title: Small bowel bacterial overgrowth in symptomatic older people: can it be diagnosed earlier?
abstract: 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).
authors.affiliation: Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK. david.elphick@nottingham.ac.uk
authors.forename: D A
authors.initials: DA
authors.lastname: Elphick
authors.forename: T S
authors.initials: TS
authors.lastname: Chew
authors.forename: S E
authors.initials: SE
authors.lastname: Higham
authors.forename: N
authors.initials: N
authors.lastname: Bird
authors.forename: A
authors.initials: A
authors.lastname: Ahmad
authors.forename: D S
authors.initials: DS
authors.lastname: Sanders
mesh_terms: 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
chemical_list: D005947:Glucose