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Small Intestinal Bacterial Overgrowth and Orocecal Transit Time in Patients of Inflammatory Bowel Disease

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Abstract

Background

Inflammatory bowel disease (IBD) consists of Ulcerative colitis (UC) and Crohn’s disease (CD). These two conditions share many common features—diarrhea, bloody stools, weight loss, abdominal pain, fever and fatigue. Small intestinal bacterial overgrowth (SIBO) is frequent in patients with CD but it has not been studied in UC Indian patients.

Aim

The study was planned to measure orocecal transit time (OCTT) and SIBO in UC and CD patients.

Methods

One hundred thirty-seven patients of IBD (95 UC and 42 CD) and 115 healthy controls were enrolled. OCTT and SIBO were measured by lactulose and glucose hydrogen breath test respectively. Concentration of hydrogen and methane were measured by SC microlyser from Quintron, USA.

Results

Mean ± standard deviation (SD) of OCTT in patients of IBD was significantly higher as compared to controls. Furthermore, OCTT was significantly higher in CD patients as compared to UC patients. It was also observed that occurrence of SIBO was significantly higher in IBD patients as compared to controls. The occurrence of SIBO in CD (45.2 %) was significantly higher as compared to patients in UC (17.8 %) group. Percentage of methane positive IBD patients (2.9 %) was significantly lower as compared to methane positive controls (24.4 %).

Conclusion

OCTT was significantly delayed in IBD patients as compared to controls and in CD patients as compared to UC patients. OCTT was significantly higher in SIBO positive IBD patients as compared to SIBO negative patients. Thus, we can suggest that delayed OCTT would have been the cause of increased SIBO in these patients.

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References

  1. Kmiec Z. Cytokines in inflammatory bowel disease. Arch Immunol Ther Exp (Warsz). 1998;46:143–155.

    CAS  Google Scholar 

  2. Kathleen A, Jurenka JS. Inflammatory bowel disease part 1: ulcerative colitis pathophysiology and conventional and alternative treatment options. Altern Med Rev. 2003;8:247–283.

    Google Scholar 

  3. Ardizzone S, Bianchi Porro G. Biologic therapy for inflammatory bowel disease. Drugs. 2005;65:2253–2286.

    Article  PubMed  CAS  Google Scholar 

  4. Ardizzone S, Bollani S, Manzionna G, Bianchi Porro G. Inflammatory bowel disease approaching the 3rd millennium: pathogenesis and therapeutic implications? Eur J Gastroenterol Hepatol. 1999;11:27–32.

    Article  PubMed  CAS  Google Scholar 

  5. Fiocchi C. Inflammatory bowel disease: etiology and pathogenesis. Gastroenterology. 1998;115:182–205.

    Article  PubMed  CAS  Google Scholar 

  6. Binion DG, Fiocchi C. Immune modulation-is the environment important? In: McLeod RS, Martin K, Sutherland LR, Wallace JL, Williams CN, eds. Trends in Inflammatory Bowel Disease Therapy. Boston: Kluwer; 1996;39–48.

    Google Scholar 

  7. Sartor RB. Current concepts of the etiology and pathogenesis of ulcerative colitis and Crohn’s disease. Gastroenterol Clin N Am. 1995;24:475–507.

    CAS  Google Scholar 

  8. Hanauer SB. Medical therapy for Crohn’s disease. Curr Opin Gastroenterol. 1999;15:308–314.

    Article  PubMed  CAS  Google Scholar 

  9. Mishkin B, Yalovsky M, Mishkin S. Increased prevalence of lactose malabsorption in Crohn’s disease patients at low risk for lactose malabsorption based on ethnic origin. Am J Gastroentrol. 1997;92:1148–1153.

    CAS  Google Scholar 

  10. Rana SV, Sharma S, Kaur J, Sinha SK, Singh K. Comparison of lactulose and glucose breath test for diagnosis of small intestinal bacterial overgrowth in patients with irritable bowel syndrome. Digestion. 2012;85:243–247.

    Article  PubMed  CAS  Google Scholar 

  11. Toskes PP, Kumar A. Enteric bacterial flora and bacterial overgrowth syndrome. In: Sleisenger NH, Fordtran GS, eds. Gastrointestinal and Liver Disease Philadelphia. Philadelphia: WB Saunders; 1998:1523–1534.

