Small Intestinal Bacterial Overgrowth Recurrence After Antibiotic Therapy
Small Intestinal Bacterial Overgrowth Recurrence After Antibiotic Therapy
Objectives: Current treatment for small intestinal bacterial overgrowth (SIBO) is based on courses of broad-spectrum antibiotics. No data concerning SIBO recurrence are available. The aims of the present study were to investigate SIBO recurrence as assessed by glucose breath test (GBT) after antibiotic treatment and conditions associated to SIBO recurrence.
Methods: Eighty consecutive patients affected by SIBO and decontaminated by rifaximin (1,200 mg per day for 1 wk) were enrolled. Diagnosis of SIBO was based on GBT. GBT was reassessed at 3, 6, and 9 months after evidence of GBT normalization. GBT positivity recurrence, predisposing conditions, and gastrointestinal symptoms were evaluated.
Results: Ten (10/80, 12.6%), 22 (22/80, 27.5%), and 35 (35/80, 43.7%) patients showed positivity to GBT at 3, 6, and 9 months after successful antibiotic treatment, respectively. At multivariate analysis, older age (OR 1.09, 95% CI 1.02-1.16), history of appendectomy (OR 5.9, 95% CI 1.45-24.19), and chronic use of proton pump inhibitors (PPIs) (OR 3.52, 95% CI 1.07-11.64) were significantly associated to GBT positivity recurrence. All gastrointestinal symptoms significantly increased at 3, 6, and 9 months in patients with evidence of GBT positivity recurrence.
Conclusions: GBT positivity recurrence rate was high after antibiotic treatment. Older age, history of appendectomy, and chronic use of PPIs were associated with GBT positivity recurrence. Patients with evidence of GBT positivity recurrence showed gastrointestinal symptoms relapse thus suggesting SIBO recurrence.
Small intestinal bacterial overgrowth (SIBO) is a clinical condition due to an increase in the level of microorganisms exceeding the presence of 10 CFU/mL of intestinal aspirate or of colonic-type bacteria within the small intestine.
In the healthy subject, the main mechanisms restricting bacterial colonization in the upper gut are the gastric acid barrier, mucosal and systemic immunity, and intestinal clearance. When these mechanisms fail, bacterial overgrowth develops: failure of the gastric acid barrier as observed in drug-induced inhibition of acid secretion; failure of mucosal and systemic immunity such as immunoglobulin deficiencies; failure of intestinal clearance as associated with anatomical abnormalities (gastrointestinal surgery, intestinal diverticula or fistula) or conditions impairing intestinal peristalsis (myopathic, neuropathic, autoimmune, metabolic, and endocrine diseases).
Antibiotic therapy is the cornerstone of the treatment of SIBO. Several absorbable and nonabsorbable broad-spectrum antibiotics have been used. Rifaximin is a rifamycin derivative with antibacterial activity caused by the inhibition of bacterial synthesis of RNA. It is active against Gram-positive and Gram-negative bacteria, including both aerobes and anaerobes. Rifaximin 1,200 mg per day for 1 wk is considered an effective treatment to achieve glucose breath test (GBT) normalization without increasing the incidence of side effects.
No data concerning SIBO recurrence and predisposing conditions are available.
The aims of the present study are to assess:
Abstract and Introduction
Abstract
Objectives: Current treatment for small intestinal bacterial overgrowth (SIBO) is based on courses of broad-spectrum antibiotics. No data concerning SIBO recurrence are available. The aims of the present study were to investigate SIBO recurrence as assessed by glucose breath test (GBT) after antibiotic treatment and conditions associated to SIBO recurrence.
Methods: Eighty consecutive patients affected by SIBO and decontaminated by rifaximin (1,200 mg per day for 1 wk) were enrolled. Diagnosis of SIBO was based on GBT. GBT was reassessed at 3, 6, and 9 months after evidence of GBT normalization. GBT positivity recurrence, predisposing conditions, and gastrointestinal symptoms were evaluated.
Results: Ten (10/80, 12.6%), 22 (22/80, 27.5%), and 35 (35/80, 43.7%) patients showed positivity to GBT at 3, 6, and 9 months after successful antibiotic treatment, respectively. At multivariate analysis, older age (OR 1.09, 95% CI 1.02-1.16), history of appendectomy (OR 5.9, 95% CI 1.45-24.19), and chronic use of proton pump inhibitors (PPIs) (OR 3.52, 95% CI 1.07-11.64) were significantly associated to GBT positivity recurrence. All gastrointestinal symptoms significantly increased at 3, 6, and 9 months in patients with evidence of GBT positivity recurrence.
Conclusions: GBT positivity recurrence rate was high after antibiotic treatment. Older age, history of appendectomy, and chronic use of PPIs were associated with GBT positivity recurrence. Patients with evidence of GBT positivity recurrence showed gastrointestinal symptoms relapse thus suggesting SIBO recurrence.
Introduction
Small intestinal bacterial overgrowth (SIBO) is a clinical condition due to an increase in the level of microorganisms exceeding the presence of 10 CFU/mL of intestinal aspirate or of colonic-type bacteria within the small intestine.
In the healthy subject, the main mechanisms restricting bacterial colonization in the upper gut are the gastric acid barrier, mucosal and systemic immunity, and intestinal clearance. When these mechanisms fail, bacterial overgrowth develops: failure of the gastric acid barrier as observed in drug-induced inhibition of acid secretion; failure of mucosal and systemic immunity such as immunoglobulin deficiencies; failure of intestinal clearance as associated with anatomical abnormalities (gastrointestinal surgery, intestinal diverticula or fistula) or conditions impairing intestinal peristalsis (myopathic, neuropathic, autoimmune, metabolic, and endocrine diseases).
Antibiotic therapy is the cornerstone of the treatment of SIBO. Several absorbable and nonabsorbable broad-spectrum antibiotics have been used. Rifaximin is a rifamycin derivative with antibacterial activity caused by the inhibition of bacterial synthesis of RNA. It is active against Gram-positive and Gram-negative bacteria, including both aerobes and anaerobes. Rifaximin 1,200 mg per day for 1 wk is considered an effective treatment to achieve glucose breath test (GBT) normalization without increasing the incidence of side effects.
No data concerning SIBO recurrence and predisposing conditions are available.
The aims of the present study are to assess:
GBT positivity recurrence rate;
conditions associated with GBT positivity recurrence;
relapse of gastrointestinal symptoms associated with GBT positivity recurrence.