Prevalence of Small Intestine Bacterial Overgrowth Diagnosed by Quantitative Culture of Intestinal Aspirate in Celiac Disease

Abstract

Background and Aim: A recent study using lactulose hydrogen-breath testing suggests that small intestine bacterial overgrowth (SIBO) is a common cause of nonresponsive celiac disease (CD). The prevalence of SIBO in CD diagnosed by quantitative culture of intestinal aspirate is unknown. The aim of this study is to evaluate the prevalence and significance of SIBO in CD based on the results of quantitative culture of intestinal aspirate. Methods: We studied patients with CD in whom culture of intestinal aspirate was evaluated for the presence of anaerobes and aerobes. Bacterial overgrowth was diagnosed if culture demonstrated > 105 colony forming units/mL. The causes of nonresponsive CD were investigated. Results: We included 149 biopsy-confirmed CD patients. The intestinal aspirate was collected in 79 (53%) patients with nonresponsive CD, 47 (32%) as initial work-up for malabsorption, and in 23 (15%) asymptomatic treated CD. SIBO was diagnosed in 14 (9.3%). Nine (11%) with nonresponsive CD, 5 (11%) at initial work-up for malabsorption, and 0 in asymptomatic treated CD. Patients with a positive culture had evidence of worse malabsorption. A coexistent disorder was found in 67% of patients with both nonresponsive CD and bacterial overgrowth. Conclusions: The prevalence of SIBO diagnosed by quantitative culture of intestinal aspirate was 9.3% in patients with CD. Patients with symptomatic treated or untreated CD were affected. SIBO may coexist with other disorders associated with nonresponsive CD.

Gastrointestinal bacterial overgrowth: pathogenesis and clinical significance

“…For instance, the prevalence of SIBO in IBS varies from 30 to 85% depending on the source used [Pimentel et al 2000;Lin, 2004;Lupascu et al 2005;Khoshini et al 2008]. The prevalence of SIBO in liver cirrhosis is 50% [Pande et al 2009] and in celiac disease, the prevalence of SIBO in some studies is also estimated to be 50% [Rubio-Tapia et al 2009]. Interestingly, in asymptomatic morbidly obese patience the prevalence of SIBO was noted to be 17% [Sabate et al 2008].…”

Bacterial overgrowth syndrome: from problem understanding to treatment

“…Нередко причиной СИБР бывает побочное действие дли-тельного бесконтрольного применения лекарственных средств, таких как антибиотики, цитостатики, ингибиторы протонной помпы и др. В патогенезе СИБР определенное значение могут иметь механические нарушения слизи-стого барьера за счет применения объемных клизм или гидроколонотерапии [4,5,[13][14][15][16].…”

“…Результаты другого исследования положительно коррели-руют с эпидемиологическими данными по развитию СИБР у детей с функциональными расстройствами били-арного тракта [21]. Существует ряд доказательств, демон-стрирующих, что у 56% пациентов с муковисцидозом, у 30-65% пациентов с хроническим панкреатитом, Такие состояния, как баугинит, наличие свища между тонкой и толстой кишкой, хирургическое удаление илеоцекального угла с илеоцекальным клапаном, могут привести к избыточной колонизации тонкой кишки у 9-55% больных с целиакией СИБР выявляется статис-тически значимо чаще по сравнению с контрольной груп-пой [14][15][16].…”

Double-Blind Randomized Controlled Trial of Rifaximin for Persistent Symptoms in Patients with Celiac Disease

“…Small intestinal bacterial overgrowth (SIBO) has been demonstrated to be a potential cause of a poor response to a GFD in up to two-thirds of patients, although the exact prevalence is debated [5][6][7][8][9]. Jejunal aspirate culture with [10 5 colony-forming units per milliliter (CFU/ml) of bacteria is considered the gold standard for SIBO diagnosis, but is technically difficult to obtain and is poorly reproducible [10].…”