Small intestinal bacterial overgrowth in patients suffering from scleroderma: clinical effectiveness of its eradication.
OBJECTIVE
After the skin, the gastrointestinal tract is the second most common target of systemic sclerosis (SSc).


OBJECTIVE
Our aims were to investigate orocecal transit time (OCTT) and the presence of small intestinal bacterial overgrowth (SIBO) in SSc as a cause of intestinal symptoms.


METHODS
Fifty-five SSc patients and 60 healthy controls, sex and age matched, entered the study. Enrolled subjects completed a questionnaire for intestinal symptoms and a global symptomatic score (GSS) was calculated. OCTT and the presence of SIBO were assessed by a lactulose breath test (LBT). Patients with SIBO were treated with rifaximin 1,200 mg/day for 10 days. Finally, a second questionnaire and LBT were performed 1 month after the end of therapy.


RESULTS
The prevalence of SIBO was higher in SSc patients compared with controls (30/54 vs 4/60, respectively, P < 0.001). OCTT was significantly slower in SSc patients compared with controls (150 min, 25-75th percentile 142.5-165 vs 105 min, 25-75th percentile 90-135, respectively, P < 0.001). In patients with SIBO, the median GSS score was 8 (25-75th percentile 3.25-10.75). Eradication of SIBO was achieved in 73.3% of patients, with a significant reduction of symptoms in 72.7% of them (GSS score 2, 25-75th percentile 1-3, P < 0.05).


CONCLUSIONS
These data suggest that SIBO occurs more frequently in SSc patients than in controls. Intestinal symptoms in these patients may be related to this syndrome and its eradication seems useful to improve clinical features. OCTT is significantly delayed in SSc patients, suggesting an impairment of intestinal motility, a further risk factor for the development of SIBO.
Parodi
Andrea
A
Di.M.I. Unit of Gastroenterology, University of Genoa, Genoa, Italy.
Sessarego
Marta
M
Greco
Alfredo
A
Bazzica
Marco
M
Filaci
Gilberto
G
Setti
Maurizio
M
Savarino
Edoardo
E
Indiveri
Francesco
F
Savarino
Vincenzo
V
Ghio
Massimo
M
D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001765:Blind Loop Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D001944:Breath Tests; D003430:Cross-Sectional Studies; D005260:Female; D005772:Gastrointestinal Transit; D006801:Humans; D007421:Intestine, Small; D007792:Lactulose; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012294:Rifamycins / Q000627:therapeutic use; D000078262:Rifaximin; D012595:Scleroderma, Systemic / Q000150:complications* / Q000453:epidemiology; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D012294:Rifamycins; D007792:Lactulose; D000078262:Rifaximin