Small intestinal bacterial overgrowth in patients with rosacea: prevalence and clinical features / 中华皮肤科杂志

Objective:To investigate the prevalence of small intestinal bacterial overgrowth (SIBO) in patients with rosacea, and to analyze the relationship between breath test results and the occurrence of rosacea.Methods:Patients with rosacea were enrolled from the outpatient department of Xiangya Hospital from March 2022 to June 2023. The methane-hydrogen breath test was used to detect intestinal levels of methane and hydrogen in all patients to investigate the prevalence of SIBO. The basic information, clinical symptoms and severity, quality of life scores, gastrointestinal symptoms, and past medical history of the patients were collected. Statistical analysis was carried out by using the chi-square test, nonparametric test and multivariate logistic regression models to investigate the relationship between SIBO and the occurrence of rosacea.Results:A total of 116 patients with rosacea completed the methane-hydrogen breath test. They were aged 18 to 56 years (median [ Q1, Q3]: 25 [22, 33] years), and included 7 males (6.0%) and 109 females (94.0%) ; there were 43 cases (37.1%) of erythematotelangiectatic rosacea, and 73 (62.9%) of papulopustular rosacea. As the breath test showed, 94 patients were diagnosed with SIBO (81.0%, 95% CI: 72.7% - 87.7%) based on the breath tests, 84 showed positive hydrogen breath test results (72.4%, 95% CI: 63.3% - 80.3%), and 47 had positive methane breath test results (40.5%, 95% CI: 31.5% - 50%). Among the 67 patients with moderate to severe erythema, 33 (49.3%) showed positive methane breath test results, and 14 of 49 (28.6%) patients with mild erythema showed positive methane breath test results, with a rate difference of 20.7% ( P = 0.025, 95% CI: 13.9% - 27.5%) ; there were no significant differences in the positive rates of SIBO and hydrogen breath test results between the patients with moderate to severe erythema and those with mild erythema (both P > 0.05). No significant differences were observed in the age, gender, clinical subtypes, severity of papulopustules, flushing and burning sensation, or rosacea quality of life index scores between the SIBO-positive and -negative groups, between hydrogen-positive and -negative groups, and between methane-positive and -negative groups (all P > 0.05). Multivariate logistic regression analysis showed that methane positivity on breath test was associated with the severity of erythema in rosacea ( OR = 2.495, 95% CI: 1.102 - 5.649, P < 0.05) . Conclusions:The prevalence of SIBO was relatively high in the patients with rosacea. However, only the positive rate of methane breath test differed between the rosacea patients and non-rosacea controls, and there was some correlation between methane positivity on breath test and increased severity of rosacea erythema.

Single hydrogen-methane breath test for the diagnosis of small intestinal bacterial growth / 中华内科杂志

