, bacterial load, transit, and inflammation in the cystic fibrosis mouse small intestine. Am J Physiol Gastrointest Liver Physiol 293: G577-G584, 2007. First published July 5, 2007; doi:10.1152/ajpgi.00195.2007.-The accumulation of mucus in affected organs is characteristic of cystic fibrosis (CF). The CF mouse small intestine has dramatic mucus accumulation and exhibits slower interdigestive intestinal transit. These factors are proposed to play cooperative roles that foster small intestinal bacterial overgrowth (SIBO) and contribute to the innate immune response of the CF intestine. It was hypothesized that decreasing the mucus accumulation would reduce SIBO and might improve other aspects of the CF intestinal phenotype. To test this, solid chow-fed CF mice were treated with an osmotic laxative to improve gut hydration or liquid-fed mice were treated orally with N-acetylcysteine (NAC) to break mucin disulfide bonds. Treatment with laxative or NAC reduced mucus accumulation by 43% and 50%, respectively, as measured histologically as dilation of the intestinal crypts. Laxative and NAC also reduced bacterial overgrowth in the CF intestine by 92% and 63%, respectively. Treatment with laxative normalized small intestinal transit in CF mice, whereas NAC did not. The expression of innate immune response-related genes was significantly reduced in laxative-treated CF mice, whereas there was no significant effect in NACtreated CF mice. In summary, laxative and NAC treatments of CF mice reduced mucus accumulation to a similar extent, but laxative was more effective than NAC at reducing bacterial load. Eradication of bacterial overgrowth by laxative treatment was associated with normalized intestinal transit and a reduction in the innate immune response. These results suggest that both mucus accumulation and slowed interdigestive small intestinal transit contribute to SIBO in the CF intestine.small intestinal bacterial overgrowth MICE that lack the expression of the cystic fibrosis (CF) transmembrane conductance regulator (Cftr) gene have a severe intestinal phenotype with many of the problems that occur in human CF patients. These include the accumulation of mucus, intestinal obstruction, slowed small intestinal transit, small intestinal bacterial overgrowth (SIBO), inflammation, and failure to thrive (4 -6, 30). Of these changes, bacterial overgrowth is of interest because it can be responsible for the majority of the other aspects of the intestinal phenotype (22, 34).Secreted gel-forming mucins, mainly Muc2 in the intestine, bind bacteria and help carry them aborally for efficient clearance from the small intestine. When mucus clearance is impaired, bacteria can proliferate in the mucus and may use it as an energy source (36). Mucus accumulation in the CF intestine is in part due to the dehydrated, acidic environment as well as the altered glycosylation of mucins (38, 40), which may increase the viscosity of mucus. Our labora...

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Risk Factors for Small Bowel Bacterial Overgrowth in Cystic Fibrosis

Abstract: Patients with CF were more likely to have elevated fasting hydrogen levels compared with controls. This suggests a high prevalence of small bowel bacterial overgrowth in CF patients. Medications commonly used by CF patients may influence intestinal health.

Cited by 99 publications

References 42 publications

Application of the Glucose Hydrogen Breath Test for the Detection of Bacterial Overgrowth in Patients with Cystic Fibrosis––A Reliable Method?

Application of the Glucose Hydrogen Breath Test for the Detection of Bacterial Overgrowth in Patients with Cystic Fibrosis––A Reliable Method?

The Cystic Fibrosis Intestine

Effects of laxative and N-acetylcysteine on mucus accumulation, bacterial load, transit, and inflammation in the cystic fibrosis mouse small intestine

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