title: Small Intestinal Bacterial Overgrowth in Patients with Refractory Functional Gastrointestinal Disorders.
abstract: OBJECTIVE
  Small intestinal bacterial overgrowth (SIBO) is considered to be involved in the pathogenesis of functional gastrointestinal disorders (FGID). However, the prevalence and clinical conditions of SIBO in patients with FGID remain to be fully elucidated. Here, we examined the frequency of SIBO in patients with refractory FGID.
  
  
  METHODS
  We prospectively enrolled patients with refractory FGID based on Rome III criteria. A glucose hydrogen breath test (GHBT) was performed using a gas analyzer after an overnight fast, with breath hydrogen concentration measured at baseline and every 15 minutes after administration of glucose for a total of 3 hours. A peak hydrogen value ≥ 10 ppm above the basal value between 60 and 120 minutes after administration of glucose was diagnosed as SIBO.
  
  
  RESULTS
  A total of 38 FGID patients, including 11 with functional dyspepsia (FD), 10 with irritable bowel syndrome (IBS), and 17 with overlapping with FD and IBS, were enrolled. Of those, 2 (5.3%) were diagnosed with SIBO (one patient diagnosed with FD; the other with overlapping FD and IBS). Their symptoms were clearly improved and breath hydrogen levels decreased to normal following levofloxacin administration for 7 days.
  
  
  CONCLUSIONS
  Two patients initially diagnosed with FD and IBS were also diagnosed with SIBO as assessed by GHBT. Although the frequency of SIBO is low among patients with FGID, it may be important to be aware of SIBO as differential diagnosis when examining patients with refractory gastrointestinal symptoms, especially bloating, as a part of routine clinical care.
authors.affiliation: Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Shimane, Japan.
authors.forename: Shino
authors.initials: S
authors.lastname: Shimura
authors.affiliation: Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Shimane, Japan.
authors.forename: Norihisa
authors.initials: N
authors.lastname: Ishimura
authors.affiliation: Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Shimane, Japan.
authors.forename: Hironobu
authors.initials: H
authors.lastname: Mikami
authors.affiliation: Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Shimane, Japan.
authors.forename: Eiko
authors.initials: E
authors.lastname: Okimoto
authors.affiliation: Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Shimane, Japan.
authors.forename: Goichi
authors.initials: G
authors.lastname: Uno
authors.affiliation: Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Shimane, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Tamagawa
authors.affiliation: Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Shimane, Japan.
authors.forename: Masahito
authors.initials: M
authors.lastname: Aimi
authors.affiliation: Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Shimane, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Oshima
authors.affiliation: Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Shimane, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Sato
authors.affiliation: Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Shimane, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Ishihara
authors.affiliation: Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Shimane, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Kinoshita
keywords: Adult; Bacterial overgrowth syndrome; Blind loop syndrome; Breath tests; Dyspepsia