Bani Chander Roland1, Gerard E Mullin2, Monica Passi3, Xi Zheng4, Ahmed Salem5, Robert Yolken2, Pankaj Jay Pasricha2. 1. Division of Gastroenterology and Hepatology, Lenox Hill Hospital, Northwell Health System, New York, NY, USA. broland@northwell.edu. 2. Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 3. Division of Gastroenterology, Northshore University Hospital, Northwell Health System, New York, NY, USA. 4. Division of Gastroenterology, Nanjing, China. 5. Department of Medicine, Cleveland Clinic, Cleveland, OH, USA.
Abstract
BACKGROUND: Small intestinal bacterial overgrowth (SIBO) is an increasingly recognized clinical syndrome; however, its etiophathogenesis is poorly understood. We hypothesized that loss of gastric acid, a delayed intestinal transit, and ileocecal valve dysfunction may contribute to the genesis of this syndrome. AIMS: Our primary aim was to assess these parameters using wireless motility capsule (WMC) testing and to correlate them with the presence or absence of SIBO. METHODS: We prospectively evaluated 30 consecutive patients at a tertiary care center with suspected SIBO, diagnosed by lactulose hydrogen breath testing (LBT), and small bowel aspirate microbiology. Patients underwent WMC testing to assess ileocecal junction pressure (ICJP), small bowel transit time (SBTT), and regional gastrointestinal pH. RESULTS: Thirty patients completed testing; 15 had a positive LBT, and 11 had a positive aspirate culture. As compared with LBT-negative patients, ICJP was lower (27.8 vs. 72.7 mmHg, p = 0.027), SBTT was longer (10.0 vs. 1.1 h, p = 0.004), gastric pH was higher (3.63 vs. 2.42, p < 0.01), and small bowel pH was higher (6.96 vs. 6.61, p = 0.05). A hypotensive ICJP (<46.61 mmHg) was more prevalent in LBT-positive patients as compared with LBT-negative patients (73.3 vs. 14.29%, p = 0.003). Logistic regression models were used to assess the magnitude of each measured WMC parameter and the presence of SIBO. p values ≤0.05 were considered statistically significant. CONCLUSIONS: Patients with SIBO have significantly lower ICJP, prolonged SBTT, and a higher gastrointestinal pH as compared to those without SIBO. These abnormalities may play different roles in the pathogenesis of SIBO, facilitating more targeted treatment to prevent recurrences of SIBO.
BACKGROUND: Small intestinal bacterial overgrowth (SIBO) is an increasingly recognized clinical syndrome; however, its etiophathogenesis is poorly understood. We hypothesized that loss of gastric acid, a delayed intestinal transit, and ileocecal valve dysfunction may contribute to the genesis of this syndrome. AIMS: Our primary aim was to assess these parameters using wireless motility capsule (WMC) testing and to correlate them with the presence or absence of SIBO. METHODS: We prospectively evaluated 30 consecutive patients at a tertiary care center with suspected SIBO, diagnosed by lactulosehydrogen breath testing (LBT), and small bowel aspirate microbiology. Patients underwent WMC testing to assess ileocecal junction pressure (ICJP), small bowel transit time (SBTT), and regional gastrointestinal pH. RESULTS: Thirty patients completed testing; 15 had a positive LBT, and 11 had a positive aspirate culture. As compared with LBT-negative patients, ICJP was lower (27.8 vs. 72.7 mmHg, p = 0.027), SBTT was longer (10.0 vs. 1.1 h, p = 0.004), gastric pH was higher (3.63 vs. 2.42, p < 0.01), and small bowel pH was higher (6.96 vs. 6.61, p = 0.05). A hypotensive ICJP (<46.61 mmHg) was more prevalent in LBT-positive patients as compared with LBT-negative patients (73.3 vs. 14.29%, p = 0.003). Logistic regression models were used to assess the magnitude of each measured WMC parameter and the presence of SIBO. p values ≤0.05 were considered statistically significant. CONCLUSIONS:Patients with SIBO have significantly lower ICJP, prolonged SBTT, and a higher gastrointestinal pH as compared to those without SIBO. These abnormalities may play different roles in the pathogenesis of SIBO, facilitating more targeted treatment to prevent recurrences of SIBO.
Entities:
Keywords:
Diarrheal disorders; Ileocecal valve; Small bowel dysmotility; Small intestinal bacterial overgrowth (SIBO); Small intestinal disorders
Authors: J Thorens; F Froehlich; W Schwizer; E Saraga; J Bille; K Gyr; P Duroux; M Nicolet; B Pignatelli; A L Blum; J J Gonvers; M Fried Journal: Gut Date: 1996-07 Impact factor: 23.059
Authors: Satish S C Rao; Braden Kuo; Richard W McCallum; William D Chey; John K DiBaise; William L Hasler; Kenneth L Koch; Jeffrey M Lackner; Carrie Miller; Richard Saad; Jack R Semler; Michael D Sitrin; Gregory E Wilding; Henry P Parkman Journal: Clin Gastroenterol Hepatol Date: 2009-05 Impact factor: 11.382
Authors: David Avelar Rodriguez; Paul MacDaragh Ryan; Erick Manuel Toro Monjaraz; Jaime Alfonso Ramirez Mayans; Eamonn Martin Quigley Journal: Front Pediatr Date: 2019-09-04 Impact factor: 3.418
Authors: Derek Mao; Therese Rey-Conde; John B North; Raymond P Lancashire; Sanjeev Naidu; Terence C Chua Journal: World J Surg Date: 2022-04-04 Impact factor: 3.282
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
Authors: Gerardo Calderon; Robert M Siwiec; Matthew E Bohm; Thomas V Nowak; John M Wo; Anita Gupta; Huiping Xu; Andrea Shin Journal: Dig Dis Sci Date: 2020-03-02 Impact factor: 3.199