BACKGROUND Small intestinal bacterial overgrowth(SIBO)poses diagnostic and treatment challenges due to its complex management and evolving guidelines.Patients often seek online information related to their health,prom...BACKGROUND Small intestinal bacterial overgrowth(SIBO)poses diagnostic and treatment challenges due to its complex management and evolving guidelines.Patients often seek online information related to their health,prompting interest in large language models,like GPT-4,as potential sources of patient education.AIM To investigate ChatGPT-4's accuracy and reproducibility in responding to patient questions related to SIBO.METHODS A total of 27 patient questions related to SIBO were curated from professional societies,Facebook groups,and Reddit threads.Each question was entered into GPT-4 twice on separate days to examine reproducibility of accuracy on separate occasions.GPT-4 generated responses were independently evaluated for accuracy and reproducibility by two motility fellowship-trained gastroenterologists.A third senior fellowship-trained gastroenterologist resolved disagreements.Accuracy of responses were graded using the scale:(1)Comprehensive;(2)Correct but inadequate;(3)Some correct and some incorrect;or(4)Completely incorrect.Two responses were generated for every question to evaluate reproducibility in accuracy.RESULTS In evaluating GPT-4's effectiveness at answering SIBO-related questions,it provided responses with correct information to 18/27(66.7%)of questions,with 16/27(59.3%)of responses graded as comprehensive and 2/27(7.4%)responses graded as correct but inadequate.The model provided responses with incorrect information to 9/27(33.3%)of questions,with 4/27(14.8%)of responses graded as completely incorrect and 5/27(18.5%)of responses graded as mixed correct and incorrect data.Accuracy varied by question category,with questions related to“basic knowledge”achieving the highest proportion of comprehensive responses(90%)and no incorrect responses.On the other hand,the“treatment”related questions yielded the lowest proportion of comprehensive responses(33.3%)and highest percent of completely incorrect responses(33.3%).A total of 77.8%of questions yielded reproducible responses.CONCLUSION Though GPT-4 shows promise as a supplementary tool for SIBO-related patient education,the model requires further refinement and validation in subsequent iterations prior to its integration into patient care.展开更多
Small intestinal bacterial overgrowth has been found to be associated with a variety of gastrointestinal disorders such as irritable bowel syndrome, inflammatory bowel disease, and, in recent years, diabetes mellitus ...Small intestinal bacterial overgrowth has been found to be associated with a variety of gastrointestinal disorders such as irritable bowel syndrome, inflammatory bowel disease, and, in recent years, diabetes mellitus and systemic sclerosis, among other extraintestinal diseases. Several novel diagnostic tools for small intestinal bacterial overgrowth have emerged in recent years, and several therapeutic approaches have been proposed. Therefore, it has become necessary to find an effective, safe, and simple diagnostic method and a safe treatment modality. This article provides a review of current diagnostic and therapeutic approaches to small intestinal bacterial overgrowth.展开更多
Human intestinal microbiota create a complex polymi-crobial ecology. This is characterised by its high population density, wide diversity and complexity of interaction. Any dysbalance of this complex intestinal microb...Human intestinal microbiota create a complex polymi-crobial ecology. This is characterised by its high population density, wide diversity and complexity of interaction. Any dysbalance of this complex intestinal microbiome, both qualitative and quantitative, might have serious health consequence for a macro-organism, including small intestinal bacterial overgrowth syndrome (SIBO).SIBO is defined as an increase in the number and/or alteration in the type of bacteria in the upper gastro-intestinal tract. There are several endogenous defence mechanisms for preventing bacterial overgrowth: gastric acid secretion, intestinal motility, intact ileo-caecal valve, immunoglobulins within intestinal secretion and bacte-riostatic properties of pancreatic and biliary secretion. Aetiology of SIBO is usually complex, associated with disorders of protective antibacterial mechanisms (e.g. achlorhydria, pancreatic exocrine insuff iciency, immuno-deficiency syndromes), anatomical abnormalities (e.g. small intestinal obstruction, diverticula, f istulae, surgical blind loop, previous ileo-caecal resections) and/or motility disorders (e.g. scleroderma, autonomic neuropathy in diabetes mellitus, post-radiation enteropathy, small intestinal pseudo-obstruction). In some patients more than one factor may be involved. Symptoms related to SIBO are bloating, diarrhoea, malabsorption, weight loss and malnutrition. The gold standard for diagnosing SIBO is still microbial investigation of jejunal aspirates. Noninvasive hydrogen and methane breath tests are most commonly used for the diagnosis of SIBO using glucose or lactulose. Therapy for SIBO must be com-plex, addressing all causes, symptoms and complica-tions, and fully individualised. It should include treatment of the underlying disease, nutritional support and cyclical gastro-intestinal selective antibiotics. Prognosis is usually serious, determined mostly by the underlying disease that led to SIBO.展开更多
