Clinical trial: the combination of rifaximin with partially hydrolysed guar gum is more effective than rifaximin alone in eradicating small intestinal bacterial overgrowth

Furnari, Manuele; Parodi, A. Ferretto; Gemignani, Lorenzo; Giannini, Edoardo G.; Marenco, S.; Savarino, Edoardo; Assandri, Lorenzo; Fazio, Valentina; Bonfanti, Daria; Inferrera, Simona

doi:10.1111/j.1365-2036.2010.04436.x

Cited by 73 publications

(55 citation statements)

References 40 publications

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“…Moroever, the prevalence of adverse events was significantly lower in patients receiving rifaximin in comparison with those receiving metronidazole. 22 Furnari et al 23 reported that 87% of patients treated with an oral antibiotic showed normal results of hydrogen breath tests. In a pilot study conducted by Khalighi et al 24 with the aim to evaluate the efficacy of a probiotic with lactic acid bacteria in the treatment of SIBO, patients receiving the probiotic demonstrated a better response than the control group (negative H 2 -breath test result in 93.3% of those receiving probiotic compared with 66.7% of the control group).…”

Section: Resultsmentioning

confidence: 99%

The prevalence of small intestinal bacterial overgrowth (SIBO) in adult patients with type 1 diabetes and relationship with metabolic control and the presence of chronic complications of the disease

Adamska¹,

Nowak²,

Piłaciński³

et al. 2016

Polish Archives of Internal Medicine

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INTRODUCTION Gastrointestinal symptoms may occur in 50% to 70% of patients with diabetes. OBJECTIVES The aim of this study was to evaluate the prevalence of small intestinal bacterial overgrowth (SIBO) in patients with diabetes, as well as the relationship between SIBO and metabolic control of diabetes and the presence of chronic complications of the disease. PATIENTS AND METHODSThe study group included 148 patients with type 1 diabetes, treated in the years 2013-2015. The control group consisted of 41 healthy volunteers. The presence of SIBO was assessed with a noninvasive breath test using 20 g of lactulose suspended in 200 ml of water, with the assessment of exhaled hydrogen concentrations. The measurements were performed at 15-minute intervals in the first hour and at 30-minute intervals in the second hour of the test. A positive result was considered as the output value of exhaled hydrogen of 20 parts per million (ppm) or higher or an increase in the output value of the exhaled hydrogen of 12 ppm during the first 60 minutes of the test. RESULTSWe observed a lower prevalence of SIBO in the study group in comparison with controls (56 patients [37.8%] vs 30 healthy volunteers [73%]; P = 0.006). In the logistic regression model, this association was independent of age, sex, body mass index, cigarette smoking, serum C-reactive protein concentrations, and estimated glomerular filtration rate (odds ratio, 0.26; 95% confidence interval, 0.10-0.68; P = 0.006).CONCLUSIONS The prevalence of SIBO in patients with type 1 diabetes is lower than that in healthy subjects. One of the possible causes might be the beneficial effect of nutritional therapy in patients with diabetes.

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Section: Resultsmentioning

confidence: 99%

The prevalence of small intestinal bacterial overgrowth (SIBO) in adult patients with type 1 diabetes and relationship with metabolic control and the presence of chronic complications of the disease

Adamska¹,

Nowak²,

Piłaciński³

et al. 2016

Polish Archives of Internal Medicine

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“…There are several options, such as non-absorbable antibiotics and probiotics for the treatment of SIBO [14][15][16]. Although rifaximin has been used for the treatment of SIBO [21] and several studies have confirmed the clinical efficacy of rifaximin in patients with IBS [22,23], no study exploring the effects of rifaximin on the prevention and treatment of NSAID-induced small intestinal damage has yet been reported. The role of probiotics in the treatment of SIBO remains controversial.…”

Section: Discussionmentioning

confidence: 98%

Role of small intestinal bacterial overgrowth in severe small intestinal damage in chronic non-steroidal anti-inflammatory drug users

Muraki

Fujiwara

Machida

et al. 2014

Scandinavian Journal of Gastroenterology

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OBJECTIVE. Enteric bacteria play a significant role in the pathogenesis of non-steroidal anti-inflammatory drug (NSAID)-induced small intestinal damage. However, the association between small intestinal bacterial overgrowth (SIBO) and NSAID-induced small intestinal damage remains unclear. The aim of the study was to examine the association between SIBO and the presence of NSAID-induced severe small intestinal damage or its symptoms in chronic NSAID users. MATERIALS AND METHODS. Forty-three patients who had been using NSAIDs for over 3 months were enrolled. They were examined by capsule endoscopy and a lactulose hydrogen breath test (LHBT). We defined severe small intestinal damage as the presence of more than four small erosions or large erosions/ulcers. The LHBT result was considered positive if there was an increase in the level of breath hydrogen gas of >20 ppm above baseline. RESULTS. Out of 43 patients, 22 (51%) had severe small intestinal damage. The LHBT was positive in 5 of 21 patients (24%) without severe small intestinal damage and in 13 of 21 patients (59%) with severe small intestinal damage. Multiple logistic regression analysis showed that an LHBT-positive result was significantly associated with increased odds ratio for severe small intestinal damage (OR, 6.54; 95% CI, 1.40-30.50). There was no significant difference in the presence of symptoms between the LHBT-positive and LHBT-negative patients with severe small intestinal damage. CONCLUSION. SIBO might have a role in the development of severe small intestinal damage in chronic NSAID users.

