Small intestinal bacterial overgrowth recurrence after antibiotic therapy.
OBJECTIVE
Current treatment for small intestinal bacterial overgrowth (SIBO) is based on courses of broad-spectrum antibiotics. No data concerning SIBO recurrence are available. The aims of the present study were to investigate SIBO recurrence as assessed by glucose breath test (GBT) after antibiotic treatment and conditions associated to SIBO recurrence.


METHODS
Eighty consecutive patients affected by SIBO and decontaminated by rifaximin (1,200 mg per day for 1 wk) were enrolled. Diagnosis of SIBO was based on GBT. GBT was reassessed at 3, 6, and 9 months after evidence of GBT normalization. GBT positivity recurrence, predisposing conditions, and gastrointestinal symptoms were evaluated.


RESULTS
Ten (10/80, 12.6%), 22 (22/80, 27.5%), and 35 (35/80, 43.7%) patients showed positivity to GBT at 3, 6, and 9 months after successful antibiotic treatment, respectively. At multivariate analysis, older age (OR 1.09, 95% CI 1.02-1.16), history of appendectomy (OR 5.9, 95% CI 1.45-24.19), and chronic use of proton pump inhibitors (PPIs) (OR 3.52, 95% CI 1.07-11.64) were significantly associated to GBT positivity recurrence. All gastrointestinal symptoms significantly increased at 3, 6, and 9 months in patients with evidence of GBT positivity recurrence.


CONCLUSIONS
GBT positivity recurrence rate was high after antibiotic treatment. Older age, history of appendectomy, and chronic use of PPIs were associated with GBT positivity recurrence. Patients with evidence of GBT positivity recurrence showed gastrointestinal symptoms relapse thus suggesting SIBO recurrence.
Lauritano
Ernesto C
EC
Internal Medicine Department, Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy.
Gabrielli
Maurizio
M
Scarpellini
Emidio
E
Lupascu
Andrea
A
Novi
Marialuisa
M
Sottili
Sandra
S
Vitale
Giovanna
G
Cesario
Valentina
V
Serricchio
Michele
M
Cammarota
Giovanni
G
Gasbarrini
Giovanni
G
Gasbarrini
Antonio
A
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001765:Blind Loop Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D001944:Breath Tests; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012294:Rifamycins / Q000627:therapeutic use*; D000078262:Rifaximin; D012307:Risk Factors; D013997:Time Factors
D000900:Anti-Bacterial Agents; D012294:Rifamycins; D000078262:Rifaximin