Professorial Surgical Unit, Department of Surgery, The University of Dublin Trinity College, Tallaght Hospital, Dublin 24, Ireland.
Professorial Surgical Unit, Department of Surgery, The University of Dublin Trinity College, Tallaght Hospital, Dublin 24, Ireland.
Pancreatology. 2018 Jun;18(4):379-385. doi: 10.1016/j.pan.2018.02.010. Epub 2018 Feb 24.
Small intestinal bacterial overgrowth (SIBO) is a condition characterised by symptoms similar to pancreatic exocrine insufficiency (PEI) in chronic pancreatitis patients. SIBO is thought to complicate chronic pancreatitis in up to 92% of cases; however, studies are heterogeneous and protocols non-standardised. SIBO may be determined by measuring lung air-expiration of either hydrogen or methane which are by-products of small bowel bacterial fermentation of intraluminal substrates such as carbohydrates. We evaluated the prevalence of SIBO among a defined cohort of non-surgical chronic pancreatitics with mild to severe PEI compared with matched healthy controls.
Thirty-five patients and 31 age-, gender- and smoking status-matched healthy controls were evaluated for SIBO by means of a fasting glucose hydrogen breath test (GHBT). The relationship between SIBO and clinical symptoms in chronic pancreatitis was evaluated.
SIBO was present in 15% of chronic pancreatitis patients, while no healthy controls tested positive (P = 0.029). SIBO was more prevalent in those taking pancreatic enzyme replacement therapy (PERT) (P = 0.016), with proton pump inhibitor use (PPI) (P = 0.022) and in those with alcohol aetiology (P = 0.023). Patients with concurrent diabetes were more often SIBO-positive and this was statistically significant (P = 0.009). There were no statistically significant differences in reported symptoms between patients with and without SIBO, with the exception of 'weight loss', with patients reporting weight loss more likely to have SIBO (P = 0.047).
The prevalence of SIBO in this study was almost 15% and consistent with other studies of SIBO in non-surgical chronic pancreatitis patients. These data support the testing of patients with clinically-relevant PEI unresolved by adequate doses of PERT, particularly in those patients with concurrent diabetes. SIBO can be easily diagnosed therefore allowing more specific and more targeted symptom treatment.
小肠细菌过度生长（SIBO）是一种以慢性胰腺炎患者胰腺外分泌功能不全（PEI）相似症状为特征的病症。据认为，SIBO 会使高达 92%的慢性胰腺炎病例复杂化；然而，研究结果存在差异，且方案不标准。SIBO 可以通过测量肺呼出的氢气或甲烷来确定，这两种气体都是小肠细菌对腔内底物（如碳水化合物）发酵的副产品。我们评估了在患有轻度至重度 PEI 的明确慢性胰腺炎非手术队列中，与匹配的健康对照组相比，SIBO 的患病率。
对 35 名患者和 31 名年龄、性别和吸烟状况匹配的健康对照者进行空腹葡萄糖氢呼气试验（GHBT）以评估 SIBO。评估了 SIBO 与慢性胰腺炎临床症状之间的关系。
15%的慢性胰腺炎患者存在 SIBO，而没有健康对照者呈阳性（P=0.029）。正在服用胰酶替代治疗（PERT）的患者中 SIBO 更为常见（P=0.016），质子泵抑制剂（PPI）的使用（P=0.022）和酒精病因（P=0.023）。同时患有糖尿病的患者更常出现 SIBO 阳性，这具有统计学意义（P=0.009）。在有 SIBO 和无 SIBO 的患者之间，报告的症状没有统计学上的显著差异，除了“体重减轻”，有体重减轻的患者更有可能出现 SIBO（P=0.047）。
在这项研究中，SIBO 的患病率接近 15%，与其他非手术慢性胰腺炎患者的 SIBO 研究一致。这些数据支持对临床相关 PEI 未通过足够剂量的 PERT 解决的患者进行测试，特别是对同时患有糖尿病的患者。SIBO 易于诊断，因此可以进行更具体和更有针对性的症状治疗。
