Aetiology, diagnosis and management of small intestinal bacterial overgrowth

Ahmed, Jabed Foyez; Padam, Pritpal; Ruban, Aruchuna

doi:10.1136/flgastro-2022-102163

Cited by 10 publications

(7 citation statements)

References 46 publications

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“…30,31 The gold standard for the diagnosis of SIBO is the quantitative evaluation of bacterial concentration through jejunal aspirate culture obtained via endoscopy. 32 While this provides a definitive diagnosis, it is difficult to routinely administer due to its invasive nature. In contrast, the glucose breath test is already recognized as a noninvasive diagnostic tool for SIBO and is extensively used in clinical settings for diagnosis and follow-up.…”

Section: Discussionmentioning

confidence: 99%

Effect of Trimebutine and Rifaximin on Breath Hydrogen and Methane by Glucose Breath Test in Patients With Functional Bloating: A Randomized Double-blind Clinical Trial

Jo,

Paik,

Lee

et al. 2024

J Neurogastroenterol Motil

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Background/Aims Drugs that stabilize intestinal motility may improve the efficacy of nonabsorbable antibiotics, such as rifaximin, against small intestinal bacterial overgrowth (SIBO). We compared the efficacy of rifaximin alone with that of its combination with trimebutine maleate against SIBO. Methods We performed a randomized double-blind placebo-controlled trial (https://cris.nih.go.kr, no. KCT0004836) that included patients with functional bloating, no constipation, and SIBO using the hydrogen (H 2 )–methane (CH 4 ) glucose breath test (GBT). Patients were randomized into 2 groups in a 1:1 ratio, namely rifaximin (1200 mg/day) + trimebutine maleate (600 mg/day) group and rifaximin + placebo group, for 2 weeks. Patients completed a symptom questionnaire and underwent a GBT at baseline and at 1 month after treatment withdrawal. The primary outcome was SIBO eradication. The secondary outcomes included changes in the concentrations of exhaled gases, symptoms, and presence of adverse events. Results The complete eradication rate of SIBO was 35.9% (14/39) in the rifaximin group, and 34.1% (14/41) in the combined group with no significant differences. In both groups, no significant differences were observed in GBT profiles before and after the treatment, respectively. However total breath H 2 and CH 4 concentration were conspicuously decreased in the combined group after treatment. The combined group exhibited substantial relief of bloating. The adverse events were similar in the 2 groups. Conclusion While the combination therapy was not superior over rifaximin alone for SIBO eradication, it improves the symptom of bloating with numerically reducing the concentration of breath H 2 /CH 4 .

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Section: Discussionmentioning

confidence: 99%

Effect of Trimebutine and Rifaximin on Breath Hydrogen and Methane by Glucose Breath Test in Patients With Functional Bloating: A Randomized Double-blind Clinical Trial

Jo,

Paik,

Lee

et al. 2024

J Neurogastroenterol Motil

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“…Small GI dysmotility has been found to be a very common underlying mechanism. Thus, change in small GI motility is a major risk factor for SIBO development ( Ahmed et al, 2023 ). Impaired immunity, gastric acid barrier failure, anatomic alterations constitute some of the other risk factors ( Adike and DiBaise, 2018 ).…”

Section: Clinical Manifestations Associated With Changes In Gi Motilitymentioning

confidence: 99%

Thyroid disorders and gastrointestinal dysmotility: an old association

Xu,

Hu,

et al. 2024

Front. Physiol.

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Gastrointestinal motility symptoms may be closely related to thyroid diseases. Sometimes, such symptoms are the only thyroid disease-related clue although the degree of the symptoms may vary. The exact mechanism of action of thyroid hormones on gastrointestinal motility is not completely understood, however, a clue lies in the fact that muscle cell receptors can be directly acted upon by thyroxines. Both hypo- and hyperthyroidism can cause impairment of gastrointestinal motility, modifying structure and function of pharynx and esophagus, and regulating esophageal peristalsis through neuro-humoral interaction. In hyperthyroid patients, alterations of postprandial and basic electric rhythms have been observed at gastro-duodenal level, often resulting in slower gastric emptying. Gastric emptying may also be delayed in hypothyroidism, but an unrelated gastric mucosa-affecting chronic modification may also cause such pattern. Hyperthyroidism commonly show malabsorption and diarrhoea, while hypothyroidism frequently show constipation. In summary, it can be stated that symptoms of gastrointestinal motility dysfunction can be related to thyroid diseases, affecting any of the gastrointestinal segment. Clinically, the typical thyroid disease manifestations may be missing, borderline, or concealed because of intercurrent sicknesses. Motility-linked gastrointestinal problems may easily conceal a misdetected, underlying dysthyroidism that should be carefully analyzed. Here, we aim to elaborate on the associations between thyroid disorders and GI dysmotility and the common clinical manifestations associated with GI dysmotility.

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“…Other emerging tests for SIBO diagnosis include molecular testing of small bowel aspirates, capsule-based measurements for volatile organic compounds and gases, and urinary excretion of bile acid conjugates by bacterial hydrolase [48,63 ▪ ,64,65].…”

Section: Diagnosismentioning

confidence: 99%

Small intestinal bacterial overgrowth: current update

Zafar,

Jimenez,

Schneider

2023

Current Opinion in Gastroenterology

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Purpose of review This article aims to provide an up-to-date review of small intestinal bacterial overgrowth (SIBO), including etiology and risk factors, clinical manifestations, diagnostic evaluation for suspected SIBO, and therapeutic options. Recent findings Recent advances in breath testing, capsule and urine-based testing have opened new avenues and improved diagnostic yield of SIBO. Nonantibiotic-based treatment strategies have shown promising results in initial trials. Summary Small intestinal bacterial overgrowth (SIBO) is a condition defined by the excess bacteria or changes in bacterial composition of the small intestine. These are associated with various gastrointestinal (GI) symptoms such as bloating, abdominal distension, diarrhea, nutrient deficiencies, and even frank weight loss. Small bowel jejunal aspirate of >105CFU/ml has traditionally been considered the gold standard for diagnosis. Glucose and lactulose breath testing have become more common in clinical practice as they are noninvasive, easily accessible, and have lower cost. Treatment focuses on the eradication of excess bacteria in the small bowel and is traditionally done with the use of oral antibiotics. Other emerging therapies may include probiotics, diet manipulation, and prokinetic agents.

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Aetiology, diagnosis and management of small intestinal bacterial overgrowth

Cited by 10 publications

References 46 publications

Effect of Trimebutine and Rifaximin on Breath Hydrogen and Methane by Glucose Breath Test in Patients With Functional Bloating: A Randomized Double-blind Clinical Trial

Effect of Trimebutine and Rifaximin on Breath Hydrogen and Methane by Glucose Breath Test in Patients With Functional Bloating: A Randomized Double-blind Clinical Trial

Thyroid disorders and gastrointestinal dysmotility: an old association

Small intestinal bacterial overgrowth: current update

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