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Dig Dis Sci. 2019 Sep 23. doi: 10.1007/s10620-019-05830-0. [Epub ahead of print]

Effectiveness of Saccharomyces boulardii and Metronidazole for Small Intestinal Bacterial Overgrowth in Systemic Sclerosis.

Author information

1
Research Division, Clinical Research Training Center, Hospital de Especialidades Centro Medico 'La Raza', Instituto Mexicano del Seguro Social, Mexico City, Mexico.
2
Postgraduate Section, Escuela Superior de Medicina (ESM), Instituto Politecnico Nacional, Mexico City, Mexico.
3
Conservation Medicine Laboratory, Escuela Superior de Medicina (ESM), Instituto Politecnico Nacional, Mexico City, Mexico.
4
Research Division, Hospital de Especialidades Centro Medico 'La Raza', Instituto Mexicano del Seguro Social, Seris y Zaachila SN, Colonia La Raza, Azcapotzalco, Mexico City, Mexico.
5
Direction of Education and Research, Hospital de Especialidades Centro Medico 'La Raza', Instituto Mexicano del Seguro Social, Mexico City, Mexico.
6
Internal Medicine Department, Hospital de Especialidades Centro Medico, 'La Raza', Instituto Mexicano del Seguro Social, Mexico City, Mexico.
7
Emergency Department, Hospital General Centro Medico 'La Raza', Instituto Mexicano del Seguro Social, Mexico City, Mexico.
8
Research Division, Hospital Regional '1° de Octubre', (ISSSTE), Mexico City, Mexico.
9
Translational Research Unit, Hospital de Especialidades Centro Medico 'La Raza', Instituto Mexicano del Seguro Social, Mexico City, Mexico.
10
Research Division, Hospital de Especialidades Centro Medico 'La Raza', Instituto Mexicano del Seguro Social, Seris y Zaachila SN, Colonia La Raza, Azcapotzalco, Mexico City, Mexico. drapilarcd@live.com.mx.

Abstract

BACKGROUND:

Small intestinal bacterial overgrowth (SIBO) affects up to 60% of patients with systemic sclerosis (SSc), and it improves with antibiotics. The addition of probiotics could lead to better results.

AIMS:

To evaluate the efficacy and safety of Saccharomyces boulardii (SB) versus metronidazole (M) versus M + SB for 2 months, to reduce gastrointestinal symptoms and SIBO assessed with hydrogen breath test in SSc.

METHODS:

An open pilot clinical trial performed in forty patients with SIBO and SSc (ACR-EULAR 2013) who signed informed consent. Three groups were assigned: M, SB, and M + SB, for 2 months. Hydrogen was measured in parts per million with a hydrogen breath test to evaluate SIBO. The National Institutes of Health Patient-Reported Outcomes Measurement Information System (NIH-PROMIS) questionnaire was applied to quantify gastrointestinal symptoms with a raw score of eight symptoms. This study is registered in ClinicalTrials.gov with the following ID: NCT03692299.

RESULTS:

Baseline characteristics were similar between groups. The average age was 53.2 ± 9.3 years, and the evolution of SSc was 13.5 (1-34) years. After 2 months of treatment, SIBO was eradicated in 55% of the M + SB group: 33% of SB, and 25% of M. The SB and M + SB groups had decreased diarrhea, abdominal pain, and gas/bloating/flatulence, but M remained unchanged. Reductions in expired hydrogen at 45 to 60 min were as follows: M + SB 48% and 44%, M 18% and 20%, and SB 53% and 60% at the first and second months, respectively (p < 0.01). Adverse effects were epigastric burning and constipation in M (53%) and M + SB (36%), and flatulence/diarrhea in SB (22%).

CONCLUSIONS:

Metronidazole treatment is partially effective in SIBO, but S. boulardii in monotherapy or in combination improves the gastrointestinal outcomes in SSc.

KEYWORDS:

Bacterial overgrowth syndrome; Hydrogen; Metronidazole; Saccharomyces; Systemic scleroderma; Systemic sclerosis

PMID:
31549334
DOI:
10.1007/s10620-019-05830-0

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