Skip to main content
Top
Published in: Digestive Diseases and Sciences 9/2013

01-09-2013 | Original Article

Small Intestinal Bacterial Overgrowth and Orocecal Transit Time in Patients of Inflammatory Bowel Disease

Authors: S. V. Rana, S. Sharma, A. Malik, J. Kaur, K. K. Prasad, S. K. Sinha, K. Singh

Published in: Digestive Diseases and Sciences | Issue 9/2013

Login to get access

Abstract

Background

Inflammatory bowel disease (IBD) consists of Ulcerative colitis (UC) and Crohn’s disease (CD). These two conditions share many common features—diarrhea, bloody stools, weight loss, abdominal pain, fever and fatigue. Small intestinal bacterial overgrowth (SIBO) is frequent in patients with CD but it has not been studied in UC Indian patients.

Aim

The study was planned to measure orocecal transit time (OCTT) and SIBO in UC and CD patients.

Methods

One hundred thirty-seven patients of IBD (95 UC and 42 CD) and 115 healthy controls were enrolled. OCTT and SIBO were measured by lactulose and glucose hydrogen breath test respectively. Concentration of hydrogen and methane were measured by SC microlyser from Quintron, USA.

Results

Mean ± standard deviation (SD) of OCTT in patients of IBD was significantly higher as compared to controls. Furthermore, OCTT was significantly higher in CD patients as compared to UC patients. It was also observed that occurrence of SIBO was significantly higher in IBD patients as compared to controls. The occurrence of SIBO in CD (45.2 %) was significantly higher as compared to patients in UC (17.8 %) group. Percentage of methane positive IBD patients (2.9 %) was significantly lower as compared to methane positive controls (24.4 %).

