Reference Value of Fecal Bacterial Smear for Antibiotic Treatment in Irritable Bowel Syndrome With Diarrhea / 胃肠病学

ABSTRACT

Background: Intestinal microbiota dysbiosis is closely related to irritable bowel syndrome (IBS). Fecal bacterial smear is a simple and economical laboratory test for determining the severity of this condition. Aims: To explore the reference value of fecal bacterial smear for antibiotic treatment in IBS with diarrhea (IBS-D). Methods: A total of 130 IBS-D patients were enrolled and allocated into four groups according to the results of fecal bacterial smear normal intestinal microbiota group and grade , Ⅱ and III dysbiosis groups. Patients with grade III dysbiosis were treated based on fecal bacterial culture and drug susceptible test; patients in other three groups were treated with rifaximin for 7 days. After 7-day rifaximin treatment, all patients were reviewed for fecal bacterial smear. The clinical efficacy and changes in fecal bacterial smear were assessed and the consistency of these two aspects was analyzed by Kappa coefficient. Results: Of the 130 IBS-D patients, 82.3% had intestinal microbiota dysbiosis, and those with grade , Ⅱ and III dysbiosis was 48.5%, 25.4%, and 8.5%, respectively. The overall efficacy of rifaximin in patients with grade +Ⅱ dysbiosis was significantly higher than that in patients with normal intestinal microbiota (57.3% vs. 30.4%, P<0.05). Furthermore, the overall efficacies in grade and grade Ⅱ dysbiosis groups, especially in grade Ⅱ dysbiosis group, were consistent with the changes in fecal bacterial smear (κ=0.653 and κⅡ=0.727, all P<0.05). Conclusions: Intestinal microbiota dysbiosis can be detected in a great proportion of patients with IBS-D, and antibiotic treatment is more effective in patients with dysbiosis. Fecal bacterial smear might be used to stratify the IBS-D patients for optimal selection of antibiotics.