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Small-Intestinal Bacterial Overgrowth is Associated With Concurrent Intestinal Inflammation But Not With Systemic Inflammation in Crohn’s Disease Patients

2017; Lippincott Williams & Wilkins; Volume: 52; Issue: 6 Linguagem: Inglês

10.1097/mcg.0000000000000803

1539-2031

José Eugênio Rios Ricci, Liliana Andrade Chebli, Tarsila Campanha da Rocha Ribeiro, Antônio Carlos Santana Castro, Pedro Duarte Gaburri, Fábio Heleno de Lima Pace, Kátia Valéria Bastos Dias Barbosa, Lincoln E.V.V.d.C. Ferreira, Maria do Carmo Friche Passos, Carla Malaguti, Álvaro Henrique de Almeida Delgado, Jacqueline Delgado Campos, Andre Renno Coelho, Júlio Maria Fonseca Chebli,

Microscopic Colitis

Goals: 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. Background: The relationship of SIBO with systemic and intestinal inflammation in CD patients is unclear. Study: 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 H 2 /CH 4 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)]. Results: 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. Conclusions: 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.