    Google Scholar 

  12. Sellin JH, Hart R. Glucose malabsorption associated with rapid intestinal transit. Am J Gastroenterol. 1992;87:584–589.

    PubMed  CAS  Google Scholar 

  13. Rana SV, Sinha SK, Sikander A, Bhasin DK, Singh K. Study of small intestinal bacterial overgrowth in North Indian patients with irritable bowel syndrome: a case control study. Trop Gastroenterol. 2008;29:23–25.

    PubMed  CAS  Google Scholar 

  14. Pimentel M, Wallace D, Hallegua D, et al. A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing. Ann Rheum Dis. 2004;63:450–452.

    Article  PubMed  CAS  Google Scholar 

  15. Rana SV, Kocchar R, Pal R, Nagi B, Singh K. Orocecal transit time in patients in chronic phase of corrosive injury. Dig Dis Sci. 2008;53:1797–1800.

    Article  PubMed  CAS  Google Scholar 

  16. Rana SV, Sinha SK, Lal S, Sikander S, Singh K. Small intestinal bacterial overgrowth in north Indian patients with celiac disease. Trop Gastroenterol. 2007;28:159–161.

    PubMed  CAS  Google Scholar 

  17. Ghoshal UC, Ghoshal U, Ayyagari A, et al. Tropical sprue is associated with contamination of small bowel with aerobic bacteria and reversible prolongation of orocecal transit time. J Gastroenterol Hepatol. 2003;18:540–547.

    Article  PubMed  Google Scholar 

  18. Ghoshal UC, Ghoshal U, Das K, Misra A. Utility of hydrogen breath tests in diagnosis of small intestinal bacterial overgrowth in malabsorption syndrome and its relationship with oro-cecal transit time. Indian J Gastroenterol. 2006;25:6–10.

    PubMed  Google Scholar 

  19. Pimentel M, Chow EJ, Lin HC. Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol. 2000;95:3503–3506.

    Article  PubMed  CAS  Google Scholar 

  20. Castiglione F, Del Vecchio Blanco G, Rispo A, et al. Orocecal transit time and bacterial overgrowth in patients with Crohn’s disease. J Clin Gastroenterol. 2000;31:63–66.

    Article  PubMed  CAS  Google Scholar 

  21. Ghoshal UC. How to interpret hydrogen breath tests. J Neurogastroenterol Motil. 2011;17:312–317.

    Article  PubMed  Google Scholar 

  22. Jorge JM, Wexner SD, Ehrenpreis ED. The lactulose hydrogen breath test as a measure of orocecal transit time. Eur J Surg. 1994;160:409–416.

    PubMed  CAS  Google Scholar 

  23. Pimentel M, Mayer AG, Park S, Chow EJ, Hasan A, Kong Y. Methane production during lactulose breath test is associated with gastrointestinal disease presentation. Dig Dis Sci. 2003;48:86–92.

    Article  PubMed  Google Scholar 

  24. Bond JH, Levitt MD. Use of pulmonary hydrogen (H2) measurements to quantitate carbohydrate absorption. Study of partially gastrectomized patients. J Clin Invest. 1972;51:1219–1225.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The authors would like to acknowledge the financial support given by the Indian Council of Medical Research (ICMR), New Delhi, no 5/4/3-2/07/NCD II.

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Authors and Affiliations

  1. Department of Super Specialty Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India

    S. V. Rana, S. Sharma, A. Malik, J. Kaur, K. K. Prasad, S. K. Sinha & K. Singh

  2. House No. 137, Sector 15 A, Chandigarh, 160012, India

    S. V. Rana

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  1. S. V. Rana
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  2. S. Sharma
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  3. A. Malik
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  4. J. Kaur
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  5. K. K. Prasad
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  6. S. K. Sinha
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  7. K. Singh
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Correspondence to S. V. Rana.

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Rana, S.V., Sharma, S., Malik, A. et al. Small Intestinal Bacterial Overgrowth and Orocecal Transit Time in Patients of Inflammatory Bowel Disease. Dig Dis Sci 58, 2594–2598 (2013). https://doi.org/10.1007/s10620-013-2694-x

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  • DOI: https://doi.org/10.1007/s10620-013-2694-x

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