SIBO in Gastroparesis: Sci-fi or Science Fact?

Clarke, John O.

doi:10.1007/s10620-013-3011-4

Cited by 3 publications

(5 citation statements)

References 10 publications

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“…Gastroparesis is characterized by nausea, vomiting, bloating, postprandial fullness, and abdominal pain in the presence of impaired gastric emptying. 9 SIBO may present with symptoms such as bloating, distention, and abdominal discomfort in the presence of abnormal or increased levels of bacteria in the proximal GI tract. 9 A relationship between SIBO and gastroparesis has been observed, 5 , 10 as well as an association between SIBO and hypothyroidism, 11 , 12 typically caused by Hashimoto’s disease.…”

Section: Discussionmentioning

confidence: 99%

“… 9 SIBO may present with symptoms such as bloating, distention, and abdominal discomfort in the presence of abnormal or increased levels of bacteria in the proximal GI tract. 9 A relationship between SIBO and gastroparesis has been observed, 5 , 10 as well as an association between SIBO and hypothyroidism, 11 , 12 typically caused by Hashimoto’s disease. 13 It has been reported that significantly more patients with overt hypothyroidism presented with SIBO, compared with healthy subjects without thyroid disease or SIBO (p < 0.001).…”

Section: Discussionmentioning

confidence: 99%

“…SIBO is characterized by abnormally high levels of bacteria in the small intestine, 9 which may lead to malabsorption and a subsequent suboptimal response of a narrow therapeutic index medication, such as L-T4, 11 absorbed in the small intestine. 3 Malabsorption of L-T4 has been recognized as an important medical problem in patients with hypothyroidism.…”

Section: Discussionmentioning

confidence: 99%

“…11 As altered GI motility is a risk factor for SIBO and is common in patients with hypothyroidism, patients with chronic GI symptoms and hypothyroidism should be assessed for the presence of SIBO. 12 SIBO is characterized by abnormally high levels of bacteria in the small intestine, 9 which may lead to malabsorption and a subsequent suboptimal response of a narrow therapeutic index medication, such as L-T4, 11 absorbed in the small intestine. 3 Malabsorption of L-T4 has been recognized as an important medical problem in patients with hypothyroidism.…”

Section: Discussionmentioning

confidence: 99%

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Levothyroxine Sodium Oral Solution Normalizes Thyroid Function in a Patient with Hashimoto’s Disease, Gastritis, Diabetic Gastroparesis, and Small Intestinal Bacterial Overgrowth (SIBO)

Henderson¹

2021

IMCRJ

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Background Levothyroxine (L-T4) is used as a standard-of-care treatment in patients with hypothyroidism. L-T4 is absorbed throughout the small intestine, and consistent drug absorption is required for successful treatment. Patients with Hashimoto’s disease (autoimmune thyroiditis) often have food and medication sensitivities, as well as comorbid gastrointestinal (GI) disorders detrimental to L-T4 absorption. Case Presentation This case report describes a 51-year-old female patient with long-standing Hashimoto’s disease and multiple sensitivities to food chemicals and medications. The patient suffered from GI symptoms and poor thyroid-stimulating hormone (TSH) control. She was switched to compounded thyroxine/triiodothyronine medication due to her multiple allergies, with only mild improvement in thyroid function and no symptom resolution. She was subsequently diagnosed with gastroparesis and small intestinal bacterial overgrowth (SIBO). Because of further worsening of her GI symptoms and weight loss, she was switched to levothyroxine sodium oral solution (Tirosint ® -SOL), which contains only three ingredients—levothyroxine, water, and glycerol—which was well tolerated and led to normalization of TSH levels. Conclusion Malabsorption of L-T4 is often seen in patients with Hashimoto’s disease-related hypothyroidism and comorbid GI conditions, such as gastroparesis and SIBO. L-T4 tablets and a compounded oral suspension were inefficiently absorbed, leading to suboptimal TSH control. Switching to levothyroxine sodium oral solution resulted in sustained TSH control with subsequent resolution of symptoms. No side effects or reactions to the medication were observed, despite the patient’s multiple allergies and sensitivities to food chemicals and medications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Levothyroxine Sodium Oral Solution Normalizes Thyroid Function in a Patient with Hashimoto’s Disease, Gastritis, Diabetic Gastroparesis, and Small Intestinal Bacterial Overgrowth (SIBO)

Henderson¹

2021

IMCRJ

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“…However, this test can suffer from false positives and negatives (with specificity of 44–100% and sensitivity of 17–89%) [ 48 , 49 ]. Moreover, as postulated by Clarke [ 50 ], this test is an unsuitable method for diagnosing SIBO in patients with GP since the results can be influenced by gut motility. Given the limitations of the breath test for the diagnosis of SIBO, published studies should be interpreted with caution.…”

Section: Microbiota and Gastroparesismentioning

confidence: 99%

Gastroparesis: The Complex Interplay with Microbiota and the Role of Exogenous Infections in the Pathogenesis of the Disease

et al. 2023

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Gastroparesis (GP) is a disorder of gastric functions that is defined by objective delayed gastric emptying in the absence of mechanical obstruction. This disease is characterized by symptoms such as nausea, post-prandial fullness, and early satiety. GP significantly impacts patients’ quality of life and contributes to substantial healthcare expenses for families and society. However, the epidemiological burden of GP is difficult to evaluate, mainly due its significant overlap with functional dyspepsia (FD). GP and FD represent two similar diseases. The pathophysiology of both disorders involves abnormal gastric motility, visceral hypersensitivity, and mucosal inflammation. Moreover, both conditions share similar symptoms, such as epigastric pain, bloating, and early satiety. The latest evidence reveals that dysbiosis is directly or indirectly connected to gut–brain axis alterations, which are the basis of pathogenesis in both FD and GP. Furthermore, the role of microbiota in the development of gastroparesis was demonstrated by some clinical studies, which found that the use of probiotics is correlated with improvements in the gastric emptying time (GET). Infections (with viruses, bacteria, and protozoa) represent a proven etiology for GP but have not been sufficiently considered in current clinical practice. Previous viral infections can be found in about 20% of idiopathic GP cases. Moreover, delayed gastric emptying during systemic protozoal infections represents a huge concern for compromised patients, and few data exist on the topic. This comprehensive narrative review analyzes the relationship between microorganisms and GP. We explore, on the one hand, the correlation between gut microbiota dysbiosis and GP pathogenesis, including treatment implications, and, on the other hand, the association between exogenous infections and the etiology of the disease.

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Liquid Thyroxine Improves Outcomes in Hypothyroid Patients With Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome

Henderson,

Smith,

Mengelkamp

et al. 2024

Endocrine Practice

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SIBO in Gastroparesis: Sci-fi or Science Fact?

Cited by 3 publications

References 10 publications

Levothyroxine Sodium Oral Solution Normalizes Thyroid Function in a Patient with Hashimoto’s Disease, Gastritis, Diabetic Gastroparesis, and Small Intestinal Bacterial Overgrowth (SIBO)

Levothyroxine Sodium Oral Solution Normalizes Thyroid Function in a Patient with Hashimoto’s Disease, Gastritis, Diabetic Gastroparesis, and Small Intestinal Bacterial Overgrowth (SIBO)

Gastroparesis: The Complex Interplay with Microbiota and the Role of Exogenous Infections in the Pathogenesis of the Disease

Liquid Thyroxine Improves Outcomes in Hypothyroid Patients With Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome

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