title: Glucose breath test and Crohn's disease: Diagnosis of small intestinal bacterial overgrowth and evaluation of therapeutic response.
abstract: OBJECTIVE
  Small intestinal bacterial overgrowth (SIBO) is characterized by an abnormal proliferation of bacterial species in the small bowel. It has been shown that patients with Crohn's disease (CD) have a higher risk of SIBO development. The aim of the present study was to investigate SIBO prevalence in CD patients, possible clinical predictors of SIBO development and response to antibiotic therapy.
  
  
  METHODS
  Sixty-eight patients (42 male, 26 female; mean age 49.3 ± 12.8 years) with CD reporting abdominal complaints were prospectively evaluated for SIBO with H2/CH4 glucose breath test (GBT).
  
  
  RESULTS
  Of the 68 patients enrolled, 18 (26.5%) tested positive for SIBO. Patients with SIBO exhibited increased stool frequency and significant reduction of stool solidity (p = 0.014), were older than patients tested negative to GBT (54.3 ± 13.0 years vs. 47.5 ± 12.3 years, p = 0.049), reported a longer history of CD (21.2 ± 10.3 years vs. 15.7 ± 10.2 years, p = 0.031) and showed a significant higher frequency of prior surgery (p = 0.001), revealing an association of number of surgical procedures (OR = 2.8315, 95% CI = 1.1525-6.9569, p = 0.023) with SIBO. Breath test normalization occurred in 13/15 patients evaluated after antibiotic and probiotic therapy. Although vitamin B12 levels were lower in patients with SIBO (p = 0.045) and a significant improvement was found after treatment (p = 0.011), this could be due to the heterogeneity, regarding vitamin B12 treatment, in our cohort.
  
  
  CONCLUSIONS
  SIBO is a frequent but underestimated condition in CD, which often mimics acute flare, effectively identified with GBT and could be treated with a combined antibiotic and probiotic therapy.
authors.affiliation: Department of Gastroenterology and Hepatology, Città della Salute e della Scienza Hospital , Turin , Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Greco
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Caviglia
authors.forename: Paola
authors.initials: P
authors.lastname: Brignolo
authors.forename: Davide Giuseppe
authors.initials: DG
authors.lastname: Ribaldone
authors.forename: Stefania
authors.initials: S
authors.lastname: Reggiani
authors.forename: Carlo
authors.initials: C
authors.lastname: Sguazzini
authors.forename: Antonina
authors.initials: A
authors.lastname: Smedile
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Pellicano
authors.forename: Andrea
authors.initials: A
authors.lastname: Resegotti
authors.forename: Marco
authors.initials: M
authors.lastname: Astegiano
authors.forename: Francesca
authors.initials: F
authors.lastname: Bresso
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy*; D001944:Breath Tests; D003424:Crohn Disease / Q000150:complications* / Q000382:microbiology*; D005243:Feces; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000382:microbiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019936:Probiotics / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents
keywords: Crohn’s disease; glucose breath test; small intestinal bacterial overgrowth