AIM To elucidate the effects of small intestinal bacterial overgrowth(SIBO) on the severity and complications of acute pancreatitis(AP).METHODS In total,208 patients with AP as defined by the revised Atlanta classific...AIM To elucidate the effects of small intestinal bacterial overgrowth(SIBO) on the severity and complications of acute pancreatitis(AP).METHODS In total,208 patients with AP as defined by the revised Atlanta classification were admitted to Xuanwu Hospital of capital Medical University from 2013 to 2016. All patients were admitted within 72 h of AP onset. The hydrogen breath test was performed 7 d after AP onset to detect hydrogen production and evaluate the development of SIBO. The incidence of SIBO was analyzed in patients with AP of three different severity grades. The association between SIBO and complications of AP was also assessed.RESULTS Of the 27 patients with severe AP(SAP),seven(25.92%) developed SIBO. Of the 86 patients with moderately severe AP(MSAP),22(25.58%) developed SIBO. Of the 95 patients with mild AP(MAP),eight(8.42%) developed SIBO. There were significant differences in the rates of SIBO among patients with AP of different severities. Additionally,more severe APwas associated with higher rates of SIBO positivity(P < 0.05). SIBO in patients with AP mainly occurred within 72 h of the onset of AP. The incidence of organ failure was significantly higher in patients with SIBO than in those without(P < 0.05).CONCLUSION SIBO occurs more frequently in patients with MSAP or SAP than in those with MAP,usually ≤ 72 h after AP onset. Additionally,SIBO is associated with organ failure.展开更多
BACKGROUND Gut dysbiosis and small intestinal bacterial overgrowth(SIBO)are commonly observed in patients with cirrhosis.Despite the substantial number of articles describing the relations between disorders of gut mic...BACKGROUND Gut dysbiosis and small intestinal bacterial overgrowth(SIBO)are commonly observed in patients with cirrhosis.Despite the substantial number of articles describing the relations between disorders of gut microbiota and various manifestations of cirrhosis,dysbiosis and SIBO were always studied separately.AIM To study the relationship of gut dysbiosis and SIBO in cirrhosis.METHODS This observational study included 47 in-patients with cirrhosis.Stool microbiome was assessed using 16 S r RNA gene sequencing.SIBO was assessed using the lactulose hydrogen breath test.RESULTS SIBO was found in 24/47(51.1%)patients.Patients with SIBO had a higher abundance of Firmicutes(P=0.017)and Fusobacteria(P=0.011),and a lower abundance of Bacteroidetes(P=0.013)than patients without SIBO.This increase in the abundance of Firmicutes occurred mainly due to an increase in the abundance of bacteria from the genus Blautia(P=0.020)of the Lachnospiraceae family(P=0.047),while the abundance of other major families of this phylum[Ruminococcaceae(P=0.856),Peptostreptococcaceae(P=0.066),Clostridiaceae(P=0.463),Eubacteriaceae(P=0.463),Lactobacillaceae(P=0.413),and Veillonellaceae(P=0.632)]did not differ significantly between the patients with and without SIBO.Reduced level of Bacteroidetes in samples from patients with SIBO was a result of the decrease in bacterial numbers from all the major families of this phylum[Bacteroidaceae(P=0.014),Porphyromonadaceae(P=0.002),and Rikenellaceae(P=0.047)],with the exception of Prevotellaceae(P=0.941).There were no significant differences in the abundance of taxa that were the main biomarkers of cirrhosis-associated gut dysbiosis[Proteobacteria(P=0.790),Bacilli(P=0.573),Enterobacteriaceae(P=0.632),Streptococcaceae(P=0.170),Staphylococcaceae(P=0.450),and Enterococcaceae(P=0.873)]between patients with and without SIBO.CONCLUSION Despite the differences observed in the gut microbiome between patients with and without SIBO,gut dysbiosis and SIBO are most likely independent disorders of gut microbiota in cirrhosis.展开更多
AIM To assess the rate of matrix Gla-protein carboxylation in patients with small intestinal bacterial overgrowth(SIBO) and to decipher its association with subclinical atherosclerosis.METHODS Patients with suspected ...AIM To assess the rate of matrix Gla-protein carboxylation in patients with small intestinal bacterial overgrowth(SIBO) and to decipher its association with subclinical atherosclerosis.METHODS Patients with suspected SIBO who presented with a low risk for cardiovascular disease and showed no evidence of atherosclerotic plaques were included in the study. A glucose breath test was performed in order to confirm the diagnosis of SIBO and vascular assessment was carried out by ultrasound examination. Plasma levels of the inactive form of MGP(dephosphorylateduncarboxylated matrix Gla-protein) were quantified by ELISA and vitamin K2 intake was estimated using a food frequency questionnaire.RESULTS Thirty-nine patients were included in the study. SIBO was confirmed in 12/39(30.8%) patients who also presented with a higher concentration ofdephosphorylated-uncarboxylated matrix Gla-protein(9.5 μg/L vs 4.2 μg/L; P = 0.004). Arterial stiffness was elevated in the SIBO group(pulse-wave velocity 10.25 m/s vs 7.68 m/s; P = 0.002) and this phenomenon was observed to correlate linearly with the levels of dephosphorylated-uncarboxylated matrix Gla-protein(β = 0.220, R2 = 0.366, P = 0.03). Carotid intima-media thickness and arterial calcifications were not observed to be significantly elevated as compared to controls.CONCLUSION SIBO is associated with reduced matrix Gla-protein activation as well as arterial stiffening. Both these observations are regarded as important indicators of subclinical atherosclerosis. Hence, screening for SIBO, intestinal decontamination and supplementation with vitamin K2 has the potential to be incorporated into clinical practice as additional preventive measures.展开更多
