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PWE-168 Is There A Relationship Between Irritable Bowel Syndrome Symptoms And Small Bowel Bacterial Overgrowth?
  1. JR Hayman1,
  2. G Pickering1,
  3. DS Sanders2
  1. 1GI Physiology, Northern General Hospital
  2. 2Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK

Abstract

Introduction Small Bowel Bacterial Overgrowth (SBBO) has recently been proposed to be prevalent in patients with diarrhoea predominant Irritable Bowel Syndrome (IBS-D). However prevalence figures in studies have varied widely dependant on the diagnostic test used, with low prevalence rates of 4% using jejunal aspirate and culture, to between 38–84% using hydrogen breath tests.

This study used the Glucose Hydrogen and Methane Breath Test (GHBT) to determine if there was a relationship between patients with IBS-D symptoms and SBBO. Concurrently any clinical features or baseline laboratory investigations indicative of a high likelihood of SBBO was investigated.

Methods A retrospective analysis of patient hospital records for patients referred to a tertiary GI Physiology Department at Sheffield Teaching Hospitals (STH) between January 1988–2013 for a routine GHBT was conducted. Data was split into two groups. Group 1 included all patients demographics referred for a GHBT (1998–2010) to investigate characteristics predictive of SBBO. Group 2 included patients who fulfilled ROME III criteria for IBS-D who underwent a GHBT (2010–2012). A positive result for SBBO was defined as a rise in hydrogen or methane levels of ≥10 ppm over baseline levels.

Results In group 1 786 patients were identified (276 male, mean age 54). Overall 175/786 (22.3%) tests were positive. Laboratory investigations and patient characteristics predictive of a positive result were low vitamin B12 (p < 0.001), low albumin <30g/dL (p < 0.001), concurrent use of a proton pump inhibitor (PPI) (p = 0.002), previous Bilroth II gastroenterostomy (p < 0.001), previous vagotomy (p < 0.001), right hemi-colectomy (p = 0.003), coeliac disease (p < 0.001), and small bowel Crohn’s disease (p = 0.04) and age over 65 years (p < 0.001). Symptoms predictive of a positive GHBT included diarrhoea (p = 0.03) and weight loss (p < 0.01).

In group 2 135/834 patients fulfilled ROME III criteria for IBS-D (42 male, mean age 43 years). Overall 26/135 (19.3%) tests were positive. A significant correlation was found between patients with IBS-D symptoms and SBBO (p = 0.01). Characteristics predictive of SBBO in IBS-D patients were previous small bowel surgery (p = 0.04) and blind loop syndrome (p = 0.04).

Conclusion This study has further highlighted the proposed relationship of IBS-D symptoms and an increased prevalence of SBBO. In IBS-D patients factors predictive of SBBO were previous small bowel surgery and blind loop syndrome. For the sub-cohort of patients attending for a GHBT factors predictive of SBBO were patient age (≥65 years), diarrhoea, weight loss, use of a PPI, previous Bilroth II gastroenterostomy, previous vagotomy, right hemi-colectomy, coeliac disease, small bowel Crohn’s disease, low Vitamin B12 and low albumin.

Disclosure of Interest None Declared.

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