Prevalence and predictors of small intestinal bacterial overgrowth in systemic sclerosis patients with gastrointestinal symptoms.
OBJECTIVE
There is a paucity of data available on small intestinal bacterial overgrowth (SIBO) in systemic sclerosis (SSc). The objectives of the study were to estimate the prevalence of SIBO in SSc patients exhibiting intestinal symptoms and identify patients at risk of SIBO regarding clinical and biological presentations and gastrointestinal symptoms captured by standardized questionnaires.


METHODS
Between 2011 and 2012, patients exhibiting intestinal complaints underwent glucose H2/CH4 breath tests (BT) and blood assays. They were interviewed using the University of California Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract Instrument 2.0 (UCLA SCTC GTI) and the Short Form-36 (SF-36). For patients diagnosed with SIBO, BT was repeated 1 to 4 months after the end of antibiotics.


RESULTS
Among 120 consecutive patients, 37 patients (29 women) exhibiting intestinal complaints were included (median age: 60 years). Fourteen patients (38%) were diagnosed with SIBO; patients from this subset had a longer disease duration (p=0.02), a significant weight loss within the past 6 months (p=0.03) and a higher total UCLA SCTC GTI score (p=0.03). The SF-36 assessment was not discriminant. Among the 14 patients treated for SIBO, 6 had a negative control BT, 4 remained positive, 2 failed to repeat the test and 2 patients died due to severe chronic malabsorption.


CONCLUSIONS
SIBO is a not uncommon, late onset, severe and not easy to treat complication of SSc. Higher UCLA SCTC GTI score and weight loss appeared to be strongly associated with SIBO.
Rheumatology A Department, Cochin Hospital, University Paris Descartes, Inserm U1016 and APHP, Paris, France. tauberma@gmail.com.
M
M
Tauber
J
J
Avouac
A
A
Benahmed
L
L
Barbot
B
B
Coustet
A
A
Kahan
Y
Y
Allanore
D015746:Abdominal Pain / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000453:epidemiology*; D001944:Breath Tests; D003248:Constipation / Q000453:epidemiology; D003903:Deuterium / Q000032:analysis; D003967:Diarrhea / Q000453:epidemiology; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology*; D006801:Humans; D007421:Intestine, Small / Q000382:microbiology*; D008297:Male; D008697:Methane / Q000032:analysis; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000453:epidemiology*; D013997:Time Factors; D015431:Weight Loss
D003903:Deuterium; D008697:Methane