Objective:To investigate the diagnostic value of a single hydrogen-methane breath test (SHMBT) for small intestinal bacterial overgrowth (SIBO).Method:The current investigation was a cross-sectional study. Questionnaires and SHMBTs were administered to 162 patients with gastrointestinal symptoms (case group) and 69 healthy volunteers (control group). Differences in SHMBT results between the two groups were assessed,and cut-off values of CH 4 (methane) and H 2 (hydrogen) were analyzed via receiver operating characteristic (ROC) curves. Lastly,archived SHMBT data from 2 655 patients with gastrointestinal symptoms (validation set) were used to evaluate the diagnostic value of the SHMBT with respect to SIBO. The Chi-square test,the Mann-Whitney U test,Spearman′s Rank correlation analysis,and the Z test were used for statistical analysis. Results:Based on the international recommended diagnostic criteria for SIBO,which are fasting CH 4 ≥10 ppm (parts per million) or H 2 ≥20 ppm,the SHMBT-positive rate in the case group was significantly higher than that of control group (35.2% vs. 21.7%, χ2=4.08, P=0.043). Levels of CH 4 and H 2 were higher in the case group than in the control group [CH 4: 3(2,7) vs. 3(1,3) ppm, H 2: 11(4,22) vs. 10(5,15) ppm],and the difference in CH 4 levels was statistically significant ( Z=6.22, P=0.001). ROC curves were generated based on whether the subjects had gastrointestinal symptoms. The areas under the ROC curves were 0.633 for CH 4 alone,0.531 for H 2 alone, and 0.620 for CH 4 combined with H 2. The cut-off values were fasting CH 4≥4 ppm,fasting H 2≥13 ppm,and fasting CH 4 ≥5 ppm (or CH 4≥4 ppm and H 2≥24 ppm),respectively. Measuring CH 4 alone and CH 4 combined with H 2 was effective for determining the presence of gastrointestinal symptoms ( P<0.05). When CH 4 alone or CH 4 combined with H 2 were used as diagnostic indicators of SIBO, the respective SHMBT-positive rates in the validation set were 34.2% and 30.4%. These rates did not significantly differ from the SIBO-positive rate of 32.0% obtained via the international recommended diagnostic criteria ( P>0.05). The specificity of CH 4 alone was 79.9%,and the accuracy of CH 4 alone was 68.8%. The specificity of CH 4 combined with H 2 was 85.0%,and the accuracy of CH 4 combined with H 2 was 71.7%. Conclusion:Rapid one-time determination of CH 4 and H 2 in exhaled breath may a viable diagnostic method for SIBO, and using CH 4 combined with H 2 ( i.e.,fasting CH 4≥5 ppm, or CH 4 ≥4 ppm and H 2 ≥24 ppm) as cutoff values may be feasible.

Effect of helicobacter pylori eradication therapy on small intestinal bacterial overgrowth in children / 中国综合临床

Objective:To investigate the effect of helicobacter pylori (HP) infection and eradication treatment on small intestinal bacterial overgrowth (SIBO) in children.Methods:A prospective case-control study was conducted to select 68 children with symptoms of abdominal distension, abdominal pain, diarrhea and suspected digestive system diseases admitted to the Affiliated Hospital of Xuzhou Medical University from June 2021 to June 2022. They were divided into HP negative group and HP positive group according to HP infection. HP positive group received triple standardized HP eradication treatment, 14 days as a course of treatment. The baseline SIBO positive rate and gastrointestinal symptom rating scale (GSRS) score of the two groups were compared. The HP positive group was followed up for 4 and 12 weeks after drug withdrawal for quantitative assessment of gastrointestinal symptoms and LHBT. The SIBO positive rate, GSRS score of the two groups and the change of SIBO positive rate and GSRS score of the HP positive group before and after treatment were compared. The measurement data with normal distribution were expressed, and independent sample t-test was used for comparison between the two groups. M( Q1, Q3) was used to represent the measurement data of non normal distribution, and Mann Whitney U test was used to compare the two groups; Friedman test was used for comparison between multiple time points, and Nemenyi test was used for pairwise comparison. Four grid table or paired χ 2 test was used to compare the counting data between groups. Results:The positive rate of SIBO in HP negative group was lower than that in HP positive group (36.1% (13/36) vs 62.5% (20/32)), the difference was statistically significant (χ 2=4.72, P=0.030). Four weeks after drug withdrawal, the SIBO positive rate in HP positive group was higher than that before treatment (87.5% (28/32) vs 62.5% (20/32)), and 12 weeks after drug withdrawal was lower than that before treatment (21.9% (7/32) vs 62.5% (20/32)), with statistically significant differences (χ 2=8.00, P=0.008; χ 2=13.00, P<0.001). There was no statistically significant difference in GSRS score between HP negative group and HP positive group ( P=0.098). The clinical symptoms of 32 children in HP positive group were improved 4 and 12 weeks after HP eradication was stopped. GSRS scores were lower than those before treatment (8.0 (6.0, 12.8), 7.0 (5.0, 9.0) points vs 15.0 (12.0, 19.0) points) , and the differences were statistically significant ( Z values were -3.91, -4.68, respectively; all P<0.001). Conclusions:HP infection can increase the positive rate of SIBO in children with suspected digestive system diseases. The standardized triple HP eradication therapy may further aggravate the overgrowth of intestinal bacteria while treating HP infection, but this effect can be eliminated after 12 weeks of treatment.

