Suri Jaspreet, Kataria Rahul, Malik Zubair, Parkman Henry P, Schey Ron
Gastroenterology Section, Department of Medicine Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA.
Medicine (Baltimore). 2018 May;97(21):e10554. doi: 10.1097/MD.0000000000010554.
Limited research exists regarding the relationship between small intestinal bacterial overgrowth (SIBO), small bowel transit (SBT), and colonic transit (CT). Furthermore, symptom analysis is limited between the subtypes of SIBO: hydrogen producing (H-SIBO) and methane producing (M-SIBO). The primary aims of this study are to: compare the SBT and CT in patients with a positive lactulose breath test (LBT) to those with a normal study; compare the SBT and CT among patients with H-SIBO or M-SIBO; compare the severity of symptoms in patients with a positive LBT to those with a normal study; compare the severity of symptoms among patients with H-SIBO or M-SIBO.A retrospective review was performed for 89 patients who underwent a LBT and whole gut transit scintigraphy (WGTS) between 2014 and 2016. Seventy-eight patients were included. WGTS evaluated gastric emptying, SBT (normal ≥40% radiotracer bolus accumulated at the ileocecal valve at 6 hours), and CT (normal geometric center of colonic activity = 1.6-7.0 at 24 hours, 4.0-7.0 at 48 hours, 6.2-7.0 at 72 hours; elevated geometric center indicates increased transit). We also had patients complete a pretest symptom survey to evaluate nausea, bloating, constipation, diarrhea, belching, and flatulence.A total of 78 patients (69 females, 9 males, mean age of 48 years, mean BMI of 25.9) were evaluated. Forty-seven patients had a positive LBT (H-SIBO 66%, M-SIBO 34%). Comparison of SBT among patients with a positive LBT to normal LBT revealed no significant difference (62.1% vs 58.6%, P = .63). The mean accumulated radiotracer was higher for H-SIBO compared to M-SIBO (71.5% vs 44.1%; P < .05). For CT, all SIBO patients had no significant difference in geometric centers of colonic activity at 24, 48, and 72 hours when compared to the normal group. When subtyping, H-SIBO had significantly higher geometric centers compared to the M-SIBO group at 24 hours (4.4 vs 3.1, P < .001), 48 hours (5.2 vs 3.8, P = .002), and at 72 hours (5.6 vs 4.3, P = .006). The symptom severity scores did not differ between the positive and normal LBT groups. A higher level of nausea was present in the H-SIBO group when compared to the M-SIBO group.Overall, the presence of SIBO does not affect SBT or CT at 24, 48, and 72 hours. However, when analyzing the subtypes, M-SIBO has significantly more delayed SBT and CT when compared to H-SIBO. These results suggest the presence of delayed motility in patients with high methane levels on LBT.
关于小肠细菌过度生长（SIBO）、小肠转运（SBT）和结肠转运（CT）之间的关系，现有研究有限。此外，对SIBO的亚型——产氢型（H-SIBO）和产甲烷型（M-SIBO）之间的症状分析也很有限。本研究的主要目的是：比较乳糖呼气试验（LBT）阳性患者与检查正常患者的SBT和CT；比较H-SIBO或M-SIBO患者之间的SBT和CT；比较LBT阳性患者与检查正常患者的症状严重程度；比较H-SIBO或M-SIBO患者之间的症状严重程度。对2014年至2016年间接受LBT和全肠道转运闪烁扫描（WGTS）的89例患者进行了回顾性研究。纳入78例患者。WGTS评估胃排空、SBT（正常情况为6小时时回盲瓣处放射性示踪剂团块累积量≥40%）和CT（正常情况下结肠活动的几何中心在24小时时为1.6 - 7.0，48小时时为4.0 - 7.0，72小时时为6.2 - 7.0；几何中心升高表明转运加快）。我们还让患者完成一项检查前症状调查，以评估恶心、腹胀、便秘、腹泻、嗳气和肠胃胀气情况。
共评估了78例患者（69例女性，9例男性，平均年龄48岁，平均体重指数25.9）。47例患者LBT阳性（H-SIBO占66%，M-SIBO占34%）。LBT阳性患者与LBT正常患者的SBT比较无显著差异（62.1%对58.6%，P = 0.63）。与M-SIBO相比，H-SIBO的放射性示踪剂平均累积量更高（71.5%对44.1%；P < 0.05）。对于CT，与正常组相比，所有SIBO患者在24、48和72小时时结肠活动的几何中心均无显著差异。进行亚型分析时，H-SIBO在24小时（4.4对3.1，P < 0.001）、48小时（5.2对3.8，P = 0.002）和72小时（5.6对4.3，P = 0.006）时的几何中心显著高于M-SIBO组。LBT阳性组与正常组的症状严重程度评分无差异。与M-SIBO组相比，H-SIBO组的恶心程度更高。
总体而言，SIBO的存在在24、48和72小时时不影响SBT或CT。然而，在分析亚型时，与H-SIBO相比，M-SIBO的SBT和CT延迟更明显。这些结果表明LBT时甲烷水平高的患者存在运动延迟。
