Greco Anna, Caviglia Gian Paolo, Brignolo Paola, Ribaldone Davide Giuseppe, Reggiani Stefania, Sguazzini Carlo, Smedile Antonina, Pellicano Rinaldo, Resegotti Andrea, Astegiano Marco, Bresso Francesca
Department of Gastroenterology and Hepatology, Città della Salute e della Scienza Hospital , Turin , Italy.
Scand J Gastroenterol. 2015;50(11):1376-81. doi: 10.3109/00365521.2015.1050691. Epub 2015 May 19.
Small intestinal bacterial overgrowth (SIBO) is characterized by an abnormal proliferation of bacterial species in the small bowel. It has been shown that patients with Crohn's disease (CD) have a higher risk of SIBO development. The aim of the present study was to investigate SIBO prevalence in CD patients, possible clinical predictors of SIBO development and response to antibiotic therapy.
Sixty-eight patients (42 male, 26 female; mean age 49.3 ± 12.8 years) with CD reporting abdominal complaints were prospectively evaluated for SIBO with H2/CH4 glucose breath test (GBT).
Of the 68 patients enrolled, 18 (26.5%) tested positive for SIBO. Patients with SIBO exhibited increased stool frequency and significant reduction of stool solidity (p = 0.014), were older than patients tested negative to GBT (54.3 ± 13.0 years vs. 47.5 ± 12.3 years, p = 0.049), reported a longer history of CD (21.2 ± 10.3 years vs. 15.7 ± 10.2 years, p = 0.031) and showed a significant higher frequency of prior surgery (p = 0.001), revealing an association of number of surgical procedures (OR = 2.8315, 95% CI = 1.1525-6.9569, p = 0.023) with SIBO. Breath test normalization occurred in 13/15 patients evaluated after antibiotic and probiotic therapy. Although vitamin B12 levels were lower in patients with SIBO (p = 0.045) and a significant improvement was found after treatment (p = 0.011), this could be due to the heterogeneity, regarding vitamin B12 treatment, in our cohort.
SIBO is a frequent but underestimated condition in CD, which often mimics acute flare, effectively identified with GBT and could be treated with a combined antibiotic and probiotic therapy.
小肠细菌过度生长（SIBO）的特征是小肠内细菌种类异常增殖。研究表明，克罗恩病（CD）患者发生SIBO的风险更高。本研究的目的是调查CD患者中SIBO的患病率、SIBO发生的可能临床预测因素以及对抗生素治疗的反应。
对68例有腹部不适症状的CD患者（42例男性，26例女性；平均年龄49.3±12.8岁）采用氢气/甲烷葡萄糖呼气试验（GBT）对SIBO进行前瞻性评估。
在纳入的68例患者中，18例（26.5%）SIBO检测呈阳性。SIBO患者的排便频率增加，粪便硬度显著降低（p=0.014），年龄大于GBT检测阴性的患者（54.3±13.0岁对47.5±12.3岁，p=0.049），CD病史更长（21.2±10.3年对15.7±10.2年，p=0.031），既往手术频率显著更高（p=0.001），显示手术次数与SIBO有关（比值比=2.8315，95%置信区间=1.1525-6.9569，p=0.023）。15例接受抗生素和益生菌治疗评估的患者中有13例呼气试验恢复正常。虽然SIBO患者的维生素B12水平较低（p=0.045），治疗后有显著改善（p=0.011），但这可能是由于我们队列中维生素B12治疗的异质性所致。
SIBO在CD中很常见但常被低估，它常类似急性发作，通过GBT可有效识别，且可用抗生素和益生菌联合治疗。
