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

Abstract

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.

Microbiota Plays a Key Role in Non-Steroidal Anti-Inflammatory Drug-Induced Small Intestinal Damage

“…We assessed the association between the severity of NSAID-induced small intestinal damage and bacterial overgrowth measured by lactulose hydrogen breath test (LHBT) in patients with rheumatoid arthritis and osteoarthritis using NSAIDs for more than 3 months [21]. Our results showed that LHBT-positive patients were significantly associated with an increased odds ratio for severe NSAID-induced small intestinal damage.…”

Proton Pump Inhibitors and Nonsteroidal Anti-inflammatory Drug–Related Lower Gastrointestinal Adverse Events

“…By using a lactulose hydrogen breath test, small bowel bacteria overgrowth was found in 59% of users with severe small bowel damage compared with only 24% of users without severe small bowel damage. 15 To further support the pathogenetic role of bacteria in NSAID enteropathy, several studies reported that antibiotics such as ampicillin and metronidazole alleviated the severity of NSAID-induced small bowel damage. 12,14 Some probiotics (eg, Lactobacillus casei) have been reported to reduce small bowel mucosal inflammation and permeability induced by NSAIDs.…”

Antiplatelet therapy with acetylsalicylic acid: Approaches to reducing the frequency of gastrointenstinal adverse reactions

“…В кли-ническом исследовании, проведенном в Японии с использова-нием капсульной эндоскопии и определением содержания во-дорода в выдыхаемом воздухе (дыхательный тест с лактулозой), обнаружили избыточный рост бактерий в тонкой кишке в 24% случаев нетяжелых энтеропатий, обусловленных приемом НПВП, и 59% -тяжелых форм патологии. Положительный ды-хательный тест с лактулозой у пациентов, получавших НПВП, повышал вероятность диагностики тяжелого повреждения тон-кой кишки с ОШ 6,54 (при 95% ДИ от 1,40 до 30,5) [56].…”