Small bowel bacterial overgrowth in symptomatic older people: can it be diagnosed earlier?
OBJECTIVE
In older people, small bowel bacterial overgrowth syndrome may be a common, but under-diagnosed, cause of diarrhoea and nutrient malabsorption. We aim to determine which clinical features and baseline laboratory investigations indicate a high likelihood of small bowel bacterial overgrowth as defined by a positive glucose breath test.


METHODS
A retrospective analysis of records for all patients referred for glucose breath test over a 6-year period to a teaching hospital.


RESULTS
Out of 197 referrals, 168 patient records were located and analysed (62 male, 106 female; median age 65). Patient characteristics predictive of a positive glucose breath test were: increasing age (p < 0.01), low serum vitamin B12 (p = 0.02), low serum albumin (p = 0.03), previous partial gastrectomy (p < 0.01), previous right hemi-colectomy (p < 0.01), presence of small bowel diverticulae (p = 0.01) and concurrent use of a proton pump inhibitor (p < 0.01). 52.5% (n = 21/40) of patients studied who were over 75 years old versus 21.8% (n = 28/128) of those under 75 years old had a positive glucose breath test (p < 0.01). The median time to diagnosis, from first hospital visit to positive glucose breath test, was 39 weeks.


CONCLUSIONS
There is often a significant delay in diagnosis of small bowel bacterial overgrowth. We suggest that this diagnosis should be considered earlier in the investigative algorithm in older patients with indicative symptoms and a predisposing factor (including previous partial gastrectomy, previous right hemi-colectomy, small bowel diverticulae or use of a proton pump inhibitor) or concurring laboratory indices (low vitamin B12 or albumin).
Elphick
D A
DA
Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK. david.elphick@nottingham.ac.uk
Chew
T S
TS
Higham
S E
SE
Bird
N
N
Ahmad
A
A
Sanders
D S
DS
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001765:Blind Loop Syndrome / Q000175:diagnosis*; D001944:Breath Tests; D005260:Female; D005947:Glucose; D006801:Humans; D007421:Intestine, Small / Q000382:microbiology; D008297:Male; D008875:Middle Aged
D005947:Glucose