Effects of polypharmacy on small intestinal bacterial overgrowth in elderly subjects / 中华老年医学杂志

Objective:To investigate the effect of multiple medications on the risk of small intestinal bacterial overgrowth(SIBO)in the elderly.Methods:Clinical data of 85 inpatients in the Department of Geriatrics, the First Hospital of Lanzhou University undergone HMBT from August 2017 to April 2021 were retrospectively analyzed.According to the HMBT results, they were divided into a SIBO(+ )group and a SIBO(-)group.Polypharmacy was defined as ≥ 5 types of medications.We analyzed the difference in the rate of polypharmacy between the two groups.Results:A total of 85 hospitalized elderly patients were included in the study.Of these patients, 38(44.71%)tested positive for SIBO.Polypharmacy occurred in 41 patients(48.24%). There were significant differences in types of drugs and polypharmacy between the SIBO(+ )group and the SIBO(-)group( t=3.01 and χ2=14.33, P<0.05 for both). Moreover, polypharmacy was a risk factor for SIBO( P=0.017, OR=10.85, 95% CI: 1.52-77.29). Among 14 commonly used drugs, gastrointestinal motility drugs were closely related to SIBO.There was a positive correlation between polypharmacy and the change in hydrogen levels at 90 min( P=0.040, r=0.22, 95% CI: 0.01-0.42). Conclusions:Polypharmacy is correlated with SIBO in the elderly, is a risk factor for SIBO and is helpful in clinical practice to assess the risk of SIBO and decide further examinations, contributing to early diagnosis and early treatment.

Influence of small intestinal bacterial overgrowth on liver cirrhosis and its treatment / 临床肝胆病杂志

Small intestinal bacterial overgrowth (SIBO) is characterized by changes in the number or species of small intestinal flora. Patients with liver cirrhosis often have intestinal congestion, edema, and delayed peristalsis and develop SIBO, which can further aggravate intestinal abnormalities. In patients with liver cirrhosis, SIBO can lead to significant adverse clinical outcomes, and since the increase in intestinal permeability may cause bacterial translocation into systemic circulation, SIBO is considered an important risk factor in the pathogenesis of liver cirrhosis, spontaneous bacterial peritonitis, and hepatic encephalopathy. Antibiotics, especially rifaximin, are the most effective therapies for SIBO, and in addition, studies are being conducted to investigate the efficacy of potential therapies such as prokinetic agents, probiotics, non-selective β-receptor blocker, and liver transplantation.

Advances in the mechanism and diagnosis of small intestinal bacterial overgrowth in children / 国际儿科学杂志

Small intestinal bacterial overgrowth(SIBO)is associated with various diseases in children.The pathogenesis involves gastric acid secretion, intestinal motility, anatomical structure and immune function.Breath test is widely used clinically because its simplicity and noninvasion, but its sensitivity and specificity are unstable.Bacterial culture of proximal intestinal fluid has been the gold standard in the past, but it is not easy to be popularized clinically for invasive examination.Next generation sequencing technology may provide function and composition of the intestinal flora.Finding a simple and accurate detection method to diagnose SIBO is an urgent problem.This paper reviews the progress in research on the pathogenesis and diagnostic methods of SIBO in children.

Research Progress on Relationship Between Small Intestinal Bacterial Overgrowth and Nonalcoholic Fatty Liver Disease / 胃肠病学

Nonalcoholic fatty liver disease (NAFLD) is a clinical syndrome characterized by hepatic steatosis and fat deposition in hepatocytes in the absence of significant alcohol use. A growing number of studies have shown significant dysregulation of intestinal microbiota in patients with chronic liver disease and cirrhosis. Small intestinal bacterial overgrowth (SIBO) is a clinical syndrome induced by excessive bacteria in small intestine. This article reviewed the correlation between SIBO and NAFLD, as well as the effect of probiotics on treatment of NAFLD.

