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World J Gastroenterol. 2014 Oct 14;20(38):13999-4003. doi: 10.3748/wjg.v20.i38.13999.

Small intestinal bacterial overgrowth in inactive Crohn's disease: influence of thiopurine and biological treatment.

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Cristina Sánchez-Montes, Vicente Ortiz, Guillermo Bastida, Ester Rodríguez, María Yago, Belén Beltrán, Mariam Aguas, Marisa Iborra, Vicente Garrigues, Julio Ponce, Pilar Nos, Gastroenterology Unit, Hospital Universitari i Politécnic La Fe, 46026 Valencia, Spain.



To investigate the influence of thiopurines and biological drugs on the presence of small intestinal bacterial overgrowth (SIBO) in patients with inactive Crohn's disease (CD).


This was a prospective study in patients with CD in remission and without corticosteroid treatment, included consecutively from 2004 to 2010. SIBO was investigated using the hydrogen glucose breath test.


One hundred and seven patients with CD in remission were included. Almost 58% of patients used maintenance immunosuppressant therapy and 19.6% used biological therapy. The prevalence of SIBO was 16.8%. No association was observed between SIBO and the use of thiopurine Immunosuppressant (12/62 patients), administration of biological drugs (2/21 patients), or with double treatment with an anti-tumor necrosis factor drugs plus thiopurine (1/13 patients). Half of the patients had symptoms that were suggestive of SIBO, though meteorism was the only symptom that was significantly associated with the presence of SIBO on univariate analysis (P < 0.05). Multivariate analysis revealed that the presence of meteorism and a fistulizing pattern were associated with the presence of SIBO (P < 0.05).


Immunosuppressants and/or biological drugs do not induce SIBO in inactive CD. Fistulizing disease pattern and meteorism are associated with SIBO.


Bacterial overgrowth; Biologics; Crohn’s disease; Inflammatory bowel disease; Thiopurines

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