title: Small-Intestinal Bacterial Overgrowth is Associated With Concurrent Intestinal Inflammation But Not With Systemic Inflammation in Crohn's Disease Patients.
abstract: We studied the prevalence and predictors of small-intestinal bacterial overgrowth (SIBO) in Crohn's disease (CD) outpatients and the relationship between SIBO and intestinal and/or systemic inflammation.
  
  
  
  The relationship of SIBO with systemic and intestinal inflammation in CD patients is unclear.
  
  
  
  In this cross-sectional study, conducted between June, 2013 and January, 2015, 92 CD patients and 97 controls with nonchronic gastrointestinal complaints were assessed for the presence of SIBO using the H2/CH4 glucose breath test. Multivariate logistic regression was performed to investigate the potential association between SIBO and demographic, disease-related data, systemic markers of inflammation (C-reactive protein, and erythrocyte sedimentation rate), and biomarker of intestinal inflammation [fecal calprotectin concentration (FCC)].
  
  
  
  The SIBO rate was significantly higher in CD patients than in controls (32.6% vs. 12.4%, respectively, P=0.0008). Patients with and without SIBO were comparable with regard to demographics, systemic inflammatory biomarkers, and disease characteristics, except for the stricturing phenotype being more common in SIBO-positive CD patients (43.3% vs. 19.3%, P=0.015). Notably, FCC was significantly higher in SIBO-positive patients (median of 485.8 vs.132.7 μg/g; P=0.004). Patients presenting increased FCC and stricturing disease had an odds of 9.43 (95% confidence interval, 3.04-11.31; P<0.0001) and 3.83 (95% confidence interval, 1.54-6.75; P=0.025) respectively, for SIBO diagnosis.
  
  
  
  In CD patients, SIBO is a highly prevalent condition. Stricturing phenotype and increased FCC were strongly and independently associated with the presence of SIBO. SIBO diagnostic work-up followed by directed treatment is recommended in CD patients who present stricturing disease, especially in those with concurrent intestinal inflammation.
authors.affiliation: Department of Medicine, Inflammatory Bowel Diseases Center, Division of Gastroenterology, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine.
authors.forename: José E R
authors.initials: JER
authors.lastname: Ricci
authors.affiliation: Department of Medicine, Inflammatory Bowel Diseases Center, Division of Gastroenterology, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine.
authors.forename: Liliana A
authors.initials: LA
authors.lastname: Chebli
authors.affiliation: Department of Medicine, Inflammatory Bowel Diseases Center, Division of Gastroenterology, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine.
authors.forename: Tarsila C D R
authors.initials: TCDR
authors.lastname: Ribeiro
authors.affiliation: Department of Medicine, Inflammatory Bowel Diseases Center, Division of Gastroenterology, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine.
authors.forename: Antonio C S
authors.initials: ACS
authors.lastname: Castro
authors.affiliation: Department of Medicine, Inflammatory Bowel Diseases Center, Division of Gastroenterology, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine.
authors.forename: Pedro D
authors.initials: PD
authors.lastname: Gaburri
authors.affiliation: Department of Medicine, Inflammatory Bowel Diseases Center, Division of Gastroenterology, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine.
authors.forename: Fabio H D L
authors.initials: FHDL
authors.lastname: Pace
authors.affiliation: Department of Medicine, Inflammatory Bowel Diseases Center, Division of Gastroenterology, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine.
authors.forename: Kátia V B D
authors.initials: KVBD
authors.lastname: Barbosa
authors.affiliation: Department of Medicine, Inflammatory Bowel Diseases Center, Division of Gastroenterology, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine.
authors.forename: Lincoln E V V D C
authors.initials: LEVVDC
authors.lastname: Ferreira
authors.affiliation: Department of Medicine, Division of Gastroenterology, Federal University of Minas Gerais, Brazil.
authors.forename: Maria D C F
authors.initials: MDCF
authors.lastname: Passos
authors.affiliation: Department of Medicine, Inflammatory Bowel Diseases Center, Division of Gastroenterology, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine.
authors.forename: Carla
authors.initials: C
authors.lastname: Malaguti
authors.affiliation: Department of Medicine, Inflammatory Bowel Diseases Center, Division of Gastroenterology, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine.
authors.forename: Álvaro H D A
authors.initials: ÁHDA
authors.lastname: Delgado
authors.affiliation: Department of Medicine, Inflammatory Bowel Diseases Center, Division of Gastroenterology, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine.
authors.forename: Jacqueline D
authors.initials: JD
authors.lastname: Campos
authors.affiliation: Department of Medicine, Inflammatory Bowel Diseases Center, Division of Gastroenterology, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine.
authors.forename: André R
authors.initials: AR
authors.lastname: Coelho
authors.affiliation: Department of Medicine, Inflammatory Bowel Diseases Center, Division of Gastroenterology, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine.
authors.forename: Julio M F
authors.initials: JMF
authors.lastname: Chebli
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001765:Blind Loop Syndrome / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D001799:Blood Sedimentation; D001938:Brazil / Q000453:epidemiology; D002097:C-Reactive Protein / Q000032:analysis; D016022:Case-Control Studies; D003424:Crohn Disease / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D003430:Cross-Sectional Studies; D005243:Feces / Q000737:chemistry; D005260:Female; D000069196:Gastrointestinal Microbiome; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007421:Intestine, Small / Q000382:microbiology*; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D039841:Leukocyte L1 Antigen Complex; D002097:C-Reactive Protein