AIM: To estimate the prevalence of small intestine bacterial overgrowth (SIBO) among patients with an earlier diagnosis of irritable bowel disease (IBS) in our geographical area, and to collect information on the use ...AIM: To estimate the prevalence of small intestine bacterial overgrowth (SIBO) among patients with an earlier diagnosis of irritable bowel disease (IBS) in our geographical area, and to collect information on the use of locally acting non-absorbable antibiotics in the management of SIBO. METHODS: A non-interventional study was conducted in 73 consecutive patients with a symptom-based diagnosis.. RESULTS: When the patients underwent a "breath test", 33 (45.2%) showed the presence of a SIBO. After treatment with rifaximin 1200 mg/d for seven days in 32 patients, 19 (59.4%) showed a negative "breath test" one week later as well as a significant reduction of symptoms, thus confirming the relationship between SIBO and many of the symptoms claimed by patients. In the other 13 patients, "breath test" remained positive, and a further cycle of treatment with ciprofloxacin 500 mg/d was given for 7 additional days, resulting in a negative "breath test" in one patient only. CONCLUSION: (1) about half of the patients with a symptomatic diagnosis of IBS have actually SIBO, which is responsible for most of the symptoms attributed to IBS; (2) only a "breath test" with lactulose (or with glucose in subjects with an intolerance to lactose) can provide a differential diagnosis between IBS and SIBO, with almost identical symptoms; and (3) the use of non-absorbable antibiotics may be useful to reduce the degree of SIBO and related symptoms; it must be accompanied, however, by the correction of the wrong alimentary habits underlying SIBO.展开更多
AIM:To analyze small intestinal bacterial overgrowth in school-aged children and the relationship between hydrogen and methane production in breath tests.METHODS:This transversal study included 85 children residing in...AIM:To analyze small intestinal bacterial overgrowth in school-aged children and the relationship between hydrogen and methane production in breath tests.METHODS:This transversal study included 85 children residing in a slum and 43 children from a private school,all aged between 6 and 10 years,in Osasco,Brazil.For characterization of the groups,data regarding the socioeconomic status and basic housing sanitary conditions were collected.Anthropometric data was obtained in children from both groups.All children completed the hydrogen(H 2) and methane(CH 4) breath test in order to assess small intestinal bacterial overgrowth(SIBO).SIBO was diagnosed when there was an increase in H 2 ≥ 20 ppm or CH 4 ≥ 10 ppm with regard to the fasting value until 60 min after lactulose ingestion.RESULTS:Children from the slum group had worse living conditions and lower nutritional indices than children from the private school.SIBO was found in 30.9%(26/84) of the children from the slum group and in 2.4%(1/41) from the private school group(P = 0.0007).Greater hydrogen production in the small intestine was observed in children from the slum group when compared to children from the private school(P = 0.007).A higher concentration of hydrogen in the small intestine(P < 0.001) and in the colon(P < 0.001) was observed among the children from the slum group with SIBO when compared to children from the slum group without SIBO.Methane production was observed in 63.1%(53/84) of the children from the slum group and in 19.5%(8/41) of the children from the private school group(P < 0.0001).Methane production was observed in 38/58(65.5%) of the children without SIBO and in 15/26(57.7%) of the children with SIBO from the slum.Colonic production of hydrogen was lower in methaneproducing children(P = 0.017).CONCLUSION:Children who live in inadequate environmental conditions are at risk of bacterial overgrowth and methane production.Hydrogen is a substrate for methane production in the colon.展开更多
AIM: Small intestinal bacterial overgrowth (SIBO) maycontribute to the appearance of several gastrointestinal nonspecific symptoms. Acute diverticulitis is affected by some similar symptoms and bacterial colonic overg...AIM: Small intestinal bacterial overgrowth (SIBO) maycontribute to the appearance of several gastrointestinal nonspecific symptoms. Acute diverticulitis is affected by some similar symptoms and bacterial colonic overgrowth. We assessed the prevalence of SIBO in acute uncomplicated diverticulitis and evaluated its influence on the clinical course of the disease.METHODS: We studied 90 consecutive patients (39 males, 51 females, mean age 67.2 years, range 32-91 years). Sixty-one patients (67.78%) and 29 patients (32.22%) were affected by constipation-or diarrhea-prevalent diverticulitis respectively. All subjects were investigated by lactulose H2-breath test at the entry and at the end of treatment. We also studied a control group of 20 healthy subjects (13 males, 7 females, mean age 53 years, range 22-71 years).RESULTS: Oro-cecal transit time (OCTT) was delayed in67/90 patients (74.44%) (range 115-210 min, mean 120 min). Fifty-three of ninety patients (58.88%) showed SIBO, while OCTT was normal in 23/90 patients (25, 56%). In the control group, the mean OCTT was 88.2 min (range 75-135 min). The difference between diverticulitic patients and