Division of Gastroenterology and Hepatology, NewYork Presbyterian Weill Cornell Medical Center, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA.
Department of Medicine, NYU Langone Medical Center, New York University School of Medicine, 550 First Ave, HCC 3-15, New York, NY, 10016, USA.
Dig Dis Sci. 2018 Sep;63(9):2439-2444. doi: 10.1007/s10620-018-5109-1. Epub 2018 May 14.
Common mechanisms against small intestinal bacterial overgrowth (SIBO), including an intact ileocecal valve, gastric acid secretion, intestinal motility, and an intact immune system, are compromised in inflammatory bowel disease (IBD), and therefore, a relatively high incidence of SIBO has been reported in this population.
We aimed to determine whether an improvement in IBD clinical activity scores is seen after testing and treating SIBO.
A retrospective cohort study of 147 patients with inflammatory bowel disease who were referred for SIBO breath testing from 1/2012 to 5/2016 was performed. Characteristics of SIBO positive and treated patients were compared to SIBO negative patients, including the changes in Partial Mayo Score or Harvey Bradshaw Index (HBI), using Student's t test for continuous variables and Chi-squared or Fisher's exact test for categorical variables.
61.9% were SIBO positive and treated, and 38.1% were SIBO negative. In Crohn's disease, the median HBI decreased from 5 to 3 and 5 to 4, in the SIBO positive and negative groups, respectively (p = 0.005). In ulcerative colitis, the Partial Mayo Score decreased from 2 to 1.5 and 2 to 1, respectively (p = 0.607).
This study examines the clinical effect of testing and treating for SIBO in an IBD population. We see a significant reduction in HBI after testing for and treating SIBO. Future prospective studies are necessary to further investigate the role of SIBO in the evaluation and management of IBD.
在炎症性肠病（IBD）中，对抗小肠细菌过度生长（SIBO）的常见机制，包括完整的回盲瓣、胃酸分泌、肠道蠕动和完整的免疫系统，都会受到损害，因此，该人群中 SIBO 的发病率相对较高。
我们旨在确定在检测和治疗 SIBO 后，IBD 临床活动评分是否有所改善。
对 2012 年 1 月至 2016 年 5 月间因 SIBO 呼气试验而转介的 147 例炎症性肠病患者进行了回顾性队列研究。比较了 SIBO 阳性和治疗患者与 SIBO 阴性患者的特征，包括使用学生 t 检验比较连续变量和卡方或 Fisher 精确检验比较分类变量的部分 Mayo 评分或 Harvey Bradshaw 指数（HBI）的变化。
61.9%的患者为 SIBO 阳性且接受了治疗，38.1%的患者为 SIBO 阴性。在克罗恩病中，SIBO 阳性和阴性组的 HBI 中位数分别从 5 降至 3 和 5 降至 4（p=0.005）。在溃疡性结肠炎中，部分 Mayo 评分分别从 2 降至 1.5 和 2 降至 1（p=0.607）。
本研究检查了在 IBD 人群中检测和治疗 SIBO 的临床效果。我们发现，在检测和治疗 SIBO 后，HBI 显著降低。未来需要进行前瞻性研究，以进一步探讨 SIBO 在 IBD 评估和管理中的作用。