Role of Small Intestinal Bacterial Overgrowth in Pathogenesis of Irritable Bowel Syndrome / 胃肠病学

Irritable bowel syndrome (IBS) is a common defecation related functional disease, presented as recurrent abdominal discomfort accompanied by a change in bowel habits. The pathogenesis of IBS is still unclear. Several factors have been identified as the etiological factors, such as altered gastrointestinal motility, visceral hypersensitivity, intestinal infection, and immunological activation, etc. Now more and more researches suggest that small intestinal bacterial overgrowth (SIBO) might be one of the pathogenic factors of IBS. This article reviewed the correlation of IBS with SIBO, the possible mechanism and treatment, so as to provide a reference for clinical diagnosis and treatment of IBS combined with SIBO.

Efficacy of low dose and short-term rifaximin on irritable bowel syndrome related with small intestinal bacterial overgrowth / 中华消化杂志

Objective To investigate the efficacy of low dose and short-term oral rifaximin in patients with small intestinal bacterial overgrowth (SIBO)related irritable bowel syndrome (IBS). Methods From June 2017 to June 2018,at the Department of Gastroenterology of Huashan Hospital,Fudan University in Shanghai,a total of 37 patients with SIBO related IBS were sequentially enrolled and divided into three groups:diarrhea type,constipation type and mixed type. All the patients received rifaximin 200 mg each time,three times per day for 14 days. The clinical efficacy before and after treatment were compared by the scores of irritable bowel syndrome symptom severity scale (IBS-SSS)and irritable bowel syndrome associated quality of life (IBS-QoL). The efficacy of rifaximin on SIBO clearance and SIBO related chronic low-grade inflammation was evaluated by lactulose breath test (LBT)and exhaled nitric oxide (eNO). T test and variance analysis were used for statistical analysis. Results Among 39 patients with SIBO related IBS,24 patients were diarrhea type,seven were constipation type and six were mixed type. Except one patient quitted the study because of chest tightness and palpitation,the IBS-SSS score of the left 36 patients before treatment was (250. 83 ± 55. 10),and decreased to (151. 11 ± 33. 96),and the difference was statistically significant (t = 13. 686,P <0. 01). Before treatment the score of IBS-QoL was (28. 03 ± 16. 16),and decreased to (14. 39 ± 9. 31)after treatment,and the difference was statistically significant (t = 6. 867,P < 0. 01 ). There was no significant difference in IBS-SSS and IBS-QoL scores among the diarrhea type,constipation type and mixed type groups (all P > 0. 05). After treated by rifaximin,the negative conversion rate of SIBO was 52. 8％(19 / 36). The negative conversion rate of hydrogen LBT was 54. 5％(12 / 22)and among 11 methane LBT positive patients,six cases turned negative;and one of three patients with both positive hydrogen LBT and methane LBT turned negative. The negative conversion rate of eNO was 41. 7％ (15 / 36). Conclusions Low dose and short term rifaximin treatment can improve the severity of clinical symptoms and quality of life in SIBO-related IBS patients,and the efficacy is not related with the subtypes of IBS.

Efficacy of low dose and short-term rifaximin on irritable bowel syndrome related with small intestinal bacterial overgrowth / 中华消化杂志