Conclusion

OCTT was significantly delayed in IBD patients as compared to controls and in CD patients as compared to UC patients. OCTT was significantly higher in SIBO positive IBD patients as compared to SIBO negative patients. Thus, we can suggest that delayed OCTT would have been the cause of increased SIBO in these patients.
Literature
1.
go back to reference Kmiec Z. Cytokines in inflammatory bowel disease. Arch Immunol Ther Exp (Warsz). 1998;46:143–155. Kmiec Z. Cytokines in inflammatory bowel disease. Arch Immunol Ther Exp (Warsz). 1998;46:143–155.
2.
go back to reference Kathleen A, Jurenka JS. Inflammatory bowel disease part 1: ulcerative colitis pathophysiology and conventional and alternative treatment options. Altern Med Rev. 2003;8:247–283. Kathleen A, Jurenka JS. Inflammatory bowel disease part 1: ulcerative colitis pathophysiology and conventional and alternative treatment options. Altern Med Rev. 2003;8:247–283.
3.
go back to reference Ardizzone S, Bianchi Porro G. Biologic therapy for inflammatory bowel disease. Drugs. 2005;65:2253–2286.PubMedCrossRef Ardizzone S, Bianchi Porro G. Biologic therapy for inflammatory bowel disease. Drugs. 2005;65:2253–2286.PubMedCrossRef
4.
go back to reference Ardizzone S, Bollani S, Manzionna G, Bianchi Porro G. Inflammatory bowel disease approaching the 3rd millennium: pathogenesis and therapeutic implications? Eur J Gastroenterol Hepatol. 1999;11:27–32.PubMedCrossRef Ardizzone S, Bollani S, Manzionna G, Bianchi Porro G. Inflammatory bowel disease approaching the 3rd millennium: pathogenesis and therapeutic implications? Eur J Gastroenterol Hepatol. 1999;11:27–32.PubMedCrossRef
5.
go back to reference Fiocchi C. Inflammatory bowel disease: etiology and pathogenesis. Gastroenterology. 1998;115:182–205.PubMedCrossRef Fiocchi C. Inflammatory bowel disease: etiology and pathogenesis. Gastroenterology. 1998;115:182–205.PubMedCrossRef
6.
go back to reference Binion DG, Fiocchi C. Immune modulation-is the environment important? In: McLeod RS, Martin K, Sutherland LR, Wallace JL, Williams CN, eds. Trends in Inflammatory Bowel Disease Therapy. Boston: Kluwer; 1996;39–48. Binion DG, Fiocchi C. Immune modulation-is the environment important? In: McLeod RS, Martin K, Sutherland LR, Wallace JL, Williams CN, eds. Trends in Inflammatory Bowel Disease Therapy. Boston: Kluwer; 1996;39–48.
7.
go back to reference Sartor RB. Current concepts of the etiology and pathogenesis of ulcerative colitis and Crohn’s disease. Gastroenterol Clin N Am. 1995;24:475–507. Sartor RB. Current concepts of the etiology and pathogenesis of ulcerative colitis and Crohn’s disease. Gastroenterol Clin N Am. 1995;24:475–507.
8.
9.
go back to reference Mishkin B, Yalovsky M, Mishkin S. Increased prevalence of lactose malabsorption in Crohn’s disease patients at low risk for lactose malabsorption based on ethnic origin. Am J Gastroentrol. 1997;92:1148–1153. Mishkin B, Yalovsky M, Mishkin S. Increased prevalence of lactose malabsorption in Crohn’s disease patients at low risk for lactose malabsorption based on ethnic origin. Am J Gastroentrol. 1997;92:1148–1153.
10.
go back to reference Rana SV, Sharma S, Kaur J, Sinha SK, Singh K. Comparison of lactulose and glucose breath test for diagnosis of small intestinal bacterial overgrowth in patients with irritable bowel syndrome. Digestion. 2012;85:243–247.PubMedCrossRef Rana SV, Sharma S, Kaur J, Sinha SK, Singh K. Comparison of lactulose and glucose breath test for diagnosis of small intestinal bacterial overgrowth in patients with irritable bowel syndrome. Digestion. 2012;85:243–247.PubMedCrossRef
11.
go back to reference Toskes PP, Kumar A. Enteric bacterial flora and bacterial overgrowth syndrome. In: Sleisenger NH, Fordtran GS, eds. Gastrointestinal and Liver Disease Philadelphia. Philadelphia: WB Saunders; 1998:1523–1534. Toskes PP, Kumar A. Enteric bacterial flora and bacterial overgrowth syndrome. In: Sleisenger NH, Fordtran GS, eds. Gastrointestinal and Liver Disease Philadelphia. Philadelphia: WB Saunders; 1998:1523–1534.
12.
go back to reference Sellin JH, Hart R. Glucose malabsorption associated with rapid intestinal transit. Am J Gastroenterol. 1992;87:584–589.PubMed Sellin JH, Hart R. Glucose malabsorption associated with rapid intestinal transit. Am J Gastroenterol. 1992;87:584–589.PubMed
13.
go back to reference Rana SV, Sinha SK, Sikander A, Bhasin DK, Singh K. Study of small intestinal bacterial overgrowth in North Indian patients with irritable bowel syndrome: a case control study. Trop Gastroenterol. 2008;29:23–25.PubMed Rana SV, Sinha SK, Sikander A, Bhasin DK, Singh K. Study of small intestinal bacterial overgrowth in North Indian patients with irritable bowel syndrome: a case control study. Trop Gastroenterol. 2008;29:23–25.PubMed
