Small intestinal bacterial overgrowth mimicking acute flare as a pitfall in patients with Crohn's Disease.
BACKGROUND
Small intestinal bacterial overgrowth (SIBO) is characterized by excessive proliferation of colonic bacterial species in the small bowel. Potential causes of SIBO include fistulae, strictures or motility disturbances. Hence, patients with Crohn's Disease (CD) are especially predisposed to develop SIBO. As result, CD patients may experience malabsorption and report symptoms such as weight loss, watery diarrhea, meteorism, flatulence and abdominal pain, mimicking acute flare in these patients.


METHODS
One-hundred-fifty patients with CD reporting increased stool frequency, meteorism and/or abdominal pain were prospectively evaluated for SIBO with the Hydrogen Glucose Breath Test (HGBT).


RESULTS
Thirty-eight patients (25.3%) were diagnosed with SIBO based on positive findings at HGBT. SIBO patients reported a higher rate of abdominal complaints and exhibited increased stool frequency (5.9 vs. 3.7 bowel movements/day, p = 0.003) and lower body weight (63.6 vs 70.4 kg, p = 0.014). There was no correlation with the Crohn's Disease Activity Index. SIBO was significantly more frequent in patients with partial resection of the colon or multiple intestinal surgeries; there was also a clear trend in patients with ileocecal resection that did not reach statistical significance. SIBO rate was also higher in patients with affection of both the colon and small bowel, while inflammation of the (neo)terminal ileum again showed only tendential association with the development of SIBO.


CONCLUSIONS
SIBO represents a frequently ignored yet clinically relevant complication in CD, often mimicking acute flare. Because symptoms of SIBO are often difficult to differentiate from those caused by the underlying disease, targeted work-up is recommended in patients with corresponding clinical signs and predisposing factors.
Klaus
Jochen
J
University Medical Center Ulm, Center for Internal Medicine, Department of Internal Medicine I, Germany. jochen.klaus@uniklinik-ulm.de
Spaniol
Ulrike
U
Adler
Guido
G
Mason
Richard A
RA
Reinshagen
Max
M
von Tirpitz C
Christian
C
D015746:Abdominal Pain / Q000209:etiology / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D001765:Blind Loop Syndrome / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D001944:Breath Tests; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D003672:Defecation / Q000502:physiology; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000382:microbiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D055815:Young Adult