healthy subjects was statistically significant (P<0.01). OCTT was longer in constipation-prevalent disease than in diarrheaprevalent disease [180.7 min (range 150-210 min) vs 121 min (range 75-180 min) (P<0.001)], but no difference in bacterial overgrowth was found between the two forms of diverticulitis.After treatment with rifaximin plus mesalazine for 10 d, followed by mesalazine alone for 8 wk, 70 patients (81.49%) were completely asymptomatic, while 16 patients (18.60%) showed only slight symptoms. Two patients (2.22%) had recurrence of diverticulitis, and two other patients (2.22%) were withdrawn from the study due to side-effects. Seventy-nine of eighty-six patients (91.86%) showed normal OCTT (range 75-105 min, mean 83 min), while OCTT was longer, but it was shorter in the remaining seven (8.14%) patients (range 105-115 min, mean of 110 min). SIBO was eradicated in all patients, while it persisted in one patient with recurrence of diverticulitis. CONCLUSION: SIBO affects most of the patients with acute diverticulitis. SIBO may worsen the symptoms of patients and prolong the clinical course of the disease, as confirmed in the case of persistence of SIBO and diverticulitis recurrence. In this case, we can hypothesize that bacteria from small bowel may re-colonize in the colon and provoke recurrence of symptoms.展开更多
Helicobacter pylori(H.pylori)infection is very common and affects a significant proportion of the world population.In contrast,the prevalence of small intestinal bacterial overgrowth(SIBO)in the general population is ...Helicobacter pylori(H.pylori)infection is very common and affects a significant proportion of the world population.In contrast,the prevalence of small intestinal bacterial overgrowth(SIBO)in the general population is not well understood.There can be coexistence of both disease states in a given patient and their clinical symptoms may also overlap with one and another.There is no clear clinical guidelines for testing for and treating SIBO in patients with H.pylori infection.This review article explores the available evidence on the relationship between H.pylori infection and SIBO,diagnosis and treatment of these entities and also comments on associated non-gastrointestinal conditions.展开更多
Background & Aims: Fermentation site and increasing time of symptomatic gas would be different between irritable bowel syndrome (IBS) and small intestine bacterial overgrowth (SIBO). The aim of this study was to d...Background & Aims: Fermentation site and increasing time of symptomatic gas would be different between irritable bowel syndrome (IBS) and small intestine bacterial overgrowth (SIBO). The aim of this study was to determine the time for increase in abdominal gas following ingestion of lactulose and the possibility of differential diagnosis of SIBO and IBS. Methods: A prospective study was conducted on a series of IBS patients (n = 14) who were referred to the Oroku-Hospital (Okinawa, Japan) from June 6, 2014 to December 30, 2014. Imaging was first performed in early morning after fasting. After ingestion of lactulose, 1 - 4 plain abdominal radiographs were taken for investigation of increased gas during the indicated timeframe. Regions of interest of the gas areas were highlighted on the images obtained. Gas images were divided into three areas, the stomach, small intestine, and large intestine, and each total area was calculated. Results: At a dose of 10 g lactulose and an observation time of two hours, patients displayed no symptoms, and the gas volume was only slightly increased. However, when the dose of lactulose was increased (13 g/50 kg), and the observation time for the lactulose challenge was extended to 240 - 300 minutes, the results clearly demonstrated an increase in the gas produced in IBS patients. Conclusions: An increased dose of lactulose coupled with an extended observation time for the lactulose challenge clearly demonstrated an increase in the gas produced in IBS patients. Alterations in diet rather than antibiotics might reduce IBS symptoms.展开更多
The intestinal microbiota and its role in health and disease processes have been the subject of several studies.It is known that changes in the intestinal microbiota occur due to several factors,such as the use of med...The intestinal microbiota and its role in health and disease processes have been the subject of several studies.It is known that changes in the intestinal microbiota occur due to several factors,such as the use of medication,age,lifestyle and diseases,which can modify intestinal homeostasis and lead to excessive growth of bacteria in the small intestine,triggering a clinical condition called small bowel bacterial overgrowth(SIBO).Individuals with SIBO may present gastrointestinal symptoms ranging from nausea,diarrhea and/or constipation,and flatulence to distension and abdominal pain,resulting from poor absorption of nutrients or changes in intestinal permeability.The gold-standard treatment is based on the use of antibiotics to eradicate bacterial overgrowth.Some studies have evaluated diets in the treatment of SIBO;however,the studies are of low methodological quality,making extrapolation of the results to clinical practice unfeasible.Thus,there is still not enough scientific evidence to support a specific type of diet for the treatment of SIBO.展开更多
