小肠细菌过度生长与克罗恩病患者的肠道炎症同时发生有关，但与全身炎症无关。

Small-Intestinal Bacterial Overgrowth is Associated With Concurrent Intestinal Inflammation But Not With Systemic Inflammation in Crohn's Disease Patients.

机构信息

Department of Medicine, Inflammatory Bowel Diseases Center, Division of Gastroenterology, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine.

Department of Medicine, Division of Gastroenterology, Federal University of Minas Gerais, Brazil.

出版信息

J Clin Gastroenterol. 2018 Jul;52(6):530-536. doi: 10.1097/MCG.0000000000000803.

DOI:10.1097/MCG.0000000000000803

PMID:28134633

Abstract

GOALS

We studied the prevalence and predictors of small-intestinal bacterial overgrowth (SIBO) in Crohn's disease (CD) outpatients and the relationship between SIBO and intestinal and/or systemic inflammation.

BACKGROUND

The relationship of SIBO with systemic and intestinal inflammation in CD patients is unclear.

STUDY

In this cross-sectional study, conducted between June, 2013 and January, 2015, 92 CD patients and 97 controls with nonchronic gastrointestinal complaints were assessed for the presence of SIBO using the H2/CH4 glucose breath test. Multivariate logistic regression was performed to investigate the potential association between SIBO and demographic, disease-related data, systemic markers of inflammation (C-reactive protein, and erythrocyte sedimentation rate), and biomarker of intestinal inflammation [fecal calprotectin concentration (FCC)].

RESULTS

The SIBO rate was significantly higher in CD patients than in controls (32.6% vs. 12.4%, respectively, P=0.0008). Patients with and without SIBO were comparable with regard to demographics, systemic inflammatory biomarkers, and disease characteristics, except for the stricturing phenotype being more common in SIBO-positive CD patients (43.3% vs. 19.3%, P=0.015). Notably, FCC was significantly higher in SIBO-positive patients (median of 485.8 vs.132.7 μg/g; P=0.004). Patients presenting increased FCC and stricturing disease had an odds of 9.43 (95% confidence interval, 3.04-11.31; P<0.0001) and 3.83 (95% confidence interval, 1.54-6.75; P=0.025) respectively, for SIBO diagnosis.

CONCLUSIONS

In CD patients, SIBO is a highly prevalent condition. Stricturing phenotype and increased FCC were strongly and independently associated with the presence of SIBO. SIBO diagnostic work-up followed by directed treatment is recommended in CD patients who present stricturing disease, especially in those with concurrent intestinal inflammation.

摘要

目的

我们研究了克罗恩病（CD）门诊患者中小肠细菌过度生长（SIBO）的流行情况和预测因素，以及 SIBO 与肠道和/或全身炎症之间的关系。

背景

SIBO 与 CD 患者全身和肠道炎症的关系尚不清楚。

研究

在这项横断面研究中，我们于 2013 年 6 月至 2015 年 1 月期间评估了 92 例 CD 患者和 97 例非慢性胃肠道症状的对照者的 SIBO 情况，使用 H2/CH4 葡萄糖呼气试验。进行多变量逻辑回归分析以研究 SIBO 与人口统计学、疾病相关数据、全身炎症标志物（C 反应蛋白和红细胞沉降率）以及肠道炎症生物标志物[粪便钙卫蛋白浓度（FCC）]之间的潜在关联。

结果

CD 患者的 SIBO 发生率明显高于对照组（分别为 32.6%和 12.4%，P=0.0008）。有和没有 SIBO 的患者在人口统计学、全身炎症生物标志物和疾病特征方面无差异，但 SIBO 阳性 CD 患者更常见狭窄表型（分别为 43.3%和 19.3%，P=0.015）。值得注意的是，SIBO 阳性患者的 FCC 明显更高（中位数分别为 485.8 和 132.7 μg/g；P=0.004）。FCC 升高和狭窄性疾病患者发生 SIBO 的几率分别为 9.43（95%置信区间，3.04-11.31；P<0.0001）和 3.83（95%置信区间，1.54-6.75；P=0.025）。