Objective@#To investigate the efficacy of low dose and short-term oral rifaximin in patients with small intestinal bacterial overgrowth (SIBO) related irritable bowel syndrome (IBS).@*Methods@#From June 2017 to June 2018, at the Department of Gastroenterology of Huashan Hospital, Fudan University in Shanghai, a total of 37 patients with SIBO related IBS were sequentially enrolled and divided into three groups: diarrhea type, constipation type and mixed type. All the patients received rifaximin 200 mg each time, three times per day for 14 days. The clinical efficacy before and after treatment were compared by the scores of irritable bowel syndrome symptom severity scale (IBS-SSS) and irritable bowel syndrome associated quality of life (IBS-QoL). The efficacy of rifaximin on SIBO clearance and SIBO related chronic low-grade inflammation was evaluated by lactulose breath test (LBT) and exhaled nitric oxide (eNO). T test and variance analysis were used for statistical analysis.@*Results@#Among 39 patients with SIBO related IBS, 24 patients were diarrhea type, seven were constipation type and six were mixed type. Except one patient quitted the study because of chest tightness and palpitation, the IBS-SSS score of the left 36 patients before treatment was (250.83±55.10), and decreased to (151.11±33.96), and the difference was statistically significant (t=13.686, P<0.01). Before treatment the score of IBS-QoL was (28.03±16.16), and decreased to (14.39±9.31) after treatment, and the difference was statistically significant (t=6.867, P<0.01). There was no significant difference in IBS-SSS and IBS-QoL scores among the diarrhea type, constipation type and mixed type groups (all P>0.05). After treated by rifaximin, the negative conversion rate of SIBO was 52.8%(19/36). The negative conversion rate of hydrogen LBT was 54.5%(12/22) and among 11 methane LBT positive patients, six cases turned negative; and one of three patients with both positive hydrogen LBT and methane LBT turned negative. The negative conversion rate of eNO was 41.7%(15/36).@*Conclusions@#Low dose and short term rifaximin treatment can improve the severity of clinical symptoms and quality of life in SIBO-related IBS patients, and the efficacy is not related with the subtypes of IBS.

Small intestinal bacterial overgrowth and low-grade systemic inflammation in 50 patients with irritable bowel syndrome / 中华消化杂志

Objective@#To investigate the incidence of small intestinal bacterial overgrowth (SIBO) and systemic low-grade inflammation in patients with irritable bowel syndrome (IBS).@*Methods@#From June to October in 2017, 50 cases of IBS patients who met Rome Ⅳ criteria were consecutively collected at Outpatient Department of Gastroenterology of Shanghai Huashan Hospital. The incidence of SIBO was detected by hydrogen lactulose breath test (LBT) and methane LBT. The incidence of systemic low-grade inflammation in IBS patients was determined by fractional exhaled nitric oxide(FeNO) breath test. Chi-square test was used for statistical analysis.@*Results@#Among 50 IBS patients, the positive rate of FeNO was 70%(35/50), and the number of FeNO positive cases in diarrhea-predominant (n=28), constipation-predominant (n=14) and mix-type (n=8) IBS paitents was 18, 11 and six, respectively, and the difference was not statistically significant among three groups (χ2=1.020, P=0.600). The incidence rate of SIBO was 60% (30/50), with 20 cases (40%) being only positive for hydrogen LBT, seven cases (14%) being methane LBT, and three cases (6%) being both positive. The numbers of hydrogen LBT and methane LBT in diarrhea-predominant, constipation-predominant, and mix-type IBS patents were 17, three, three and two, six, two, respectively. There were statistically significant differences in positive rates of hydrogen LBT and methane LBT among three groups (χ2=6.076 and 6.392, both P<0.05). The positive rate of FeNO in IBS patients with SIBO was higher than that of IBS patients without SIBO (90%, 27/30 vs. 40%, 8/20), and the difference was statistically significant (χ2=14.286, P<0.01).@*Conclusions@#Combination of hydrogen LBT and methane LBT has a higher detection rate of SIBO than traditional single hydrogen LBT. There is a correlation between SIBO and systemic low-grade inflammation in IBS patients.