[目的]探讨香砂六君子汤联合枯草杆菌二联活菌肠溶胶囊治疗脾胃气虚型乙肝肝硬化合并小肠细菌过度生长(SIBO)的疗效。[方法]连续性招募2020年12月至2022年12月收治的80例乙肝肝硬化合并SIBO患者,采用随机数字表法将其分为两组,每组各40...[目的]探讨香砂六君子汤联合枯草杆菌二联活菌肠溶胶囊治疗脾胃气虚型乙肝肝硬化合并小肠细菌过度生长(SIBO)的疗效。[方法]连续性招募2020年12月至2022年12月收治的80例乙肝肝硬化合并SIBO患者,采用随机数字表法将其分为两组,每组各40例。对照组给予枯草杆菌二联活菌肠溶胶囊治疗,观察组给予香砂六君子汤联合枯草杆菌二联活菌肠溶胶囊治疗。观察两组疗效、SIBO转阴率、中医证候积分、肝功能、免疫功能、炎症因子和不良反应。[结果]观察组总有效率和治疗14 d SIBO转阴率高于对照组(P<0.05)。两组治疗后食欲不振,脘腹痞胀食后尤甚,大便溏泄,神疲肢倦,头晕乏力证候积分较治疗前降低(P<0.05),血清谷草转氨酶(AST)、谷丙转氨酶(ALT)、总胆红素(TBiL)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平,外周血CD8^(+)占比较治疗前降低(P<0.05),总蛋白(TP)、外周血CD3^(+)、CD4^(+)占比较治疗前增高(P<0.05),观察组治疗后中医证候积分,血清ΑST、ALT、IL-6、TNF-α水平,外周血CD8^(+)占比低于对照组(P<0.05),外周血CD3^(+)、CD4^(+)占比、CD4^(+)/CD8^(+)高于对照组(P<0.05)。[结论]香砂六君子汤联合枯草杆菌二联活菌肠溶胶囊可更显著改善临床症状,提高T淋巴细胞免疫功能和抑制炎症反应,在治疗乙肝肝硬化合并SIBO方面具有更显著的临床疗效。展开更多
文摘BACKGROUND Small intestinal bacterial overgrowth(SIBO)poses diagnostic and treatment challenges due to its complex management and evolving guidelines.Patients often seek online information related to their health,prompting interest in large language models,like GPT-4,as potential sources of patient education.AIM To investigate ChatGPT-4's accuracy and reproducibility in responding to patient questions related to SIBO.METHODS A total of 27 patient questions related to SIBO were curated from professional societies,Facebook groups,and Reddit threads.Each question was entered into GPT-4 twice on separate days to examine reproducibility of accuracy on separate occasions.GPT-4 generated responses were independently evaluated for accuracy and reproducibility by two motility fellowship-trained gastroenterologists.A third senior fellowship-trained gastroenterologist resolved disagreements.Accuracy of responses were graded using the scale:(1)Comprehensive;(2)Correct but inadequate;(3)Some correct and some incorrect;or(4)Completely incorrect.Two responses were generated for every question to evaluate reproducibility in accuracy.RESULTS In evaluating GPT-4's effectiveness at answering SIBO-related questions,it provided responses with correct information to 18/27(66.7%)of questions,with 16/27(59.3%)of responses graded as comprehensive and 2/27(7.4%)responses graded as correct but inadequate.The model provided responses with incorrect information to 9/27(33.3%)of questions,with 4/27(14.8%)of responses graded as completely incorrect and 5/27(18.5%)of responses graded as mixed correct and incorrect data.Accuracy varied by question category,with questions related to“basic knowledge”achieving the highest proportion of comprehensive responses(90%)and no incorrect responses.On the other hand,the“treatment”related questions yielded the lowest proportion of comprehensive responses(33.3%)and highest percent of completely incorrect responses(33.3%).A total of 77.8%of questions yielded reproducible responses.CONCLUSION Though GPT-4 shows promise as a supplementary tool for SIBO-related patient education,the model requires further refinement and validation in subsequent iterations prior to its integration into patient care.
文摘Small intestinal bacterial overgrowth has been found to be associated with a variety of gastrointestinal disorders such as irritable bowel syndrome, inflammatory bowel disease, and, in recent years, diabetes mellitus and systemic sclerosis, among other extraintestinal diseases. Several novel diagnostic tools for small intestinal bacterial overgrowth have emerged in recent years, and several therapeutic approaches have been proposed. Therefore, it has become necessary to find an effective, safe, and simple diagnostic method and a safe treatment modality. This article provides a review of current diagnostic and therapeutic approaches to small intestinal bacterial overgrowth.
基金Supported by The Research Project MZO 00179906 from the Ministry of Health, Czech Republicby Research Grant GACR 305/08/0535, Czech Republic
文摘Human intestinal microbiota create a complex polymi-crobial ecology. This is characterised by its high population density, wide diversity and complexity of interaction. Any dysbalance of this complex intestinal microbiome, both qualitative and quantitative, might have serious health consequence for a macro-organism, including small intestinal bacterial overgrowth syndrome (SIBO).SIBO is defined as an increase in the number and/or alteration in the type of bacteria in the upper gastro-intestinal tract. There are several endogenous defence mechanisms for preventing bacterial overgrowth: gastric acid secretion, intestinal motility, intact ileo-caecal valve, immunoglobulins within intestinal secretion and bacte-riostatic properties of pancreatic and biliary secretion. Aetiology of SIBO is usually complex, associated with disorders of protective antibacterial mechanisms (e.g. achlorhydria, pancreatic exocrine insuff iciency, immuno-deficiency syndromes), anatomical abnormalities (e.g. small intestinal obstruction, diverticula, f istulae, surgical blind loop, previous ileo-caecal resections) and/or motility disorders (e.g. scleroderma, autonomic neuropathy in diabetes mellitus, post-radiation enteropathy, small intestinal pseudo-obstruction). In some patients more than one factor may be involved. Symptoms related to SIBO are bloating, diarrhoea, malabsorption, weight loss and malnutrition. The gold standard for diagnosing SIBO is still microbial investigation of jejunal aspirates. Noninvasive hydrogen and methane breath tests are most commonly used for the diagnosis of SIBO using glucose or lactulose. Therapy for SIBO must be com-plex, addressing all causes, symptoms and complica-tions, and fully individualised. It should include treatment of the underlying disease, nutritional support and cyclical gastro-intestinal selective antibiotics. Prognosis is usually serious, determined mostly by the underlying disease that led to SIBO.
基金Supported by Wu Jieping Medical Foundation,No.320.6750.12120
文摘AIM To elucidate the effects of small intestinal bacterial overgrowth(SIBO) on the severity and complications of acute pancreatitis(AP).METHODS In total,208 patients with AP as defined by the revised Atlanta classification were admitted to Xuanwu Hospital of capital Medical University from 2013 to 2016. All patients were admitted within 72 h of AP onset. The hydrogen breath test was performed 7 d after AP onset to detect hydrogen production and evaluate the development of SIBO. The incidence of SIBO was analyzed in patients with AP of three different severity grades. The association between SIBO and complications of AP was also assessed.RESULTS Of the 27 patients with severe AP(SAP),seven(25.92%) developed SIBO. Of the 86 patients with moderately severe AP(MSAP),22(25.58%) developed SIBO. Of the 95 patients with mild AP(MAP),eight(8.42%) developed SIBO. There were significant differences in the rates of SIBO among patients with AP of different severities. Additionally,more severe APwas associated with higher rates of SIBO positivity(P < 0.05). SIBO in patients with AP mainly occurred within 72 h of the onset of AP. The incidence of organ failure was significantly higher in patients with SIBO than in those without(P < 0.05).CONCLUSION SIBO occurs more frequently in patients with MSAP or SAP than in those with MAP,usually ≤ 72 h after AP onset. Additionally,SIBO is associated with organ failure.
基金Supported by Biocodex Microbiota Foundation:National Research Grant Russia 2019.
文摘BACKGROUND Gut dysbiosis and small intestinal bacterial overgrowth(SIBO)are commonly observed in patients with cirrhosis.Despite the substantial number of articles describing the relations between disorders of gut microbiota and various manifestations of cirrhosis,dysbiosis and SIBO were always studied separately.AIM To study the relationship of gut dysbiosis and SIBO in cirrhosis.METHODS This observational study included 47 in-patients with cirrhosis.Stool microbiome was assessed using 16 S r RNA gene sequencing.SIBO was assessed using the lactulose hydrogen breath test.RESULTS SIBO was found in 24/47(51.1%)patients.Patients with SIBO had a higher abundance of Firmicutes(P=0.017)and Fusobacteria(P=0.011),and a lower abundance of Bacteroidetes(P=0.013)than patients without SIBO.This increase in the abundance of Firmicutes occurred mainly due to an increase in the abundance of bacteria from the genus Blautia(P=0.020)of the Lachnospiraceae family(P=0.047),while the abundance of other major families of this phylum[Ruminococcaceae(P=0.856),Peptostreptococcaceae(P=0.066),Clostridiaceae(P=0.463),Eubacteriaceae(P=0.463),Lactobacillaceae(P=0.413),and Veillonellaceae(P=0.632)]did not differ significantly between the patients with and without SIBO.Reduced level of Bacteroidetes in samples from patients with SIBO was a result of the decrease in bacterial numbers from all the major families of this phylum[Bacteroidaceae(P=0.014),Porphyromonadaceae(P=0.002),and Rikenellaceae(P=0.047)],with the exception of Prevotellaceae(P=0.941).There were no significant differences in the abundance of taxa that were the main biomarkers of cirrhosis-associated gut dysbiosis[Proteobacteria(P=0.790),Bacilli(P=0.573),Enterobacteriaceae(P=0.632),Streptococcaceae(P=0.170),Staphylococcaceae(P=0.450),and Enterococcaceae(P=0.873)]between patients with and without SIBO.CONCLUSION Despite the differences observed in the gut microbiome between patients with and without SIBO,gut dysbiosis and SIBO are most likely independent disorders of gut microbiota in cirrhosis.
文摘AIM To assess the rate of matrix Gla-protein carboxylation in patients with small intestinal bacterial overgrowth(SIBO) and to decipher its association with subclinical atherosclerosis.METHODS Patients with suspected SIBO who presented with a low risk for cardiovascular disease and showed no evidence of atherosclerotic plaques were included in the study. A glucose breath test was performed in order to confirm the diagnosis of SIBO and vascular assessment was carried out by ultrasound examination. Plasma levels of the inactive form of MGP(dephosphorylateduncarboxylated matrix Gla-protein) were quantified by ELISA and vitamin K2 intake was estimated using a food frequency questionnaire.RESULTS Thirty-nine patients were included in the study. SIBO was confirmed in 12/39(30.8%) patients who also presented with a higher concentration ofdephosphorylated-uncarboxylated matrix Gla-protein(9.5 μg/L vs 4.2 μg/L; P = 0.004). Arterial stiffness was elevated in the SIBO group(pulse-wave velocity 10.25 m/s vs 7.68 m/s; P = 0.002) and this phenomenon was observed to correlate linearly with the levels of dephosphorylated-uncarboxylated matrix Gla-protein(β = 0.220, R2 = 0.366, P = 0.03). Carotid intima-media thickness and arterial calcifications were not observed to be significantly elevated as compared to controls.CONCLUSION SIBO is associated with reduced matrix Gla-protein activation as well as arterial stiffening. Both these observations are regarded as important indicators of subclinical atherosclerosis. Hence, screening for SIBO, intestinal decontamination and supplementation with vitamin K2 has the potential to be incorporated into clinical practice as additional preventive measures.
文摘AIM: To estimate the prevalence of small intestine bacterial overgrowth (SIBO) among patients with an earlier diagnosis of irritable bowel disease (IBS) in our geographical area, and to collect information on the use of locally acting non-absorbable antibiotics in the management of SIBO. METHODS: A non-interventional study was conducted in 73 consecutive patients with a symptom-based diagnosis.. RESULTS: When the patients underwent a "breath test", 33 (45.2%) showed the presence of a SIBO. After treatment with rifaximin 1200 mg/d for seven days in 32 patients, 19 (59.4%) showed a negative "breath test" one week later as well as a significant reduction of symptoms, thus confirming the relationship between SIBO and many of the symptoms claimed by patients. In the other 13 patients, "breath test" remained positive, and a further cycle of treatment with ciprofloxacin 500 mg/d was given for 7 additional days, resulting in a negative "breath test" in one patient only. CONCLUSION: (1) about half of the patients with a symptomatic diagnosis of IBS have actually SIBO, which is responsible for most of the symptoms attributed to IBS; (2) only a "breath test" with lactulose (or with glucose in subjects with an intolerance to lactose) can provide a differential diagnosis between IBS and SIBO, with almost identical symptoms; and (3) the use of non-absorbable antibiotics may be useful to reduce the degree of SIBO and related symptoms; it must be accompanied, however, by the correction of the wrong alimentary habits underlying SIBO.
基金Supported by Coordination for the Improvement of Higher Education Personnel (CAPES) and Food and Nutrition Fund Municipal Health Fund of Osasco,Sao Paulo,Brazil
文摘AIM:To analyze small intestinal bacterial overgrowth in school-aged children and the relationship between hydrogen and methane production in breath tests.METHODS:This transversal study included 85 children residing in a slum and 43 children from a private school,all aged between 6 and 10 years,in Osasco,Brazil.For characterization of the groups,data regarding the socioeconomic status and basic housing sanitary conditions were collected.Anthropometric data was obtained in children from both groups.All children completed the hydrogen(H 2) and methane(CH 4) breath test in order to assess small intestinal bacterial overgrowth(SIBO).SIBO was diagnosed when there was an increase in H 2 ≥ 20 ppm or CH 4 ≥ 10 ppm with regard to the fasting value until 60 min after lactulose ingestion.RESULTS:Children from the slum group had worse living conditions and lower nutritional indices than children from the private school.SIBO was found in 30.9%(26/84) of the children from the slum group and in 2.4%(1/41) from the private school group(P = 0.0007).Greater hydrogen production in the small intestine was observed in children from the slum group when compared to children from the private school(P = 0.007).A higher concentration of hydrogen in the small intestine(P < 0.001) and in the colon(P < 0.001) was observed among the children from the slum group with SIBO when compared to children from the slum group without SIBO.Methane production was observed in 63.1%(53/84) of the children from the slum group and in 19.5%(8/41) of the children from the private school group(P < 0.0001).Methane production was observed in 38/58(65.5%) of the children without SIBO and in 15/26(57.7%) of the children with SIBO from the slum.Colonic production of hydrogen was lower in methaneproducing children(P = 0.017).CONCLUSION:Children who live in inadequate environmental conditions are at risk of bacterial overgrowth and methane production.Hydrogen is a substrate for methane production in the colon.
文摘AIM: Small intestinal bacterial overgrowth (SIBO) maycontribute to the appearance of several gastrointestinal nonspecific symptoms. Acute diverticulitis is affected by some similar symptoms and bacterial colonic overgrowth. We assessed the prevalence of SIBO in acute uncomplicated diverticulitis and evaluated its influence on the clinical course of the disease.METHODS: We studied 90 consecutive patients (39 males, 51 females, mean age 67.2 years, range 32-91 years). Sixty-one patients (67.78%) and 29 patients (32.22%) were affected by constipation-or diarrhea-prevalent diverticulitis respectively. All subjects were investigated by lactulose H2-breath test at the entry and at the end of treatment. We also studied a control group of 20 healthy subjects (13 males, 7 females, mean age 53 years, range 22-71 years).RESULTS: Oro-cecal transit time (OCTT) was delayed in67/90 patients (74.44%) (range 115-210 min, mean 120 min). Fifty-three of ninety patients (58.88%) showed SIBO, while OCTT was normal in 23/90 patients (25, 56%). In the control group, the mean OCTT was 88.2 min (range 75-135 min). The difference between diverticulitic patients and healthy subjects was statistically significant (P<0.01). OCTT was longer in constipation-prevalent disease than in diarrheaprevalent disease [180.7 min (range 150-210 min) vs 121 min (range 75-180 min) (P<0.001)], but no difference in bacterial overgrowth was found between the two forms of diverticulitis.After treatment with rifaximin plus mesalazine for 10 d, followed by mesalazine alone for 8 wk, 70 patients (81.49%) were completely asymptomatic, while 16 patients (18.60%) showed only slight symptoms. Two patients (2.22%) had recurrence of diverticulitis, and two other patients (2.22%) were withdrawn from the study due to side-effects. Seventy-nine of eighty-six patients (91.86%) showed normal OCTT (range 75-105 min, mean 83 min), while OCTT was longer, but it was shorter in the remaining seven (8.14%) patients (range 105-115 min, mean of 110 min). SIBO was eradicated in all patients, while it persisted in one patient with recurrence of diverticulitis. CONCLUSION: SIBO affects most of the patients with acute diverticulitis. SIBO may worsen the symptoms of patients and prolong the clinical course of the disease, as confirmed in the case of persistence of SIBO and diverticulitis recurrence. In this case, we can hypothesize that bacteria from small bowel may re-colonize in the colon and provoke recurrence of symptoms.
文摘Helicobacter pylori(H.pylori)infection is very common and affects a significant proportion of the world population.In contrast,the prevalence of small intestinal bacterial overgrowth(SIBO)in the general population is not well understood.There can be coexistence of both disease states in a given patient and their clinical symptoms may also overlap with one and another.There is no clear clinical guidelines for testing for and treating SIBO in patients with H.pylori infection.This review article explores the available evidence on the relationship between H.pylori infection and SIBO,diagnosis and treatment of these entities and also comments on associated non-gastrointestinal conditions.
文摘Background & Aims: Fermentation site and increasing time of symptomatic gas would be different between irritable bowel syndrome (IBS) and small intestine bacterial overgrowth (SIBO). The aim of this study was to determine the time for increase in abdominal gas following ingestion of lactulose and the possibility of differential diagnosis of SIBO and IBS. Methods: A prospective study was conducted on a series of IBS patients (n = 14) who were referred to the Oroku-Hospital (Okinawa, Japan) from June 6, 2014 to December 30, 2014. Imaging was first performed in early morning after fasting. After ingestion of lactulose, 1 - 4 plain abdominal radiographs were taken for investigation of increased gas during the indicated timeframe. Regions of interest of the gas areas were highlighted on the images obtained. Gas images were divided into three areas, the stomach, small intestine, and large intestine, and each total area was calculated. Results: At a dose of 10 g lactulose and an observation time of two hours, patients displayed no symptoms, and the gas volume was only slightly increased. However, when the dose of lactulose was increased (13 g/50 kg), and the observation time for the lactulose challenge was extended to 240 - 300 minutes, the results clearly demonstrated an increase in the gas produced in IBS patients. Conclusions: An increased dose of lactulose coupled with an extended observation time for the lactulose challenge clearly demonstrated an increase in the gas produced in IBS patients. Alterations in diet rather than antibiotics might reduce IBS symptoms.
文摘The intestinal microbiota and its role in health and disease processes have been the subject of several studies.It is known that changes in the intestinal microbiota occur due to several factors,such as the use of medication,age,lifestyle and diseases,which can modify intestinal homeostasis and lead to excessive growth of bacteria in the small intestine,triggering a clinical condition called small bowel bacterial overgrowth(SIBO).Individuals with SIBO may present gastrointestinal symptoms ranging from nausea,diarrhea and/or constipation,and flatulence to distension and abdominal pain,resulting from poor absorption of nutrients or changes in intestinal permeability.The gold-standard treatment is based on the use of antibiotics to eradicate bacterial overgrowth.Some studies have evaluated diets in the treatment of SIBO;however,the studies are of low methodological quality,making extrapolation of the results to clinical practice unfeasible.Thus,there is still not enough scientific evidence to support a specific type of diet for the treatment of SIBO.
文摘[目的]探讨香砂六君子汤联合枯草杆菌二联活菌肠溶胶囊治疗脾胃气虚型乙肝肝硬化合并小肠细菌过度生长(SIBO)的疗效。[方法]连续性招募2020年12月至2022年12月收治的80例乙肝肝硬化合并SIBO患者,采用随机数字表法将其分为两组,每组各40例。对照组给予枯草杆菌二联活菌肠溶胶囊治疗,观察组给予香砂六君子汤联合枯草杆菌二联活菌肠溶胶囊治疗。观察两组疗效、SIBO转阴率、中医证候积分、肝功能、免疫功能、炎症因子和不良反应。[结果]观察组总有效率和治疗14 d SIBO转阴率高于对照组(P<0.05)。两组治疗后食欲不振,脘腹痞胀食后尤甚,大便溏泄,神疲肢倦,头晕乏力证候积分较治疗前降低(P<0.05),血清谷草转氨酶(AST)、谷丙转氨酶(ALT)、总胆红素(TBiL)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平,外周血CD8^(+)占比较治疗前降低(P<0.05),总蛋白(TP)、外周血CD3^(+)、CD4^(+)占比较治疗前增高(P<0.05),观察组治疗后中医证候积分,血清ΑST、ALT、IL-6、TNF-α水平,外周血CD8^(+)占比低于对照组(P<0.05),外周血CD3^(+)、CD4^(+)占比、CD4^(+)/CD8^(+)高于对照组(P<0.05)。[结论]香砂六君子汤联合枯草杆菌二联活菌肠溶胶囊可更显著改善临床症状,提高T淋巴细胞免疫功能和抑制炎症反应,在治疗乙肝肝硬化合并SIBO方面具有更显著的临床疗效。