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“…Patients with SIBO complain of similar symptoms to IBS and a proportion of IBS patients have notable symptoms relief after antibiotic therapy (20,21). At present, the diagnosis of SIBO is challenging.…”

Section: Introductionmentioning

confidence: 99%

“…Thereafter, subjects were requested to eat a light dinner the day preceding the examination (21) and to fast until the examination. They were also asked to refrain from smoking and from physical activity the day before the test.…”

Section: Study Protocolmentioning

confidence: 99%

Measurement of oro-caecal transit time by magnetic resonance imaging

Savarino¹,

Savarino

Fox

et al. 2015

Eur Radiol

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OBJECTIVES To assess prospectively the agreement of orocaecal transit time (OCTT) measurements by lactulose hydrogen breath test (LHBT) and magnetic resonance imaging (MRI) in healthy subjects. METHODS Volunteers underwent abdominal 1.5-T MRI using axial and coronal single-shot fast-spin-echo T2-weighted sequences, having fasted and after lactulose ingestion (10 g/125 mL). Imaging and H2 excretion gas-chromatography were performed concurrently every 15 min up to 180 min. MR images were analyzed using semiautomatic segmentation to calculate small bowel gas volume (SBGV) and visually to detect bolus arrival in the caecum. Agreement between MRI-and LHBT-OCTT was assessed. RESULTS Twenty-eight subjects (17 men/11 women; mean age ± standard deviation 30 ± 8 years) were evaluated. Two H2 non-producers on LHBT were excluded. OCTT measured by MRI and LHBT was concordant in 18/26 (69 %) subjects (excellent agreement, k = 0.924). Median SBGV was 49.0 mL (interquartile interval 44.1 -51.6 mL). In 8/26 (31 %) subjects, MRI showed that the lactulose bolus was in the terminal ileum and not the caecum when H2E increased on LHBT. Median OCTT measured by MRI was significantly longer than OCTT measured by LHBT [135 min (120 -150 min) vs. 127.5 min (105 -150 min); p = 0.008]. Above baseline levels, correlation between [H2] and SBGV was significant (r = 0.964; p < 0.001). CONCLUSIONS MRI provides valid measurements of OCTT and gas production in the small bowel. KEY POINTS • MRI is a valid technique to measure OCTT. • Excellent agreement between MRI and LHBT was found. • Measuring gas production using MRI may provide evidence of small bowel fermentation. Methods: Volunteers underwent abdominal 1.5-T MRI using axial and coronal single-shot fast-spin-echo T2-weighted sequences in the fasted condition and after lactulose ingestion (10g/125mL). Imaging and H 2 excretion gas-cromatography were performed concurrently every 15 minutes up to 180 minutes. MR images were analyzed using semiautomatic segmentation to calculate small bowel gas volume (SBGV) and visually to detect bolus arrival in the cecum.Agreement between MRI-and LHBT-OCTT was assessed.Results: Twenty-eight subjects (17 males/11 females;mean age±standard deviation 30±8 years) were evaluated. Two H 2 non-producers on LHBT were excluded. OCTT measured by MRI and LHBT was concordant in 18/26 (69%) subjects (excellent agreement,k=0.924). Median SBGV was 49.0 mL (interquartile interval 44.1-51.6 mL). In 8/26 (31%) subjects, MRI showed the lactulose bolus was in the terminal ileum and not the cecum when H 2 E increased on LHBT. Thus, median OCTT measured by MRI was significantly longer than that measured by min)vs.127.5(105-150min);p=0.008]. Above baseline levels, correlation between [H 2 ] and SBGV was significant (r=0.964;p<0.001).Conclusions: MRI provides valid measurements of OCTT and gas production in the small bowel. Keypoints: MRI is a valid technique to measure OCTT.  Excellent agreement between MRI and LHBT was found. Measuring gas production using MRI may pro...

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Clinical trial: the combination of rifaximin with partially hydrolysed guar gum is more effective than rifaximin alone in eradicating small intestinal bacterial overgrowth

Cited by 73 publications

References 40 publications

The prevalence of small intestinal bacterial overgrowth (SIBO) in adult patients with type 1 diabetes and relationship with metabolic control and the presence of chronic complications of the disease

The prevalence of small intestinal bacterial overgrowth (SIBO) in adult patients with type 1 diabetes and relationship with metabolic control and the presence of chronic complications of the disease

Role of small intestinal bacterial overgrowth in severe small intestinal damage in chronic non-steroidal anti-inflammatory drug users

Measurement of oro-caecal transit time by magnetic resonance imaging

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