Small intestinal bacterial overgrowth and low-grade systemic inflammation in 50 patients with irritable bowel syndrome / 中华消化杂志

Objective To investigate the incidence of small intestinal bacterial overgrowth (SIBO) and systemic low-grade inflammation in patients with irritable bowel syndrome (IBS ) .Methods From June to October in 2017 ,50 cases of IBS patients who met Rome Ⅳ criteria were consecutively collected at Outpatient Department of Gastroenterology of Shanghai Huashan Hospital .The incidence of SIBO was detected by hydrogen lactulose breath test (LBT) and methane LBT .The incidence of systemic low-grade inflammation in IBS patients was determined by fractional exhaled nitric oxide (FeNO) breath test .Chi-square test was used for statistical analysis .Results Among 50 IBS patients ,the positive rate of FeNO was 70％ (35/50) ,and the number of FeNO positive cases in diarrhea-predominant (n=28) ,constipation-predominant (n= 14) and mix-type (n= 8) IBS paitents was 18 ,11 and six ,respectively ,and the difference was not statistically significant among three groups (χ2=1 .020 ,P=0 .600) .The incidence rate of SIBO was 60％ (30/50) ,with 20 cases (40％ ) being only positive for hydrogen LBT ,seven cases (14％ ) being methane LBT ,and three cases (6％ ) being both positive .The numbers of hydrogen LBT and methane LBT in diarrhea-predominant ,constipation-predominant ,and mix-type IBS patents were 17 , three ,three and two ,six ,two ,respectively .There were statistically significant differences in positive rates of hydrogen LBT and methane LBT among three groups (χ2 =6 .076 and 6 .392 ,both P<0 .05) . The positive rate of FeNO in IBS patients with SIBO was higher than that of IBS patients without SIBO (90％ ,27/30 vs .40％ ,8/20) ,and the difference was statistically significant (χ2 =14 .286 ,P<0 .01) . Conclusions Combination of hydrogen LBT and methane LBT has a higher detection rate of SIBO than traditional single hydrogen LBT . There is a correlation between SIBO and systemic low-grade inflammation in IBS patients .

Obesity Is Inversely Related to Hydrogen-Producing Small Intestinal Bacterial Overgrowth in Non-Constipation Irritable Bowel Syndrome

There have been inconsistent findings on the association of obesity and non-constipation irritable bowel syndrome (IBS). Small intestinal bacterial overgrowth (SIBO) with hydrogen (H₂) gas forming-microflora causes non-constipation IBS. But, the effect of H₂ producing SIBO on obesity in non-constipation IBS patients has not been studied yet. The aim of this study was to investigate the association between obesity and SIBO in non-constipation IBS patients. We reviewed the charts of patients who showed IBS symptoms along with the documented results of their lactulose hydrogen breath test (LHBT) for SIBO. Multivariate models were used to assess the association between obesity and SIBO. Four-hundred fifty-eight patients were retrospectively included in the study. Of the 485 IBS patients, 158 (30.7%) subjects had positive results for LHBT. Subjects without SIBO showed significantly higher levels of body mass index (24.8 vs. 23.3; P < 0.001) and waist circumference (86.5 vs. 82.7; P < 0.001) as compared to subjects with SIBO. In multivariate analysis, the odds ratios of SIBO were 0.396 (P = 0.018) for obesity and 0.482 (P = 0.021) for abdominal obesity. This is the first human study to demonstrate that obesity is inversely related to SIBO with H2 gas production in non-constipation IBS patients.

A study on the role of small intestinal bacterial overgrowth in patients with functional dyspepsia

Background: Functional dyspepsia (FD) accounts for majority of dyspepsia. Before labeling them as FD, a bunch of investigations to be done to rule out organic cause. Small intestinal bacterial overgrowth (SIBO) which is one of the cause for dyspepsia is not commonly sought and always neglected among physicians. So we aimed to study the frequency of SIBO in patients with dyspeptic symptoms and whether to include investigations to diagnose SIBO in the algorithm of approach to dyspepsia. Materials and methods: We consecutively enrolled 50 newly diagnosed functional dyspepsia patients based on Rome III criteria and 50 healthy controls in this study. They underwent glucose hydrogen breath test (GHBT) after overnight fasting. Results: In the cases with FD, 6 (12%) subjects were found to have positive GHBT and diagnosed as SIBO, whereas in the controls 2 (4%) had positive GHBT with no statistical significant difference among groups with a P value of 0.140. In the cases with FD, the most common subtype was post prandial distress syndrome (46%), followed by epigastric pain syndrome (36%) and mixed type Sabarinathan Ramanathan, Premkumar Karunakaran, Kani Shaikh Mohamed, Ratnakar Kini, Pugazhendhi Thangavel, Murali Ananthavadivelu, Mohammed Ali, Rabindranath Eswaran, Thinakar Mani, Chandrashekar Patil. A study on the role of small intestinal bacterial overgrowth in patients with functional dyspepsia. IAIM, 2017; 4(5): 88-97. Page 89 (18%). Patients with SIBO were treated with rifaximin 1200 mg/day in divided doses for 10 days. GHBT was repeated after 4 weeks and found to be normalized in all cases. Conclusion: SIBO should be considered before making a diagnosis of FD. GHBT is a simple noninvasive method to diagnose SIBO. One could avoid taking unnecessary drugs by timely diagnosis of SIBO in patients with dyspepsia.

