![]() ![]() From our findings, we also discuss the utility of and problems with hydrogen breath testing. In the present study, we examined the frequency of SIBO in patients with refractory FGID using GHBT. Therefore, the frequency of SIBO in patients with refractory or intractable FGID is likely greater as compared with that in those with well-controlled symptoms. Conventional treatment for FGID, such as prokinetics, proton pump inhibitors (PPIs), and antidepressants, may not be effective for symptoms occurring in patients with SIBO. 19? 21 These results support the hypothesis that SIBO may play a role in FGID. 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? 18 with the prevalence reported to be 56.5% in patients with FD 16 and ranging from 2?84% in those with IBS. 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. 13 Greater diagnostic accuracy has been demonstrated for a glucose hydrogen breath test (GHBT) with fewer false-positive results as compared to a lactulose hydrogen breath test (LHBT). On the other hand, noninvasive hydrogen breath tests using glucose or lactulose have been widely used as a diagnostic tool to establish SIBO, though their accuracy remains in dispute. However, the technique for sample collection is invasive and because of limited access by the instrumentation generally utilized, patients with isolated distal SIBO remain undiagnosed. 12 Recent studies have suggested that SIBO may have a role in the pathogenesis of FGID.Ĭonventionally, a diagnosis of SIBO is based on jejunal aspirate culture findings. 9? 11 Bacterial flora in the proximal small intestine generally consists of aerobe and facultative anaerobic bacteria at ≤ 10 4 colony forming units (CFU)/mL in healthy subjects, while an abnormally high microbial population level in the small intestine is known as small intestinal bacterial overgrowth (SIBO). 4? 8 Recently, a considerable number of studies have suggested that gut flora plays an important role in occurrence of symptoms and possibly the pathogenesis of FGID. 1? 3 Although the pathophysiological mechanisms underlying these disorders are not completely understood, dysmotility, visceral hypersensitivity, abnormal brain-gut interaction, microbiome differences, psychiatric co-morbidity, and immune activation have been suggested to play important roles. The prevalence of FGID among general populations worldwide is approximately 20?30%. Keywords: Adult, Bacterial overgrowth syndrome, Blind loop syndrome, Breath tests, Dyspepsiaįunctional gastrointestinal disorders (FGID) are among the most common disorders of the gastrointestinal tract reported in visits to health care providers and have a large impact on health care costs. ![]() 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. Two patients initially diagnosed with FD and IBS were also diagnosed with SIBO as assessed by GHBT. Their symptoms were clearly improved and breath hydrogen levels decreased to normal following levofloxacin administration for 7 days. Of those, 2 (5.3%) were diagnosed with SIBO (one patient diagnosed with FD the other with overlapping FD and IBS). ResultsĪ 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. A peak hydrogen value ≥ 10 ppm above the basal value between 60 and 120 minutes after administration of glucose was diagnosed as SIBO. 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. We prospectively enrolled patients with refractory FGID based on Rome III criteria. Here, we examined the frequency of SIBO in patients with refractory FGID. However, the prevalence and clinical conditions of SIBO in patients with FGID remain to be fully elucidated. Small intestinal bacterial overgrowth (SIBO) is considered to be involved in the pathogenesis of functional gastrointestinal disorders (FGID). ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |