Small Intestinal Bacterial Overgrowth in Patients with Refractory Functional Gastrointestinal Disorders

Abstract

Background/aims: Small intestinal bacterial overgrowth (SIBO) is considered to be involved in the pathogenesis of functional gastrointestinal disorders (FGID). However, the prevalence and clinical conditions of SIBO in patients with FGID remain to be fully elucidated. Here, we examined the frequency of SIBO in patients with refractory FGID.

Methods: We prospectively enrolled patients with refractory FGID based on Rome III criteria. A glucose hydrogen breath test (GHBT) was performed using a gas analyzer after an overnight fast, with breath hydrogen concentration measured at baseline and every 15 minutes after administration of glucose for a total of 3 hours. A peak hydrogen value ≥ 10 ppm above the basal value between 60 and 120 minutes after administration of glucose was diagnosed as SIBO.

Results: A total of 38 FGID patients, including 11 with functional dyspepsia (FD), 10 with irritable bowel syndrome (IBS), and 17 with overlapping with FD and IBS, were enrolled. Of those, 2 (5.3%) were diagnosed with SIBO (one patient diagnosed with FD; the other with overlapping FD and IBS). Their symptoms were clearly improved and breath hydrogen levels decreased to normal following levofloxacin administration for 7 days.

Conclusions: Two patients initially diagnosed with FD and IBS were also diagnosed with SIBO as assessed by GHBT. Although the frequency of SIBO is low among patients with FGID, it may be important to be aware of SIBO as differential diagnosis when examining patients with refractory gastrointestinal symptoms, especially bloating, as a part of routine clinical care.

Keywords: Adult; Bacterial overgrowth syndrome; Blind loop syndrome; Breath tests; Dyspepsia.

Figure 1

Patterns shown by glucose hydrogen breath test findings obtained by administering 50 g of glucose to the subjects. The results were classified as normal, small intestinal bacterial overgrowth (SIBO), and indeterminate patterns. SIBO was diagnosed when the basal value was < 10 ppm and the subtracted peak value above the basal level was ≥ 10 ppm at 60–120 minutes after glucose loading.

Figure 2

Patterns shown by glucose hydrogen breath test findings in 2 patients with small intestinal bacterial overgrowth before and after levofloxacin administration. (A) Case A. (B) Case B.