title: Dysmotility and proton pump inhibitor use are independent risk factors for small intestinal bacterial and/or fungal overgrowth.
abstract: BACKGROUND
  Whether intestinal dysmotility and the use of a proton pump inhibitor (PPI) either independently or together contributes to small intestinal bacterial overgrowth (SIBO), and/or small intestinal fungal overgrowth (SIFO) is not known.
  
  
  OBJECTIVE
  To investigate the role of dysmotility and PPI use in patients with persistent gastrointestinal complaints.
  
  
  METHODS
  Patients with unexplained gastrointestinal symptoms and negative endoscopy/radiology tests completed a validated symptom questionnaire and underwent 24-h ambulatory antro-duodeno-jejunal manometry (ADJM). Simultaneously, duodenal aspirate was obtained for aerobic, anaerobic and fungal culture. Dysmotility was diagnosed by (>2): absent phase III MMC, absent/diminished postprandial response, diminished amplitude of antral/intestinal phasic activity, impaired antro-duodenal coordination. Bacterial growth ≥10³ CFU/mL or fungal growth was considered evidence for SIBO/SIFO. PPI use was documented. Correlation of symptoms with presence of SIBO or SIFO was assessed.
  
  
  RESULTS
  One hundred and fifty subjects (M/F = 47/103) were evaluated; 94/150 (63%) had overgrowth: 38/94 (40%) had SIBO, 24/94 (26%) had SIFO and 32/94 (34%) had mixed SIBO/SIFO. SIBO was predominately due to Streptococcus, Enterococcus, Klebsiella and E. coli. SIFO was due to Candida. Eighty of 150 (53%) patients had dysmotility and 65/150 (43%) used PPI. PPI use (P = 0.0063) and dysmotility (P = 0.0003) were independent significant risk factors (P < 0.05) for overgrowth, but together did not pose additional risk. Symptom profiles were similar between those with or without SIBO/SIFO.
  
  
  CONCLUSIONS
  Dysmotility and PPI use were independent risk factors for SIBO or SIFO and were present in over 50% of subjects with unexplained gastrointestinal symptoms. Diagnosis of overgrowth requires testing because symptoms were poor predictors of overgrowth.
authors.affiliation: Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
authors.forename: C
authors.initials: C
authors.lastname: Jacobs
authors.forename: E
authors.initials: E
authors.lastname: Coss Adame
authors.forename: A
authors.initials: A
authors.lastname: Attaluri
authors.forename: J
authors.initials: J
authors.lastname: Valestin
authors.forename: S S C
authors.initials: SS
authors.lastname: Rao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000382:microbiology*; D003114:Colony-Forming Units Assay; D004751:Enteritis / Q000382:microbiology*; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D005767:Gastrointestinal Diseases / Q000150:complications*; D005769:Gastrointestinal Motility; D006801:Humans; D007421:Intestine, Small / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000382:microbiology*; D054328:Proton Pump Inhibitors / Q000009:adverse effects*; D012307:Risk Factors; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors