Excessive bacterial growth syndrome in small intestine burdens the clinical picture of inflammatory bowel diseases

Abstract

Research objective: to study the frequency of small intestinal bacterial overgrowth (SIBO) and factors associated with it in patients with inflammatory bowel diseases (IBD). Materials and methods of the study: 152 patients with IBD (Crohn’s disease and ulcerative colitis) a hydrogen breathing test (HBT) with lactulose, performed by the “Gastro+” monitor using lactulose. In all patients, the characteristics of the course of IBD were evaluated, including 60 parameters: the time of diagnosis of IBD, the existing symptoms assessed by a visually analog scale (VAS), extra-intestinal manifestations, current and previous treatment, severity of attack, extent of the lesion in UC, phenotypic variant in CD, the level of endoscopic activity, the presence or absence of surgical interventions, indicators of laboratory and instrumental methods of examination, etc. Results. The frequency of positive hydrogen breath test was 48%, in patients with CD - 50.7% (n=36), in patients with UC - 45.7% (n=37) (p= 0.626). The presence of SIBO in general in IBD patients was associated with the level of clinical and endoscopic activity and the form of the disease, the severity of the attack; as well as in UC patients - the extent of the colon lesion, in CD patients - the presence of penenting and stenosing phenotypes. Patients with IBD with the presence of SIBR complain of a greater number of defecations, a lower body mass index, the presence of a decrease in body weight within 1 month before the examination and more frequent complaints of bloating, flatulence, tearfulness and weakness. Thus, a hydrogen breath test can be used for differential diagnosis of exacerbation of IBD from clinical manifestations caused by SIBO.