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Dysmotility and proton pump inhibitor use are independent risk factors for small intestinal bacterial and/or fungal overgrowth
Author(s) -
Jacobs C.,
Coss Adame E.,
Attaluri A.,
Valestin J.,
Rao S. S. C.
Publication year - 2013
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.12304
Subject(s) - small intestinal bacterial overgrowth , gastroenterology , medicine , proton pump inhibitor , antrum , postprandial , enterococcus , stomach , irritable bowel syndrome , microbiology and biotechnology , biology , insulin , antibiotics
Summary Background Whether intestinal dysmotility and the use of a proton pump inhibitor (PPI) either independently or together contributes to small intestinal bacterial overgrowth ( SIBO ), and/or small intestinal fungal overgrowth ( SIFO ) is not known. Aim To investigate the role of dysmotility and PPI use in patients with persistent gastrointestinal complaints. Methods Patients with unexplained gastrointestinal symptoms and negative endoscopy/radiology tests completed a validated symptom questionnaire and underwent 24‐h ambulatory antro‐duodeno‐jejunal manometry (ADJM). Simultaneously, duodenal aspirate was obtained for aerobic, anaerobic and fungal culture. Dysmotility was diagnosed by (>2): absent phase III MMC, absent/diminished postprandial response, diminished amplitude of antral/intestinal phasic activity, impaired antro‐duodenal coordination. Bacterial growth ≥10 3 CFU/mL or fungal growth was considered evidence for SIBO/SIFO. PPI use was documented. Correlation of symptoms with presence of SIBO or SIFO was assessed. Results One hundred and fifty subjects (M/F = 47/103) were evaluated; 94/150 (63%) had overgrowth: 38/94 (40%) had SIBO , 24/94 (26%) had SIFO and 32/94 (34%) had mixed SIBO / SIFO . SIBO was predominately due to Streptococcus, Enterococcus, Klebsiella and E. coli . SIFO was due to Candida . Eighty of 150 (53%) patients had dysmotility and 65/150 (43%) used PPI . PPI use ( P = 0.0063) and dysmotility ( P = 0.0003) were independent significant risk factors ( P < 0.05) for overgrowth, but together did not pose additional risk. Symptom profiles were similar between those with or without SIBO / SIFO . Conclusions Dysmotility and PPI use were independent risk factors for SIBO or SIFO and were present in over 50% of subjects with unexplained gastrointestinal symptoms. Diagnosis of overgrowth requires testing because symptoms were poor predictors of overgrowth.