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Dig Dis Sci. 2018 May 14. doi: 10.1007/s10620-018-5109-1. [Epub ahead of print]

Testing and Treating Small Intestinal Bacterial Overgrowth Reduces Symptoms in Patients with Inflammatory Bowel Disease.

Author information

1
Division of Gastroenterology and Hepatology, NewYork Presbyterian Weill Cornell Medical Center, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA. shc9085@nyp.org.
2
Division of Gastroenterology and Hepatology, NewYork Presbyterian Weill Cornell Medical Center, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA.
3
Department of Medicine, NYU Langone Medical Center, New York University School of Medicine, 550 First Ave, HCC 3-15, New York, NY, 10016, USA.
4
Department of Medicine, NewYork Presbyterian Weill Cornell Medical Center, 521 East 70th Street, New York, NY, 10021, USA.
5
Department of Medicine, Mount Sinai Beth Israel, 350 East 17th Street, 20th Floor, New York, NY, 10003, USA.
6
Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medical College, 402 East 67th Street, New York, NY, 10065, USA.

Abstract

BACKGROUND:

Common mechanisms against small intestinal bacterial overgrowth (SIBO), including an intact ileocecal valve, gastric acid secretion, intestinal motility, and an intact immune system, are compromised in inflammatory bowel disease (IBD), and therefore, a relatively high incidence of SIBO has been reported in this population.

AIMS:

We aimed to determine whether an improvement in IBD clinical activity scores is seen after testing and treating SIBO.

METHODS:

A retrospective cohort study of 147 patients with inflammatory bowel disease who were referred for SIBO breath testing from 1/2012 to 5/2016 was performed. Characteristics of SIBO positive and treated patients were compared to SIBO negative patients, including the changes in Partial Mayo Score or Harvey Bradshaw Index (HBI), using Student's t test for continuous variables and Chi-squared or Fisher's exact test for categorical variables.

RESULTS:

61.9% were SIBO positive and treated, and 38.1% were SIBO negative. In Crohn's disease, the median HBI decreased from 5 to 3 and 5 to 4, in the SIBO positive and negative groups, respectively (p = 0.005). In ulcerative colitis, the Partial Mayo Score decreased from 2 to 1.5 and 2 to 1, respectively (p = 0.607).

CONCLUSIONS:

This study examines the clinical effect of testing and treating for SIBO in an IBD population. We see a significant reduction in HBI after testing for and treating SIBO. Future prospective studies are necessary to further investigate the role of SIBO in the evaluation and management of IBD.

KEYWORDS:

Bloating; Breath test; Crohn’s disease; Ulcerative colitis

PMID:
29761252
DOI:
10.1007/s10620-018-5109-1

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