Effect of Gut Microbiota on Chronic Constipation and Guiding the Clinical Treatment / 胃肠病学

Gut microbiota is characteristically changed and participates in the pathogenesis and progression of a variety of diseases.Studies have shown that the ecological diversities of gut microbiota of constipated patients are disturbed, and some probiotics are effective for treatment of chronic constipation.This article reviewed the research progress on alterations of gut microbiota in chronic constipation, the mechanism of which affecting gastrointestinal motility, the interaction between microbiota and motility, and the efficacy of probiotics for clarifying the effect of gut microbiota on chronic constipation and guiding the clinical treatment.

Risk of Bacterial Infection from Proton Pump Inhibitor Use

Currently, proton pump inhibitors are used in a wide range of patients with gastroesophageal reflux disease, peptic ulcer, and upper gastrointestinal symptoms such as dyspepsia. In addition, the application of proton pump inhibitors for prevention of gastrointestinal complications induced by non-steroidal anti-inflammatory drugs is expected to increase their use in the future. The use of proton pump inhibitors promotes bacterial growth by reducing gastric acid concentration. If the acidity (pH) of the stomach fluid is lower than 4, most pathogens can be sterilized. However, patients who need to use a proton pump inhibitor should maintain a gastric acidity of at least 5 or 6, and can be at risk of infections such as pneumonia and Clostridium difficile infection. Several infectious diseases associated with the use of proton pump inhibitors were reviewed.

Determination of Rifaximin Treatment Period According to Lactulose Breath Test Values in Nonconstipated Irritable Bowel Syndrome Subjects

Small intestinal bacterial overgrowth (SIBO) can partly explain irritable bowel syndrome (IBS), and rifaximin has been observed to improve abdominal symptoms in nonconstipated IBS patients. However, there are few reports on the association of the rifaximin treatment periods with the results of a lactulose breath test (LBT). Therefore, we performed a retrospective review of patient charts to investigate the relation between the rifaximin treatment periods with LBT results in nonconstipated IBS patients. We also evaluated the time to achieve a symptomatic improvement in the IBS patients as compared to the changes in the LBT. We reviewed the charts for patients who showed IBS symptoms with documented positive results for LBT during their initial visit and who had a follow-up LBT after treatment with rifaximin. The LBT values were compared to the subjects' symptom scores. A total of 102 subjects had a follow-up LBT to assess LBT normalization. The subjects were divided into groups according to treatment periods of 4 weeks (n = 36), 8 weeks (n = 43), and 12 weeks (n = 23). The groups with a longer treatment exhibited an increase in the hydrogen gas value at 90 min and its sum during 90 min at the initial LBT. There were significant differences in hydrogen gas value at 90 min and in its sum during 90 min at the initial LBT between the groups treated for 4 and 12 weeks. The most significant treatment response was observed during the first 4 weeks for all treatment groups. Symptomatic improvement occurred earlier than LBT normalization in the treatment period over 4 weeks. The results indicate that different rifaximin treatment periods are needed in accordance with LBT levels to effectively eradicate SIBO.

