Saudi J Gastroenterol文档格式.docx
- 文档编号:20477144
- 上传时间:2023-01-23
- 格式:DOCX
- 页数:8
- 大小:32.94KB
Saudi J Gastroenterol文档格式.docx
《Saudi J Gastroenterol文档格式.docx》由会员分享,可在线阅读,更多相关《Saudi J Gastroenterol文档格式.docx(8页珍藏版)》请在冰豆网上搜索。
371–375.
SmallIntestinalBacterialOvergrowthandLactoseIntoleranceContributetoIrritableBowelSyndromeSymptomatologyinPakistan
JavedYakoob,
ZaighamAbbas,
RustamKhan,
SaeedHamid,
SafiaAwan,
and
WasimJafri
Abstract
Background/Aim:
Thesymptomsofirritablebowelsyndromeresemblethoseofsmallintestinalbacterialovergrowth(SIBO).TheaimofthisstudywastodeterminethefrequencyofSIBOandlactoseintolerance(LI)occurrenceinpatientswithdiarrhea-predominantirritablebowelsyndrome(IBS-D)accordingtoRomeIIIcriteria.
PatientsandMethods:
Inthisretrospectivecase-controlstudy,patientsover18yearsofagewithalteredbowelhabit,bloating,andpatientswhohadlactoseHydrogenbreathtest(H2BT)donewereincluded.The“cases”weredefinedaspatientswhofulfillRomeIIIcriteriaforIBS-D,while“controls”werethosehavingchronicnonspecificdiarrhea(CNSD)whodidnotfulfillRomeIIIcriteriaforIBS-D.Demographicdata,predominantbowelhabitpattern,concurrentuseofmedications,etc.,werenoted.
Results:
PatientswithIBS-Dwere119(51%)withameanageof35±
13years,whilethosewithCNSDwere115(49%)withmeanage36±
15years.PatientsinbothIBS-DandCNSDwerecomparableingender,withmale87(74%)andfemale77(64%).SIBOwasdocumentedbylactoseH2BTin32/234(14%)cases.Itwaspositivein22/119(19%)caseswithIBS-D,while10/115(9%)caseshadCNSD(P
=0.03).LIwaspositivein43/234(18%)cases.Ofthese,25/119(21%)caseshadIBS-Dand18/115(16%)caseshadCNSD(P
=0.29).
Conclusion:
SIBOwasseeninasignificantnumberofourpatientswithIBS-D.TherewasnosignificantageorgenderdifferenceinpatientswithorwithoutSIBO.
Keywords:
Hydrogenbreathtest,IBS-diarrhea,lactoseintolerance,RomeIIIcriteria,smallintestinalbacterialovergrowth,youngage
Irritablebowelsyndrome(IBS)isthemostcommonlydiagnosedchronicfunctionalgastrointestinaldisorderworldwideincludingAsia.[1,2]IBSaffectsfemalesapproximatelytwiceasoftenasmalesandismostfrequentlydiagnosedinindividualsbetweentheagesof30and50years.[1,2]However,thereisalackoffemaledominanceinAsianstudies.[3]SymptomsofIBScansubstantiallyimpactpatients’qualityoflife,andtheeffectofIBSonphysicalandpsychologicalhealthcannegativelyimpacttheworkplace.[4–6]TheeconomicburdenofIBSissubstantialandincludesdirectphysicians’costsaswellasindirectcostsintermsofemployeeabsenteeism.IBSischaracterizedbyabdominaldiscomfortassociatedwithalteredbowelhabitsincludingconstipation,diarrhea,oralternatingperiodsofconstipationanddiarrhea.
