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A Journal on Gastroenterology, Nutrition and Dietetics
Indexed/Abstracted in: CAB, EMBASE, PubMed/MEDLINE, Scopus, Emerging Sources Citation Index
Minerva Gastroenterologica e Dietologica 2006 March;52(1):89-95
Small intestine bacterial overgrowth in irritable bowel syndrome: a retrospective study with rifaximin
Cuoco L., Salvagnini M.
Gastroenterology Unit S. Bortolo Hospital, Vicenza, Italy
Aim. Irritable bowel syndrome (IBS) is a frequent diagnosis in gastroenterology, but it is now clear that an altered dynamic equilibrium and bacterial overgrowth in the small intestine may mimic an IBS-like syndrome.
Methods. We have, therefore, evaluated the real prevalence of small intestinal bacterial overgrowth (SIBO) by retrospectively examining the glucose hydrogen (H2) breath test in 96 patients with a previous symptoms-based IBS diagnosis. Moreover, we wished to evaluate the efficacy of the locally acting antibiotic rifaximin in eradicating a SIBO syndrome.
Results. The breath test showed a SIBO syndrome in 44 out 96 IBS patients (45.8%), who had H2 peaks in the expired air higher than 10 ppm over the baseline value (mean: 36.2±18.7 ppm). All these patients were treated with rifaximin (1 200 mg/day for 14 days) followed by a twenty-day cycle of probiotics. Twenty-three of them returned to a control visit within 4-5 months: the glucose breath test became negative in 19 cases (82.6%; P<0.01) and mean peak value of H2 significantly decreased from 40.9±20.4 to 4.78±8.42 ppm (P<0.001). Patients reported also a substantial improvement of the IBS symptoms. No adverse effect was observed.
Conclusion. These data indicate a SIBO syndrome is present in about half of patients with an IBS diagnosis and, therefore, it should always be suspected in these patients. Moreover, the use of broad-spectrum non absorbable antibiotics, such as rifaximin, represents a safe and effective approach to SIBO with a low risk of causing microbial resistance.