Small Intestinal Bacterial Overgrowth (SIBO), a clinically overdiagnosed entity? / Sobrecrecimiento bacteriano del intestino delgado (SIBO), ¿una entidad clínica sobrediagnosticada?

Small intestinal bacterial overgrowth (SIBO) is a clinical entity recognized since ancient times; it represents the consequences of bacterial overgrowth in the small intestine associated with malabsorption. Recently, SIBO as a term has been popularized due to its high prevalence reported in various pathologies since the moment it is indirectly diagnosed with exhaled air tests. In the present article, the results of duodenal/jejunal aspirate culture testing as a reference diagnostic method, as well as the characteristics of the small intestinal microbiota described by culture-dependent and culture-independent techniques in SIBO, and their comparison with exhaled air testing are presented to argue about its overdiagnosis.

Small intestinal bacterial overgrowth in spinal cord injury patients. / Sobrecrecimiento bacteriano del intestino delgado en pacientes con lesión medular.

AIM: Spinal cord injury (SCI) patients may have intestinal dysmotility and digestive symptoms that are associated with small intestinal bacterial overgrowth (SIBO). The aim of this study is to describe the prevalence of SIBO in SCI patients and the risk factors of its development. METHODS: Twenty-nine consecutive SCI patients were studied (10 women/19 men; mean age 47 years), 16 with subacute injuries (<9 months) and 13 with chronic injuries (>1 year). Nine patients were affected by tetraplegia and 15 by paraplegia. Each patient underwent a glucose breath test according to the North American Consensus and the presence of abdominal symptoms was evaluated during the test. The results were compared with 15 non-neurological patients with SIBO. RESULTS: Six patients tested positive for SIBO (21%), all of them affected by SCI in the subacute phase, 6/16 vs. 0/13 in the chronic phase (P<.05) and the majority with tetraplegia, 5/9 vs. 1/19 with paraplegia (P<.05). No statistically significant relationship was found with other clinical characteristics. All the tests were positive for methane or mixed (methane and hydrogen), while only 67% of the controls had methane-predominant production (P>.05). CONCLUSION: SCI patients can develop SIBO, more frequently in the subacute phase and in tetraplegic patients, highlighting a high production of methane. This complication should be considered in neurogenic bowel management.

Dyspepsia in children: organic or functional? Experience in a tertiary care hospital.

INTRODUCTION: Dyspepsia comprises a group of symptoms that can have organic or functional origin. The purpose of this study was to describe the main causes of dyspepsia and its clinical evolution in children cared for in a tertiary care hospital. MATERIAL AND METHODS: Retrospective study in children with dyspepsia. Patients underwent endoscopy with biopsy and rapid urease test to detect the presence of Helicobacter pylori. In case of normal endoscopy and biopsy, hydrogen breath test was performed. In all cases, follow-up was provided in order to evaluate symptom improvement. RESULTS: One hundred children were included, out of whom 52 were girls; mean age was 8.59 years. Esophagitis or erosive gastropathy were found in 54% of the cases (n = 54), H. pylori infection in 12% (n = 12), small intestinal bacterial overgrowth in 12% (n = 12), and functional dyspepsia in 20% (n = 20). CONCLUSION: In children with dyspepsia, organic causes should first be ruled out before dyspepsia being characterized as functional. In general terms, we consider that a stepped approach that includes endoscopy with biopsy, search for H. pylori and hydrogen breath test is necessary.

