Department of Medicine, McMaster University, Hamilton, ON, Canada.
Canadian Scleroderma Research Group, Montreal, Canada.
Rheumatology (Oxford). 2018 Oct 1;57(10):1802-1811. doi: 10.1093/rheumatology/key175.
Almost all patients with SSc have gastrointestinal manifestations. Small intestinal bacterial overgrowth (SIBO) occurs in 30-60% of patients and leads to malnutrition and impaired quality of life. Recent systematic reviews have reported efficacy of treatments for SIBO, but these are not specific to patients with SSc. We conducted a systematic review of the evidence for all possible SIBO treatments in the SSc population.
The following databases were searched: MEDLINE, EMBASE and the Cochrane Library, from database inception to 1 January 2017. All evidence for all possible SIBO treatments including antibiotics, prokinetics, probiotics and alternative treatments was included. Treatment outcomes included symptomatic relief or demonstrated SIBO eradication.
Of 5295 articles, five non-randomized studies were reviewed with a total of 78 SSc patients with SIBO. One trial assessed octreotide while the remaining four trials investigated the effectiveness of ciprofloxacin, rifaximin, norfloxacin and metronidazole, and the combination of amoxicillin, ciprofloxacin and metronidazole. Studies were generally of low quality and most were un-controlled.
Data indicate that, for some SSc patients, antibiotics can eradicate SIBO. There is a paucity of data reporting the effectiveness of either prokinetics or probiotics in SSc.
几乎所有硬皮病患者都有胃肠道表现。小肠细菌过度生长（SIBO）在 30-60%的患者中发生，并导致营养不良和生活质量受损。最近的系统评价报告了 SIBO 治疗的疗效，但这些并不特定于硬皮病患者。我们对硬皮病患者所有可能的 SIBO 治疗方法进行了系统评价。
检索了以下数据库：MEDLINE、EMBASE 和 Cochrane 图书馆，从数据库建立到 2017 年 1 月 1 日。所有可能的 SIBO 治疗方法的证据均包括抗生素、促动力药、益生菌和替代治疗。治疗结果包括症状缓解或证实 SIBO 根除。
在 5295 篇文章中，共审查了 5 项非随机研究，共有 78 例硬皮病合并 SIBO 患者。一项试验评估了奥曲肽，而其余四项试验研究了环丙沙星、利福昔明、诺氟沙星和甲硝唑以及阿莫西林、环丙沙星和甲硝唑联合治疗的有效性。这些研究的质量普遍较低，且大多数为非对照研究。
数据表明，对于某些硬皮病患者，抗生素可以根除 SIBO。促动力药或益生菌在硬皮病中的有效性的数据报告很少。
