Small intestinal bacterial overgrowth in systemic sclerosis.
OBJECTIVE
The aims of this study were to: (i) determine the prevalence of small intestinal bacterial overgrowth (SIBO) in unselected patients with SSc; (ii) assess both clinical presentation and outcome of SIBO; and (iii) make predictions about which SSc patients are at risk for SIBO.


METHODS
Fifty-one consecutive patients with SSc underwent glucose hydrogen and methane (H(2)/CH(4)) breath test. All SSc patients also completed a questionnaire for intestinal symptoms, and a global symptomatic score (GSS) was calculated. SSc patients with SIBO were given rotating courses of antibiotics (norfloxacin/metronidazole) for 3 months; glucose H(2)/CH(4) breath test was performed at 3-month follow-up.


RESULTS
The prevalence of SIBO was 43.1% in our SSc patients. After logistic regression, we identified the following risk factors for SIBO: presence of diarrhoea and constipation. Interestingly, we observed a marked correlation between values of GSS of digestive symptoms (> or =5) and the presence of SIBO (P = 10(-6)); indeed, both sensitivity and specificity of GSS > or =5 to predict SIBO were as high as 0.909 and 0.862, respectively. Finally, eradication of SIBO was obtained in 52.4% of the SSc patients with a significant improvement of intestinal symptoms.


CONCLUSIONS
Our study underscores that SIBO often occurs in SSc patients. We further suggest that GSS may be systematically performed in SSc patients; since we found a correlation between GSS of digestive symptoms > or =5 and SIBO, we suggest that glucose H(2)/CH(4) breath test may be performed in the subgroup of SSc patients exhibiting GSS > or =5.
Marie
Isabelle
I
Department of Internal Medicine, Rouen University Hospital, 76301 Rouen Cedex, France. isabelle.marie@chu-rouen.fr
Ducrotté
Philippe
P
Denis
Philippe
P
Menard
Jean-François
JF
Levesque
Hervé
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001765:Blind Loop Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D001944:Breath Tests / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005769:Gastrointestinal Motility; D006801:Humans; D007421:Intestine, Small / Q000382:microbiology*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000150:complications* / Q000382:microbiology / Q000503:physiopathology; D055815:Young Adult