INTRODUCCIÓN: La dispepsia consiste en un conjunto de síntomas que pueden tener origen orgánico o funcional. El objetivo de este estudio fue describir las principales causas de la dispepsia y su evolución clínica en niños en un hospital de tercer nivel. MATERIAL Y MÉTODOS: Estudio retrospectivo en niños con dispepsia. Los pacientes fueron sometidos a endoscopia con toma de biopsia y prueba de urea rápida para Helicobacter pylori. En caso de endoscopia y biopsia normal, se tomó prueba de hidrogeniones en aliento. En todos los casos se dio seguimiento para evaluar la mejoría de síntomas. RESULTADOS: Se incluyeron 100 niños, de los cuales 52 eran niñas; la edad media fue de 8.59 años. Se encontró esofagitis y gastropatía erosiva en el 54% de los casos (n = 54), infección por H. pylori en el 12% (n = 12), sobrecrecimiento bacteriano del intestino delgado en el 12% (n = 12) y dispepsia funcional en el 20% (n = 20). CONCLUSIÓN: En niños con dispepsia se deben de descartar primero causas orgánicas antes de diagnosticar dispepsia funcional. En términos generales consideramos que es necesario un abordaje escalonado que incluya endoscopia con toma de biopsia, búsqueda de H. pylori y una prueba de hidrogeniones.

Relación endoscópica entre duodenitis inespecífica y sobrecrecimiento bacteriano del intestino delgado / Endoscopic relationship between non specific duodenitis and snall intestine bacterial overgrowth

Cuando aparece una proliferación de la flora de tipo colónico en el intestino delgado se producen alteraciones en la digestión y absorción intestinal, que clínicamente conforman el síndrome del Sobrecrecimiento Bacteriano del Intestino Delgado (SBID). En el SBID la concentración bacteriana aumenta hasta 107-109 UFC/ml en intestino delgado. El principio del test de hidrógeno espirado es la administración de un carbohidrato (Lactulosa, dxilosa, glucosa), que al ser degradado por las bacterias produce un aumento de los niveles de hidrógeno espirado en pacientes con SBID. Hipótesis: Si la duodenitis inespecífica se manifiesta clínicamente de manera similar al (SBID) entonces puede haber una relación entre ambas patologías. Métodos: Se realizó un estudio clínico descriptivo prospectivo de una muestra seleccionada quienes tuvieron como hallazgo en la endoscopia digestiva superior duodenitis inespecífica. Se usó Video endoscopio Olympus GIF-140, en dicha endoscopia se tomó biopsia del tejido duodenal con pinza. Posteriormente el paciente fue sometido a prueba de hidrógeno en aliento aire espirado con 10 gr de Lactulosa. Resultados: La prueba de Hidrógeno en aliento resultó positiva en 18 pacientes (29,5%) y negativo en 43 (70,5%) (p=1,000). La sensibilidad fue de 29,6% y Especificidad 71% (IC 95%). Conclusiones: 1) La prueba de Hidrógeno en aire espirado con Lactulosa es una prueba con poca sensibilidad pero específica para el Diagnóstico de SBID. 2) La prevalencia de duodenitis giardiásica fue del 11,5% en la población estudiada. 3) Los hallazgos histológicos referentes a las alteraciones de las vellosidades intestinales no están correlacionados con el SBID.

When a proliferation of the flora of type colonic appears in the small intestine they are caused by alterations in the digestion and intestinal absorption, which they make up clinically the syndrome of the Small Intestine Bacterial Overgrowth (SIBO). In SIBO the bacterial concentration increased to 107-109 UFC/ml in the small intestine. The origin of the exhaled hydrogen test is the administration of a carbohydrate (Lactulose, d-xylose, glucose), which when broken down by the bacteria produce an increase in the levels of the exhaled hydrogen in patients with SIBO. Hypothesis: If the non-specific duodenitis appears clinically similar in a way to (SIBO) then there may be a connection between both pathologies. Methods: We carried out a prospective descriptive clinical trial of a selected sample who had the finding of nonspecific duodenitis in the upper endoscopy. We used Video endoscope Olympus GIF-140, in that endoscopic was taken biopsy of the duodenal tissue with forceps. Subsequently, the patient was undergone of Breath-hydrogen test with 10 gr of lactulose. Results: the hydrogen breath test was positive in 18 patients (29.5%) and negative in 43 (70.5%) (p = 1.000). The sensitivity was 29.6% and specificity 71% (95%). Conclusions: 1) Hydrogen breath test with lactulose is less sensitive but specific for the diagnosis of SIBO. 2) The prevalence of giardiasic duodenitis was 11.5% in our trial. 3.) Histological findings regarding alterations of the intestinal villi are uncorrelated with SIBO.