Original article—alimentary tractIncreased Incidence of Small Intestinal Bacterial Overgrowth During Proton Pump Inhibitor Therapy
Section snippets
Patients
Between January 2006 and September 2008, 450 consecutive subjects were enrolled in 3 different groups. In group 1 were 200 patients affected by gastroesophageal reflux disease and using PPIs for at least 2 months. Group 2 had 200 patients with IBS (Rome III diagnostic criteria) in absence of PPI treatment for at least 3 years. The rationale for using IBS as “pathologic” control (PC) stands on the large prevalence of SIBO in IBS patients and the overlapping of symptoms between the 2 clinical
Demographics
Overall 450 subjects were evaluated in this study:
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200 patients with gastroesophageal reflux disease using PPIs (esoprazole 35%, lansoprazole 30%, omeprazole 15%, rabeprazole 10%, pantoprazole 10%): mean age 39 ± 19 years; 120 male, with a median duration of PPI treatment of 36 months (range, 2 months to 7 years), at standard dosage for at least 3 fourths of the considered time. At the observation time 68% of them were H. pylori negative.
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200 patients with IBS (40% diarrhea, 40% constipation, 20%
Discussion
The gold standard for the diagnosis of SIBO is yet to be defined, as direct tests of culture have substantial limitations for accessibility and performance difficulties.5 Hydrogen breath tests are indirect diagnostic methods based on the fact that detection of hydrogen in expired breath is considered a measure of the metabolic acivity of enteric bacteria because mammalian tissues do not generate hydrogen. They are noninvasive, easy to perform, sensitive enough, and highly specific for SIBO
Acknowledgments
This work was partially presented, as an oral comunication, at the Digestive Disease Week, AGA Institute, 2009, Chicago, Illinois.
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Conflicts of interest The authors disclose no conflicts.