Dietmar Enko1, Gernot Kriegshäuser2. 1. Institute of Clinical Chemistry and Laboratory Medicine, General Hospital Steyr, Sierningerstraße 170, 4400 Steyr, Austria; Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria. Electronic address: dietmar.enko@gespag.at. 2. Institute of Clinical Chemistry and Laboratory Medicine, General Hospital Steyr, Sierningerstraße 170, 4400 Steyr, Austria; Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria. Electronic address: gernot.kriegshaeuser@gespag.at.
Abstract
OBJECTIVES: Helicobacter pylori infection is considered to alter the bacterial flora in the upper gastrointestinal tract. This study aimed at investigating the presence of small intestinal bacterial overgrowth (SIBO) in patients with active H. pylori infection assessed by functional breath testing. DESIGN AND METHODS: A total of 109 outpatients, who were referred for the H. pylori13C-urea breath test (13C-UBT) by general practitioners and specialists, were also tested for the presence of SIBO by the glucose hydrogen (H2)/methane (CH4) breath test (HMBT). A detailed anamnesis was carried out about the history of H. pylori infection, eradication therapies, proton pump inhibitor intake, and comorbidities. RESULTS: In total, 36/109 (33.0%) patients had a positive H. pylori13C-UBT, and 35/109 (32.1%) patients had a positive glucose HMBT, the latter being indicative of SIBO. Interestingly, individuals with a positive H. pylori13C-UBT were significantly more often associated with a positive glucose HMBT (p=0.002). Cohen's κ measuring agreement between the 13C-UBT and the glucose HMBT was 0.31 (confidence intervals: 0.12-0.50) (p=0.001). Altogether, 19 of 54 (35.2%) patients, who had completed up to four eradication therapies, were diagnosed with SIBO by HMBT. CONCLUSIONS: H. pylori infection was found to be significantly associated with the presence of SIBO as determined by functional breath testing. In addition, SIBO rates appeared to have increased after completed eradication therapies. However, further longitudinal studies are warranted to fully elucidate the relationship and treatment modalities of coincident H. pylori infection and SIBO.
OBJECTIVES:Helicobacter pyloriinfection is considered to alter the bacterial flora in the upper gastrointestinal tract. This study aimed at investigating the presence of small intestinal bacterial overgrowth (SIBO) in patients with active H. pyloriinfection assessed by functional breath testing. DESIGN AND METHODS: A total of 109 outpatients, who were referred for the H. pylori13C-urea breath test (13C-UBT) by general practitioners and specialists, were also tested for the presence of SIBO by the glucosehydrogen (H2)/methane (CH4) breath test (HMBT). A detailed anamnesis was carried out about the history of H. pyloriinfection, eradication therapies, proton pump inhibitor intake, and comorbidities. RESULTS: In total, 36/109 (33.0%) patients had a positive H. pylori13C-UBT, and 35/109 (32.1%) patients had a positive glucose HMBT, the latter being indicative of SIBO. Interestingly, individuals with a positive H. pylori13C-UBT were significantly more often associated with a positive glucose HMBT (p=0.002). Cohen's κ measuring agreement between the 13C-UBT and the glucose HMBT was 0.31 (confidence intervals: 0.12-0.50) (p=0.001). Altogether, 19 of 54 (35.2%) patients, who had completed up to four eradication therapies, were diagnosed with SIBO by HMBT. CONCLUSIONS:H. pyloriinfection was found to be significantly associated with the presence of SIBO as determined by functional breath testing. In addition, SIBO rates appeared to have increased after completed eradication therapies. However, further longitudinal studies are warranted to fully elucidate the relationship and treatment modalities of coincident H. pyloriinfection and SIBO.
Authors: Uday C Ghoshal; Sanjeev Sachdeva; Ujjala Ghoshal; Asha Misra; Amarender Singh Puri; Nitesh Pratap; Ayesha Shah; M Masudur Rahman; Kok Ann Gwee; Victoria P Y Tan; Tahmeed Ahmed; Yeong Yeh Lee; B S Ramakrishna; Rupjyoti Talukdar; S V Rana; Saroj K Sinha; Minhu Chen; Nayoung Kim; Gerald Holtmann Journal: Indian J Gastroenterol Date: 2022-10-10