Esposito I, de Leone A, Di Gregorio G, Giaquinto S, de Magistris L, Ferrieri A, Riegler G
Department of Clinical and Experimental Internal Medicine, Second University of Naples, Italy.
World J Gastroenterol. 2007 Dec 7;13(45):6016-21. doi: 10.3748/wjg.v13.45.6016.
To estimate the prevalence of small intestine bacterial overgrowth (SIBO) among patients with an earlier diagnosis of irritable bowel disease (IBS) in our geographical area, and to collect information on the use of locally acting non-absorbable antibiotics in the management of SIBO.
A non-interventional study was conducted in 73 consecutive patients with a symptom-based diagnosis.
When the patients underwent a "breath test", 33 (45.2%) showed the presence of a SIBO. After treatment with rifaximin 1,200 mg/d for seven days in 32 patients, 19 (59.4%) showed a negative "breath test" one week later as well as a significant reduction of symptoms, thus confirming the relationship between SIBO and many of the symptoms claimed by patients. In the other 13 patients, "breath test" remained positive, and a further cycle of treatment with ciprofloxacin 500 mg/d was given for 7 additional days, resulting in a negative "breath test" in one patient only.
(1) about half of the patients with a symptomatic diagnosis of IBS have actually SIBO, which is responsible for most of the symptoms attributed to IBS; (2) only a "breath test" with lactulose (or with glucose in subjects with an intolerance to lactose) can provide a differential diagnosis between IBS and SIBO, with almost identical symptoms; and (3) the use of non-absorbable antibiotics may be useful to reduce the degree of SIBO and related symptoms; it must be accompanied, however, by the correction of the wrong alimentary habits underlying SIBO.
评估在我们所在地区较早诊断为肠易激综合征（IBS）的患者中，小肠细菌过度生长（SIBO）的患病率，并收集有关使用局部作用的不可吸收抗生素治疗SIBO的信息。
对73例连续的基于症状诊断的患者进行了一项非干预性研究。
当患者进行“呼气试验”时，33例（45.2%）显示存在SIBO。32例患者接受1200mg/d利福昔明治疗7天后，19例（59.4%）在一周后“呼气试验”呈阴性，且症状明显减轻，从而证实了SIBO与患者所声称的许多症状之间的关系。在另外13例患者中，“呼气试验”仍为阳性，另外给予500mg/d环丙沙星再治疗7天，结果仅1例患者“呼气试验”转为阴性。
（1）约一半有症状诊断为IBS的患者实际上患有SIBO，这是IBS相关大多数症状的原因；（2）只有用乳果糖进行“呼气试验”（或对乳糖不耐受的患者用葡萄糖进行“呼气试验”）才能对症状几乎相同的IBS和SIBO进行鉴别诊断；（3）使用不可吸收抗生素可能有助于降低SIBO的程度和相关症状；然而，必须同时纠正SIBO潜在的不良饮食习惯。
