Untitled

Abstract

The aim of this study was to determine whether an indirect noninvasive indicator of proximal bacterial overgrowth, the glucose breath test, was of diagnostic value in inflammatory bowel disease. Twenty four of 71 Crohn's disease patients tested had a positive glucose breath test. No statistical conclusions could be drawn between the Crohn's disease activity index and glucose breath test status. Of patients with radiologic evidence of small bowel stricture(s), 96.0% had a positive glucose breath test, while only one of 46 negative glucose breath test patients had a stricture. The positive and negative predictive values for a positive glucose breath test as an indicator of stricture formation were 96.0% and 97.8%, respectively. This correlation was not altered in Crohn's disease patients with fistulae or status postresection of the terminal ileum. The data in ulcerative colitis were nondiagnostic. In conclusion, the glucose breath test appears to be an accurate noninvasive inexpensive diagnostic test for small bowel stricture(s) and secondary bacterial overgrowth in Crohn's disease.

Small intestinal bacterial overgrowth mimicking acute flare as a pitfall in patients with Crohn's Disease

“…A comparison of the prevalence of bacterial overgrowth in subgroups of patients with low (CDAI <150), moderate (CDAI = 150–300) and high (CDAI >300) disease activity showed no significant differences. This confirms data reported by Mishkin et al, who found no statistically significant correlation between CDAI and HGBT results in patients with CD [10]. …”

“…False positive findings may also be returned in patients with prior extensive resection of the small bowel which leads to accelerated intestinal transit as part of a short-bowel syndrome [10]. A false negative HGBT may occur in patients receiving antibiotics or with induced reduction in intestinal bacterial load secondary to bowel preparation, e.g.…”

“…Reported risk factors for the development of bacterial overgrowth in patients with CD include surgical procedures involving the gastrointestinal tract, especially ileocecal resection, as well as strictures or fistulae [3,8,10]. Surgery affecting the integrity of the ileocecal valve may be followed by changes in the bacterial colonization of the proximal ileum characterized especially by an increase in the proportion of Gram-negative species [2,7].…”

“…Castiglione et al implicate entero-enteric fistulae and strictures as possible etiological factors in the development of SIBO in patients who have not undergone prior surgery [8]. Mishkin et al describe bacterial overgrowth as an indicator for strictures in patients with CD [10]. In their study, 24 of 25 patients (96%) with radiologically confirmed strictures exhibited SIBO.…”

“…There is a paucity of data in the literature regarding the prevalence of SIBO in patients with CD [8-10]. In many cases, bacterial overgrowth may be overlooked due to the fact that the symptoms of SIBO do not differ significantly from those of the underlying disease process itself sometimes even mimicking an acute flare.…”