14.
go back to reference Pimentel M, Wallace D, Hallegua D, et al. A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing. Ann Rheum Dis. 2004;63:450–452.PubMedCrossRef Pimentel M, Wallace D, Hallegua D, et al. A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing. Ann Rheum Dis. 2004;63:450–452.PubMedCrossRef
15.
go back to reference Rana SV, Kocchar R, Pal R, Nagi B, Singh K. Orocecal transit time in patients in chronic phase of corrosive injury. Dig Dis Sci. 2008;53:1797–1800.PubMedCrossRef Rana SV, Kocchar R, Pal R, Nagi B, Singh K. Orocecal transit time in patients in chronic phase of corrosive injury. Dig Dis Sci. 2008;53:1797–1800.PubMedCrossRef
16.
go back to reference Rana SV, Sinha SK, Lal S, Sikander S, Singh K. Small intestinal bacterial overgrowth in north Indian patients with celiac disease. Trop Gastroenterol. 2007;28:159–161.PubMed Rana SV, Sinha SK, Lal S, Sikander S, Singh K. Small intestinal bacterial overgrowth in north Indian patients with celiac disease. Trop Gastroenterol. 2007;28:159–161.PubMed
17.
go back to reference Ghoshal UC, Ghoshal U, Ayyagari A, et al. Tropical sprue is associated with contamination of small bowel with aerobic bacteria and reversible prolongation of orocecal transit time. J Gastroenterol Hepatol. 2003;18:540–547.PubMedCrossRef Ghoshal UC, Ghoshal U, Ayyagari A, et al. Tropical sprue is associated with contamination of small bowel with aerobic bacteria and reversible prolongation of orocecal transit time. J Gastroenterol Hepatol. 2003;18:540–547.PubMedCrossRef
18.
go back to reference Ghoshal UC, Ghoshal U, Das K, Misra A. Utility of hydrogen breath tests in diagnosis of small intestinal bacterial overgrowth in malabsorption syndrome and its relationship with oro-cecal transit time. Indian J Gastroenterol. 2006;25:6–10.PubMed Ghoshal UC, Ghoshal U, Das K, Misra A. Utility of hydrogen breath tests in diagnosis of small intestinal bacterial overgrowth in malabsorption syndrome and its relationship with oro-cecal transit time. Indian J Gastroenterol. 2006;25:6–10.PubMed
19.
go back to reference Pimentel M, Chow EJ, Lin HC. Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol. 2000;95:3503–3506.PubMedCrossRef Pimentel M, Chow EJ, Lin HC. Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol. 2000;95:3503–3506.PubMedCrossRef
20.
go back to reference Castiglione F, Del Vecchio Blanco G, Rispo A, et al. Orocecal transit time and bacterial overgrowth in patients with Crohn’s disease. J Clin Gastroenterol. 2000;31:63–66.PubMedCrossRef Castiglione F, Del Vecchio Blanco G, Rispo A, et al. Orocecal transit time and bacterial overgrowth in patients with Crohn’s disease. J Clin Gastroenterol. 2000;31:63–66.PubMedCrossRef
21.
22.
go back to reference Jorge JM, Wexner SD, Ehrenpreis ED. The lactulose hydrogen breath test as a measure of orocecal transit time. Eur J Surg. 1994;160:409–416.PubMed Jorge JM, Wexner SD, Ehrenpreis ED. The lactulose hydrogen breath test as a measure of orocecal transit time. Eur J Surg. 1994;160:409–416.PubMed
23.
go back to reference Pimentel M, Mayer AG, Park S, Chow EJ, Hasan A, Kong Y. Methane production during lactulose breath test is associated with gastrointestinal disease presentation. Dig Dis Sci. 2003;48:86–92.PubMedCrossRef Pimentel M, Mayer AG, Park S, Chow EJ, Hasan A, Kong Y. Methane production during lactulose breath test is associated with gastrointestinal disease presentation. Dig Dis Sci. 2003;48:86–92.PubMedCrossRef
24.
go back to reference Bond JH, Levitt MD. Use of pulmonary hydrogen (H2) measurements to quantitate carbohydrate absorption. Study of partially gastrectomized patients. J Clin Invest. 1972;51:1219–1225.PubMedCrossRef Bond JH, Levitt MD. Use of pulmonary hydrogen (H2) measurements to quantitate carbohydrate absorption. Study of partially gastrectomized patients. J Clin Invest. 1972;51:1219–1225.PubMedCrossRef
Metadata
Title
Small Intestinal Bacterial Overgrowth and Orocecal Transit Time in Patients of Inflammatory Bowel Disease
Authors
S. V. Rana
S. Sharma
A. Malik
J. Kaur
K. K. Prasad
S. K. Sinha
K. Singh
Publication date
01-09-2013
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 9/2013
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-013-2694-x

Other articles of this Issue 9/2013

Digestive Diseases and Sciences 9/2013 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.