Chander Roland Bani, Mullin Gerard E, Passi Monica, Zheng Xi, Salem Ahmed, Yolken Robert, Pasricha Pankaj Jay
Division of Gastroenterology and Hepatology, Lenox Hill Hospital, Northwell Health System, New York, NY, USA.
Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Dig Dis Sci. 2017 Dec;62(12):3525-3535. doi: 10.1007/s10620-017-4726-4. Epub 2017 Sep 4.
Small intestinal bacterial overgrowth (SIBO) is an increasingly recognized clinical syndrome; however, its etiophathogenesis is poorly understood. We hypothesized that loss of gastric acid, a delayed intestinal transit, and ileocecal valve dysfunction may contribute to the genesis of this syndrome.
Our primary aim was to assess these parameters using wireless motility capsule (WMC) testing and to correlate them with the presence or absence of SIBO.
We prospectively evaluated 30 consecutive patients at a tertiary care center with suspected SIBO, diagnosed by lactulose hydrogen breath testing (LBT), and small bowel aspirate microbiology. Patients underwent WMC testing to assess ileocecal junction pressure (ICJP), small bowel transit time (SBTT), and regional gastrointestinal pH.
Thirty patients completed testing; 15 had a positive LBT, and 11 had a positive aspirate culture. As compared with LBT-negative patients, ICJP was lower (27.8 vs. 72.7 mmHg, p = 0.027), SBTT was longer (10.0 vs. 1.1 h, p = 0.004), gastric pH was higher (3.63 vs. 2.42, p < 0.01), and small bowel pH was higher (6.96 vs. 6.61, p = 0.05). A hypotensive ICJP (<46.61 mmHg) was more prevalent in LBT-positive patients as compared with LBT-negative patients (73.3 vs. 14.29%, p = 0.003). Logistic regression models were used to assess the magnitude of each measured WMC parameter and the presence of SIBO. p values ≤0.05 were considered statistically significant.
Patients with SIBO have significantly lower ICJP, prolonged SBTT, and a higher gastrointestinal pH as compared to those without SIBO. These abnormalities may play different roles in the pathogenesis of SIBO, facilitating more targeted treatment to prevent recurrences of SIBO.
小肠细菌过度生长（SIBO）是一种越来越受到认可的临床综合征；然而，其发病机制尚不清楚。我们推测胃酸缺乏、肠道转运延迟和回盲瓣功能障碍可能导致该综合征的发生。
我们的主要目的是使用无线动力胶囊（WMC）测试评估这些参数，并将它们与SIBO的存在与否相关联。
我们在一家三级医疗中心对30例连续的疑似SIBO患者进行了前瞻性评估，这些患者通过乳果糖氢呼气试验（LBT）和小肠抽吸物微生物学诊断。患者接受WMC测试以评估回盲部压力（ICJP）、小肠转运时间（SBTT）和胃肠道局部pH值。
30例患者完成测试；15例LBT呈阳性，11例抽吸物培养呈阳性。与LBT阴性患者相比，ICJP较低（27.8对72.7mmHg，p = 0.027），SBTT较长（10.0对1.1小时，p = 0.004），胃pH值较高（3.63对2.42，p < 0.01），小肠pH值较高（6.96对6.61，p = 0.05）。与LBT阴性患者相比，LBT阳性患者中低血压性ICJP（<46.61mmHg）更为普遍（73.3%对14.29%，p = 0.003）。使用逻辑回归模型评估每个测量的WMC参数的大小和SIBO的存在。p值≤0.05被认为具有统计学意义。
与无SIBO的患者相比，SIBO患者的ICJP显著降低，SBTT延长，胃肠道pH值更高。这些异常可能在SIBO的发病机制中发挥不同作用，有助于更有针对性地进行治疗以预防SIBO复发。