Ecological Imbalance of Intestinal Flora and Irritable Bowel Syndrome / 胃肠病学

The pathogenesis of irritable bowel syndrome(IBS)is not fully clear,and might be associated with various factors. In 1980s,correlation between ecological imbalance of intestinal flora and IBS was raised. Recently,remarkable efficacy was observed in the treatment of post-infectious IBS(PI-IBS)by re-balancing the intestinal flora with probiotics. Thus it was proved that intestinal flora might play an important role in the pathogenesis of IBS. In this article,the association between ecological imbalance of intestinal flora and IBS as well as the related treatment strategies were reviewed.

Evaluating the efficacy of probiotic on treatment in patients with small intestinal bacterial overgrowth (SIBO) - A pilot study.

Background & objectives: Small intestinal bacterial overgrowth (SIBO) leads to several gastrointestinal (GI) problems and complications leading to malabsorption. The effectiveness of probiotics in the treatment of SIBO syndrome has not been well studied. this pilot study was aimed to assess the efficacy of a probiotic consisting of lactobacilli in the treatment of SIBO. Methods: In this study, 30 cases suffering from chronic abdominal pain or diarrhoea and with a positive hydrogen breath test were randomized in a double-blind manner into two groups: probiotic drug user and control group. After an initial 3-week aggressive therapy with broad-spectrum antibiotics, a 15-day maintenance antibiotic therapy with lactol was administered for the study group and the same regimen without lactol for the control group. After six months the HBT result and the GI symptoms were analyzed and compared between the two groups. Results: the result of hydrogen breath test and the clinical symptoms in patients receiving the maintenance regimen with lactol probiotic showed a better response. The hydrogen breath test turned negative in 93.3 per cent of those receiving lactol compared to 66.7 per cent of the controls. In all the cases receiving lactol, the abdominal pain disappeared completely (p=0.002). In addition, other GI problems including flatulence, belching and diarrhoea significantly improved in the study group (p<0.05). Interpretation & conclusions: Based on the preliminary data it seems that adding lactol probiotic to the maintenance therapy of small intestinal bacterial overgrowth patients on routine antibiotic therapy will be beneficial in preventing the complications of this syndrome.

High Prevalence of Small Intestinal Bacterial Overgrowth in Lactose Intolerance Patients: Is It a Chicken and Egg Situation.

Background: Lactose intolerance is highly prevalent in Mediterranean area. Substantial portions of patients remain symptomatic in spite of fair lactose-free diet. Aims: Assess in a series of IBS consecutive patients: 1) the prevalence of lactose intolerance; 2) the frequency of association of lactose intolerance with SIBO; 3) the possibility of SIBO as a cause of symptom persistence in patients with lactose intolerance on lactose-free diet; 4) the ability of LHBT to diagnose SIBO. Place and Duration of the Study: Patients were recruited from November 2011 to July 2012 at the Gastroenterology Unit of Mauriziano Hospital U.Ist , Turin, Italy. Methodology: Lactose malabsorption was assessed by means of LHBT and SIBO by means of GHBT and LHBT, using Breath Tracker digital microlyzer on 500 IBS patients and 50 controls. SIBO was treated, with rifaximin 1200 mg a day for 2 weeks, randomly, on 1 to 1 basis. Results: Prevalence of lactose intolerance resulted to be 59% in IBS patients and 6% in controls, with a statistically significant difference (p<.001). SIBO was present in 72% of patients with lactose intolerance in IBS group, ad in none of the subjects with lactose malabsorption (3) in control group. After 6 months, 105 out of 106 patients affected by LI + SIBO treated with rifaximin + lactose free diet, and 34 out of 107 patients affected by LI + SIBO treated only with a lactose free diet resulted completely asymptomatic. Concordance between LHBT and GHBT for SIBO diagnosis was 98%. Conclusions: Lactose intolerance is a common condition in patients with IBS in Northwest Italy (59%) very frequently associated with SIBO (72%). This association turned out to be a major cause of symptom persistence in patients on lactose-free diet until successful eradication of SIBO was achieved. LHBT is a simple test able to diagnose simultaneously lactose malabsorption and SIBO.