title: Small intestinal bacterial overgrowth in patients with lower gastrointestinal symptoms and a history of previous abdominal surgery.
abstract: BACKGROUND
  The small intestinal bacterial overgrowth (SIBO) breath test has had positive results in 84% of patients with irritable bowel syndrome vs 20% of controls. We hypothesized that SIBO would be more prevalent in patients with symptoms consistent with irritable bowel syndrome who have undergone previous abdominal surgery.
  
  
  OBJECTIVE
  To identify causative factors for SIBO.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Tertiary colorectal surgery clinic.
  
  
  METHODS
  Result of SIBO breath test.
  
  
  RESULTS
  We identified 77 patients whose differential diagnosis included SIBO from January 1, 2005, to December 31, 2007; 18 were excluded because of noncompliance with testing and 2 because of a decision to treat SIBO without formal testing. Symptoms were chronic abdominal pain in 30 patients (53%), bloating in 25 (44%), constipation in 37 (65%), and diarrhea in 7 (12%). Mean (SD) symptom duration was 45 (22) months. Of the 57 patients enrolled in this study, 45 (79%) tested positive for SIBO and 37 (82%) of those had a history of surgery, whereas 12 (21%) tested negative for SIBO and 9 (75%) of those had a history of surgery. Of the 36 SIBO-positive patients with a history of abdominal surgery (mean number of procedures, 2), the surgery locations were as follows: female reproductive organs, 23 (64%); hindgut, 15 (42%); foregut, 8 (22%); and midgut, 6 (17%). Open surgery alone was performed in 32 patients (56%) vs laparoscopic surgery in 7 (12%). Both open and laparoscopic procedures had been performed in 6 patients (11%). Four patients (7%) had a history of small intestinal obstruction. The mean age of SIBO-positive patients was higher than that of SIBO-negative patients (57 vs 44 years; P < .01). Analysis did not reveal any clinically significant independent factor associated with SIBO.
  
  
  CONCLUSIONS
  Physicians should consider SIBO in the differential diagnosis of patients with normal anatomic findings and chronic lower gastrointestinal complaints.
authors.affiliation: Huntington Medical Research Institutes, 10 Pico St, Pasadena, CA 91105, USA.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Petrone
authors.forename: Grant
authors.initials: G
authors.lastname: Sarkisyan
authors.forename: Maura
authors.initials: M
authors.lastname: Fernández
authors.forename: Eileen
authors.initials: E
authors.lastname: Coloma
authors.forename: Gabriel
authors.initials: G
authors.lastname: Akopian
authors.forename: Adrian
authors.initials: A
authors.lastname: Ortega
authors.forename: Howard S
authors.initials: HS
authors.lastname: Kaufman
mesh_terms: D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001419:Bacteria / Q000378:metabolism*; D001944:Breath Tests / Q000379:methods; D003937:Diagnosis, Differential; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D041981:Gastrointestinal Tract / Q000473:pathology; D006090:Gram-Negative Bacteria; D016480:Helicobacter pylori; D006801:Humans; D006859:Hydrogen / Q000378:metabolism*; D006863:Hydrogen-Ion Concentration; D007421:Intestine, Small / Q000382:microbiology*; D043183:Irritable Bowel Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D016015:Logistic Models; D008297:Male; D008697:Methane / Q000378:metabolism*; D008875:Middle Aged; D012107:Research Design; D012189:Retrospective Studies; D012294:Rifamycins; D000078262:Rifaximin; D018401:Sample Size
chemical_list: D000890:Anti-Infective Agents; D005765:Gastrointestinal Agents; D012294:Rifamycins; D006859:Hydrogen; D000078262:Rifaximin; D008697:Methane