Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA,
Dig Dis Sci. 2014 Jun;59(6):1269-77. doi: 10.1007/s10620-014-3166-7. Epub 2014 May 3.
Small intestinal bacterial overgrowth (SIBO) is a significant and increasingly recognized syndrome. While the development may be multifactorial, impairment of the ileocecal valve (ICV), small bowel motility, and gastric acid secretion have been hypothesized to be risk factors. ICV dysfunction remains largely unexplored using standard technology. The wireless motility capsule (WMC) that evaluates pressure, pH, and temperature throughout the GI tract provides the ability to assess these parameters.
The primary aims of this study were to assess the relationship of ICV pressures, small bowel transit time (SBTT) and intestinal pH with lactulose hydrogen breath testing (LBT) results in subjects with suspected SIBO.
We retrospectively studied consecutive patients referred to our institution for WMC and LBT from 2010-2012. Ileocecal junction pressures (IJP), as a surrogate for ICV pressures, were defined as the highest pressure over a 4-min window prior to the characteristic ileocecal pH drop. SBTT and pH were calculated and compared with LBT results.
Twenty-three patients underwent both WMC and LBT, with positive results observed in 15 (65.2%). IJP were significantly higher in LBT(-) negative vs. LBT(+) (79.9 vs. 45.1, p < 0.01). SBTT was significantly longer in LBT(+) versus LBT(-) (5.82 vs. 3.81 h, p = 0.05). Among LBT(+) subjects, gastric pH was significantly higher versus LBT(-) subjects (2.76 vs. 1.63, p = 0.01). There was poor correlation between IJP and other parameters (SBTT, small bowel pH, and gastric pH).
Low IJP is significantly associated with SIBO. While this is physiologically plausible, to our knowledge, this is the first study to make this connection. Prolonged SBTT and higher pH are also independently associated with SIBO. Our findings add value of the WMC test as a diagnostic tool in patients with functional gastrointestinal complaints and suggest re-focus of attention on the ileocecal valve as a prominent player in intestinal disorders.
小肠细菌过度生长（SIBO）是一种重要且日益被认识的综合征。虽然发病机制可能是多因素的，但回盲瓣（ICV）功能障碍、小肠运动功能障碍和胃酸分泌减少被认为是危险因素。ICV 功能障碍在很大程度上尚未通过标准技术进行探索。无线动力胶囊（WMC）可评估整个胃肠道的压力、pH 值和温度，从而能够评估这些参数。
本研究的主要目的是评估疑似 SIBO 患者的 ICV 压力、小肠通过时间（SBTT）和肠道 pH 值与乳果糖氢呼气试验（LBT）结果的关系。
我们回顾性研究了 2010 年至 2012 年期间因 WMC 和 LBT 而被转至我院的连续患者。回盲交界压力（IJP）作为 ICV 压力的替代指标，定义为在特征性回盲 pH 值下降之前的 4 分钟窗口内的最高压力。计算 SBTT 和 pH 值，并与 LBT 结果进行比较。
23 例患者同时进行了 WMC 和 LBT，其中 15 例（65.2%）结果阳性。LBT（-）阴性与 LBT（+）阳性患者的 IJP 显著更高（79.9 与 45.1，p < 0.01）。LBT（+）阳性患者的 SBTT 明显长于 LBT（-）阴性患者（5.82 与 3.81 小时，p = 0.05）。在 LBT（+）患者中，胃 pH 值明显高于 LBT（-）患者（2.76 与 1.63，p = 0.01）。IJP 与其他参数（SBTT、小肠 pH 值和胃 pH 值）之间相关性差。
低 IJP 与 SIBO 显著相关。虽然这在生理学上是合理的，但据我们所知，这是首次将这一联系建立起来。SBTT 延长和 pH 值升高也与 SIBO 独立相关。我们的发现增加了 WMC 测试作为功能性胃肠疾病患者的诊断工具的价值，并表明人们重新关注回盲瓣作为肠道疾病的重要参与者。
