title: The impact of alcohol consumption and cholecystectomy on small intestinal bacterial overgrowth.
abstract: BACKGROUND
  The etiology of small intestinal bacterial overgrowth (SIBO) is diverse and frequently multi-factorial. SIBO is thought to result from structural changes of the gastrointestinal tract, disordered peristalsis of the stomach and/or small intestine, or a disruption of the normal mucosal defenses of the small intestine. Alcoholics are reported to have higher rates of SIBO, as diagnosed by jejunal aspirate; however, no data are available on the association between moderate alcohol consumption and SIBO.
  
  
  OBJECTIVE
  To evaluate the association between moderate alcohol consumption and SIBO and identify risk factors for SIBO using the lactulose breath test (LBT).
  
  
  METHODS
  A retrospective chart review was completed for 210 consecutive patients who underwent the LBT between 2008 and 2010. We reviewed demographic data, including age, race, body mass index, alcohol and tobacco history, medication use, comorbid medical conditions, and history of abdominal surgery.
  
  
  RESULTS
  The study included 196 patients (68 % female; mean age 55 years), 93 of whom had a positive LBT (47.4 %). Of those patients who consumed a moderate amount of alcohol, 58 % had a positive LBT, compared to 38.9 % of abstainers (P = 0.008). Those with a history of cholecystectomy had significantly lower rates of a positive LBT than those who had not (33.3 vs. 51.7 % respectively; P = 0.031). Neither proton pump inhibitor (PPI) use nor tobacco use was associated with a positive LBT.
  
  
  CONCLUSIONS
  In this retrospective review, moderate alcohol consumption was a strong risk factor for SIBO. Cholecystectomy appeared to be protective against SIBO. Neither PPI use nor tobacco use was associated with an increased risk of SIBO.
authors: Department of Gastroenterology and Hepatology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA, gabbars@ccf.org.
authors: Scott L
authors: SL
authors: Gabbard
authors: Brian E
authors: BE
authors: Lacy
authors: Gary M
authors: GM
authors: Levine
authors: Michael D
authors: MD
authors: Crowell
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects*; D001062:Appendectomy; D015415:Biomarkers / Q000378:metabolism; D001944:Breath Tests; D016022:Case-Control Studies; D002763:Cholecystectomy; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000382:microbiology*; D007792:Lactulose / Q000378:metabolism; D016014:Linear Models; D016015:Logistic Models; D008286:Malabsorption Syndromes / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D007792:Lactulose