Anemerginghypothesissuggeststhatsmallintestinalbacterialovergrowth(SIBO)maycontributetoIBSpathophysiology.[7]SIBOisaconditioncharacterizedbyabnormallyhighbacterialcount(≥105colony-formingunits/ml)intheproximalsmallintestine,resemblingdistributionofbacterianormallyfoundinthecolon.[8,9]SymptomsofSIBOincludeabdominalpain,bloating,flatulence,anddiarrhea,similartothoseobservedinpatientswithIBS.[10,11]SIBOwasdetectedin17to84%ofpatientswhometRomeIorRomeII[12–16]criteriaforIBSusingHydrogenbreathtesting(H2BT)withglucoseorlactulose.Furthermore,treatmentwithantibioticscanreduceoreradicateSIBO[16–21]andimprovesymptomsofIBS[22,23]whichsupportstheroleofSIBOinIBS.AsdiagnosisofIBSisbasedonacombinationofsymptomsthatarealsocommoninpatientswithmalabsorptiondisorders,itispossiblethatsomeofthesepatientsmaybemisdiagnosedasIBS,particularlyifspecifictestsarenotperformed.[7]ThiswassupportedbythereportsofdiagnosisofceliacdiseaseinpatientspresentingasIBS.[19–21]AsH2BTissimplertoadminister,ismorecost-effective,anddoesnotexposethepatienttoradiation,ithasbecomethenoninvasivegoldstandardinthediagnosisofSIBO.Previously,SIBOinIBSwasshowntobeassociatedwithpositivelactoseH2BT.[15]Inastudyof98consecutiveIBSpatients,apositivelactulosebreathtestwasfoundin64of98(65%)subjects;
theseSIBOpatientsshowedasignificantlyhigherprevalenceofpositivitytothelactosebreathtest(P<
0.05).[15]ClinicalstudiesevaluatingcharacteristicsassociatedwithSIBOinpatientswithIBS-diarrhea(IBS-D)accordingtoRomeIIIcriteriaarelacking.Therefore,thepurposeofthisstudywastodeterminethefrequencyofSIBOandlactoseintolerance(LI)occurrenceinpatientswithIBS-DaccordingtoRomeIIIcriteriaanddeterminethepredictorsofSIBOinthesepatients.
Goto:
PATIENTSANDMETHODS
Patients
Inthisretrospectivecase-controlledstudy,themedicalrecordsofpatientsover18yearsofagewhoattendedgastroenterologyclinicsupervisedbytheinvestigatorsattheUniversityHospitalwithalteredbowelhabitandbloating,wereincluded.TheyhadlactoseH2BTdonebetweenJanuary2007andOctober2010.TheEthicsReviewCommitteeattheUniversityapprovedthestudy.The“cases”had,overthepastthreemonthsormore,atleastthreebowelmovementsperdaydescribedaslooseorwaterystoolsassociatedwithurgency,andfulfilledtheRomeIIIcriteriaforIBS-D,[2]while“controls”werethosehavingchronicnonspecificdiarrhea(CNSD)definedasabdominalpainordiscomfortassociatedwithintermittentdiarrheawithmorethan3stoolsadayforatleast4weeksandlessthan12weeksanddidnotfulfillRomeIIIcriteriaforIBS-D.[24]Demographicdata,predominantbowelhabitpattern,andconcurrentuseofmedicationswerenoted.Thesepatientsunderwentthoroughhistory,physicalexamination,completebloodcount,serumcreatinine,electrolytes,andstoolmicroscopy.Allthepatientshadcolonoscopywithrectalbiopsytoexcludeinflammatoryboweldiseaseandmicroscopiccolitis.Exclusioncriteriawereconcurrentuseofopiatesanalgesics,prokineticdrugs,andPPI,havinginfectionwith
Giardialamblia,Entamebahistolytica,Blastocystishominis,positiveserologyforceliacdiseaseasdeterminedbytissuetransglutaminaseantibody-IgAandtransglutaminaseantibody-IgGandabnormalthyroidactivityassuggestedbyserumthyroxinandthyroid-stimulatinghormonelevel.PatientswithpredisposingconditionsforSIBO,e.g.,priorsmallintestinalsurgery,scleroderma,diabetesmellitus,livercirrhosis,formsofautonomicneuropathy,historyofpepticulcerandtherapywithH2antagonists/PPIsduringthepreceding8weeks,hypothyroidism,intestinalpseudo-obstruction,colonoscopywithinaweekbeforeH2BT,anddrugsknowntointerferewithgastrointestinalmotility,e.g.,anticholinergicsandantidepressantswerealsoexcluded.
Hydrogenbreathtest
AllpatientsunderwentalactoseH2BTatthebeginningofthestudy.ImmediatelybeforetheH2BT,patientsusedamouthwashcontaining40mlof1%chlorhexidine.TheH2BTwasdonewithpatientfastingovernightfor12hours.Patientswereaskedtorefrainfromsmokingafterthelastmealtilltheendofthetestandfromexercise30minutesbeforeandduringthetest.Antibioticswerestopped4weeksbeforeadministeringtheSIBObreathtest.Patientsalsoavoidedlaxatives,stoolsofteners,orstoolbulkingagentsoneweekpriortothetest.Foodwithhighfibercontent,e.g.,beans,pasta,meats,fiberorbrancereals,coladrinks,butter,ormargarine,wasavoided24hourspriortothetest.Samplesofexpiredairwerecollected.Fivesampleswerecollectedincludingonefastingsample(0minute)afterthedoseof50glactoseforadult,andfoursamplesat30,60,90,and120minutesinterval.Expiratorybreathsamplesobtainedwereanalyzedimmediatelyaftercollection,usingacommercialdevice(GaSampler;
QuinTronInstrumentCompany,Milwaukee,Wisconsin).Gaschromatography(ModelDP;
QuinTronInstrumentCompany,Milwaukee,Wisconsin)wasemployedtomeasuretheconcentrationinpartspermillion(ppm)ofhydrogenintheair.ThediagnosticcriteriaforapositiveSIBOwasariseabovebaselineof20ppmin30or60-minutebreathsample,whileisolatedpositivebreathtestat90or120-minutesamplescorrespondingtothepassageoflactoseintothecolonwastakenasLIratherthanSIBO.[23,24]Definitionsofnormalandabnormalresultsofbreathtestsarevariableandthereisalackofgenerallyaccepteddefinitions.ThesensitivityandspecificityofthelactuloseH2BTindetectingSIBOhasbeenreportedtobeonly68%and44%,respectively.[25]However,sensitivityingeneralisacceptable,becauseofthelowspecificityfordiagnosingSIBOcomparedwithjejunalcultures.[26]
Samplesize
ThesoftwareEPIInfowasutilisedforsamplesizeestimation.Assuminga30%prevalenceofSIBOinIBS-Dand8%inCNSD,[27]atwo-sidedalphaof0.05andoddsratioof2withan80%powertodetectadifference,therequiredsamplesizeforthisobjectivewas115forthecasesand115forcontrol.
Statisticalmethod
Resultswereexpressedasmean±
standarddeviationforcontinuousvariables(e.g.,age)andnumber(percentage)forcategoricaldata(e.g.,gender,diarrhea,etc.).ComparisonofIBS-DpatientsandCNSDpatientswithothercovariateslikeage,gender,hydrogentest,hemoglobin,andserologyofceliacdiseasewasdonebyusingtheindependentsample
t-test,PearsonChi-squaretest,andFisherExacttestwhereappropriate.ThepatientswerefurtherdividedintoSIBOpositiveandSIBOnegativeandacomparisonwasdonewithothercovariates.A
P
valueof<
0.05wasconsideredasstatisticallysignificant.All
valuesweretwosided.StatisticalinterpretationofdatawasperformedbyusingthecomputerizedsoftwareprogramSPSSversion17.0.
RESULTS
PatientswithIBS-D(119,51%)hadameanageof35±
13yearsandmale:
fema
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- Saudi Gastroenterol