Drug‐induced hypochlorhydria causes high duodenal bacterial counts in the elderly

Pereira, Stephen P.; Gainsborough, Nicola; Dowling, R. H.

doi:10.1046/j.1365-2036.1998.00275.x

Cited by 64 publications

(35 citation statements)

References 26 publications

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“…Some studies have shown that use of PPI is associated with increased frequency of SIBO [26,27] while others failed to show such an association [28]. Our study showed SIBO to be equally common among patients on PPI and those not on it.…”

Section: Discussioncontrasting

confidence: 50%

Frequency and Factors Associated with Small Intestinal Bacterial Overgrowth in Patients with Cirrhosis of the Liver and Extra Hepatic Portal Venous Obstruction

et al. 2009

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Spontaneous bacterial peritonitis (SBP), a common complication of cirrhosis of liver, might result from translocation of bacteria from the small bowel. However, there is scanty data on frequency of small intestinal bacterial overgrowth (SIBO) in patients with cirrhosis of the liver. There are no data on SIBO in patients with extra-hepatic portal venous obstruction (EHPVO) in the literature. A total of 174 patients with cirrhosis of the liver, 28 with EHPVO and 51 healthy controls were studied for SIBO using glucose hydrogen breath test (GHBT). Persistent rise in breath hydrogen 12 ppm above basal (at least two readings) was considered diagnostic of SIBO. Of 174 patients (age 47.2 +/- 11.9 years, 80.5% male) with cirrhosis due to various causes, 67 (38.5%) were in Child's class A, 70 (40.2%) class B and 37 (21.7%) class C. Of the 174 patients with cirrhosis, 42 (24.14%) had SIBO as compared to 1 of 51 (1.9%) healthy controls (P < 0.0001). Patients with EHPVO had similar frequency of SIBO compared to healthy controls [2/28 (7.14%) vs 1/51 (1.97%), P = ns]. Frequency of SIBO in Child's A, B and C was comparable [13 (18.6%) vs 16 (23.9%) and 13 (35.1%), respectively; P = ns]. Presence of SIBO were not related to ascites, etiology of cirrhosis, and degree of liver dysfunction. SIBO is common in patients with cirrhosis of the liver. Patients with EHPVO do not have higher frequency of SIBO than healthy subjects. SIBO in cirrhosis is not related to the degree of derangement in liver function or of portal hypertension.

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Section: Discussioncontrasting

confidence: 50%

Frequency and Factors Associated with Small Intestinal Bacterial Overgrowth in Patients with Cirrhosis of the Liver and Extra Hepatic Portal Venous Obstruction

et al. 2009

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“…Vitamin B 12 malabsorption occurs as a result of competition for the vitamin by anaerobic bacteria present in the small bowel [23] . PPI use is known to predispose to bacterial overgrowth on duodenal aspirates, but the clinical signifi cance of this has previously been uncertain [12,24,25] possible explanation for the higher yield of a positive GBT in the older age group is related to underlying disease processes. We and others have noted that a gastroenterostomy strongly predisposes to a positive GBT result [26] .…”

Section: Discussionmentioning

confidence: 99%

Small Bowel Bacterial Overgrowth in Symptomatic Older People: Can It Be Diagnosed Earlier?

et al. 2005

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Background/Objectives: In older people, small bowel bacterial overgrowth syndrome may be a common, but under-diagnosed, cause of diarrhoea and nutrient malabsorption. We aim to determine which clinical features and baseline laboratory investigations indicate a high likelihood of small bowel bacterial overgrowth as defined by a positive glucose breath test. Methods: A retrospective analysis of records for all patients referred for glucose breath test over a 6-year period to a teaching hospital. Results: Out of 197 referrals, 168 patient records were located and analysed (62 male, 106 female; median age 65). Patient characteristics predictive of a positive glucose breath test were: increasing age (p < 0.01), low serum vitamin B₁₂(p = 0.02), low serum albumin (p = 0.03), previous partial gastrectomy (p < 0.01), previous right hemi-colectomy (p < 0.01), presence of small bowel diverticulae (p = 0.01) and concurrent use of a proton pump inhibitor (p < 0.01). 52.5% (n = 21/40) of patients studied who were over 75 years old versus 21.8% (n = 28/128) of those under 75 years old had a positive glucose breath test (p < 0.01). The median time to diagnosis, from first hospital visit to positive glucose breath test, was 39 weeks. Conclusions: There is often a significant delay in diagnosis of small bowel bacterial overgrowth. We suggest that this diagnosis should be considered earlier in the investigative algorithm in older patients with indicative symptoms and a predisposing factor (including previous partial gastrectomy, previous right hemi-colectomy, small bowel diverticulae or use of a proton pump inhibitor) or concurring laboratory indices (low vitamin B₁₂ or albumin).

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“…Bacterial overgrowth in the absence of structural abnormalities appears to occur in older individuals based on breath H 2 analysis after a 50-gram glucose challenge [32] and may lead to nutritional deficiencies [33] . Such small bowel bacterial overgrowth may be associated with gastric achlorhydria [34,35] , but in some subjects appears to result from altered intestinal motor function rather than changes in gastric pH or changes in luminal IgA secretion [36] . Thorough studies of motor activity in the elderly demonstrate some delay in gastric emptying, but little effect in overall small and large bowel transit [37,38] .…”

Section: Small Intestinal Bacterial Overgrowth Syndromementioning

confidence: 99%

Intestinal Malabsorption in the Elderly

Holt¹

2007

Dig Dis

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Background: Intestinal malabsorption in the elderly is infrequent, and clinical features are muted so that the diagnosis is often missed. Physiologic changes with aging are restricted to altered absorption of calcium and perhaps zinc and magnesium; however, achlorhydria can lead to impaired absorption of vitamin B₁₂, folic acid, and calcium. Methods and Results: Small bowel bacterial overgrowth occurs more commonly in elderly than in younger patients, accompanying gastric hypochlorhydria, altered intestinal motor activity, or diseases such as Parkinson’s disease. Changes in pancreatic anatomy and secretion occur but are insufficient to produce macronutrient malabsorption. In addition to pancreatic cancer and pancreatic stones, older patients may present with severe pancreatic insufficiency of unknown etiology. Celiac disease is recognized as very common at all ages and may not become evident until late in life. Manifestations of celiac disease in the elderly are occult and the diagnosis often is not considered until serologic tests are performed and confirmed by upper small intestinal biopsy. Associated intestinal lymphoma, esophageal carcinoma, intestinal pseudo-obstruction, and splenic atrophy may be more common in the elderly. Treatment of older patients with celiac disease with a gluten-free diet may be difficult, and intensive vitamin and micronutrient replacement is mandatory. A pragmatic approach to the evaluation of malabsorption in elderly patients is discussed.

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Drug‐induced hypochlorhydria causes high duodenal bacterial counts in the elderly

Abstract: Drug-induced hypochlorhydria causes high duodenal bacterial counts in the elderly but, in the short term, this bacterial overgrowth is not associated with malabsorption.

Cited by 64 publications

References 26 publications

Frequency and Factors Associated with Small Intestinal Bacterial Overgrowth in Patients with Cirrhosis of the Liver and Extra Hepatic Portal Venous Obstruction

Frequency and Factors Associated with Small Intestinal Bacterial Overgrowth in Patients with Cirrhosis of the Liver and Extra Hepatic Portal Venous Obstruction

Small Bowel Bacterial Overgrowth in Symptomatic Older People: Can It Be Diagnosed Earlier?

Intestinal Malabsorption in the Elderly

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