Introduction
SIBO—definition and clinical symptoms
Symptoms | Pathogenesis |
---|---|
Flatulence | Bacterial fermentation of carbohydrates with water, short-chain fatty acids and gases overproduction in intestinal lumen |
Diarrhea | |
Steatorrhoea | Bacterial deconjugation of bile acids leading to insufficient absorption of fats and fat-soluble vitamins |
Fat-soluble vitamins deficiency symptoms (A, D, E) | |
Neurological and psychiatric symptoms of malignant anaemia | Bacterial vitamin B12 consumption |
Malabsorption syndrome symptoms (weight loss, no weight gain, malnutrition) | Reduced availability of nutrients (proteins, sugars) used by bacteria |
Hypoproteinemia symptoms (symmetrical, pitting oedema) | Impaired function of the intestinal barrier causing increased protein permeability and protein loss |
Systemic disorders (glomerulonephritis, hepatitis, fatty liver disease, arthritis, tendonitis) and cutaneous lesions | Increased bacterial counts and intestinal barrier destruction lead to the development of antigenemia and consequently to the production of antibodies and the development of type III hypersensitivity reactions |
The prevalence of SIBO in SSc—the systematic review of the literature
Materials and methods
Study | Marie et al. [19] | Savarino et al. [23] | Fynne et al. [10] | Gemignani et al. [12] | Tauber et al. [24] | Parodi et al. [21] | Marie et al. [18] |
---|---|---|---|---|---|---|---|
Study duration | 01.2011–06.2014 | no data | no data | 06.2009–03.2011 | 01.2011–12.2012 | No data | 01.2006–06.2007 |
Study group (SSca patients) | n = 125 | n = 99 | n = 15 | n = 50 | n = 37 | n = 55 | n = 51 |
Women/men | 99/26 | 80/10 | 13/12 | 43/7 | 29/8 | 50/5 | 41/10 |
Average age (years) | 55 | 59 | 58 | 54 | 60 | 59 | 54 |
Number of patients with dcSScb | 43 (34.4%) | 31 (31%) | 15 (100%) | 18 (36%) | 14 (38%) | 18 | 25 (49%) |
Number of patients with lcSScc | 82 (65.6%) | 68 (68%) | 0 | 32 (64%) | 23 (62%) | 37 | 26 (51%) |
Average duration of the disease (years) | 4 | 87% > 5 12% < 5 | No data | 5 | 9 | No data | 4 |
Control group of healthy people | No control group | n = 60 | n = 17 | n = 60 | No control group | n = 60 | No control group |
Women/men | – | 50/10 | 12/5 | 48/12 | – | 48/12 | – |
Average age (years) | – | 57 | 52 | 48 | – | 51 | – |
Diagnostic methods for SIBOf | GHBTd | LHBTe | GHBT | GHBT | GHBT | LHBT | GHBT |
Criteria for positive diagnostic test result | (1) H2g and/or CH4h increase > 20 ppmi above basal value; (2) H2 and/or CH4 increase > 10 ppm on 2 consecutive measurements within the 2 first hours;( 3) H2 and/or CH4 increase > 10 ppm between minimal and maximal values | H2 and/or CH4 excretion increase > 10 ppm compared with baseline in three consecutive air samples | H2 and/or CH4 increase > 10 ppm above basal value | H2 and/or CH4 increase > 12 ppm above basal value | H2 and/or CH4 increase > 20 ppm in 2 consecutive measurements H2 and/or CH4 increase > 12 ppm in 3 consecutive measurements | H2/CH4 excretion increase > 10 ppm compared to the basal value in 2 consecutive measurements | (1) H2 and/or CH4 increase > 20 ppm above basal value; (2) H2 and/or CH4 increase > 10 ppm on 2 consecutive measurements within the 2 first hours; (3) H2 and/or CH4 increase > 10 ppm between minimal and maximal values |
Positive results for SIBO, n | |||||||
In the study group | 44 (46,2%) | 47 (46%) | 3 (21%) | 9 (18%) | 14 (38%) | 30 (55%) | 22 (43%) |
In the control group | 3 (5%) | No data | 3 (5%) | 4 (7%) | |||
Type of study | Prospective | Retrospective cohort | Prospective cohort | Prospective cohort | Prospective | Prospective cohort | Case series |
Results
Marie et al. [18] | Tauber et al. [24] | |||||
---|---|---|---|---|---|---|
Patients with SIBOa (n = 22) | Patients without SIBO (n = 29) | p value | Patients with SIBO (n = 14) | Patients without SIBO (n = 23) | p value | |
Clinical characteristic | ||||||
SScb duration (years) | 8.3 (1–37) | 4.9 (1–20) | 0.0067 | 11 (1–29) | 7 (3–35) | 0.02 |
Age (years) | 59.5 (23–82) | 50 (34–73) | 0.0292 | 61.5 (42–80) | 59 (35–79) | 0.5 |
SSc subset, n (%) | ||||||
dcSScc lcSScd | 8, (36.4) 14, (63.6) | 17 (58.6) 12 (41.4) | 0.159 | 5 (36) 9 (64) | 9 (39) 14 (61) | 0.9 |
Laboratory findings | ||||||
Anti-Scl70 Abe | 22.7% | 27.6% | 0.755 | 7% (1) | 39% (9) | 0.04 |
ACA Ab | 40.9% | 24.9% | 0.235 | 57% (8) | 33% (7) | 0.3 |
Hemoglobin (g/dl) | 12.2 (8.9–14.5) | 13.9 (10.3–15.5) | 0.002 | No data | ||
Ferritin (µg/l) | 44.5 (5-307) | 60 (2-730) | 0.361 | 51.9 (10–147) | 63.6 (10–170) | 0.07 |
Vitamin B12 (pmol/l) | 225 (30–748) | 288 (131–587) | 0.133 | 322 (166–697) | 373 (232–488) | 0.1 |
Total serum protein (g/l) | 65.5 (51–77) | 69 (55–76) | 0.66 | No data | ||
Serum albumin (g/l) | 39 (32–49) | 42 (30–50) | 0.024 | 39.2 (35–44) | 40 (33–45) | 0.2 |
Phosphor (mmol/l) | No data | 1.05 (0.83–1.35) | 1.21 (0.94–3.32) | 0.03 | ||
Calcium (mmol/l) | No data | 2.27 (2.14–2.41) | 2.33 (2.22–2.47) | 0.03 | ||
Triglycerides (mmol/l) | No data | 0.96 (0.66–1.24) | 1.51 (0.64–3.32) | 0.04 | ||
ESRf (mm/h) | 24 (4–70) | 8 (2–78) | 0.003 | No data |
Marie et al. [18] | Parodi et al. [21] | Fynne et al. [10] | Gemigani et al. [12] | |||
---|---|---|---|---|---|---|
Patients with siboa (n = 22) | Patients without SIBO (n = 29) | Patients with SIBO (n = 30) | Patients without SIBO (n = 25) | No group division | No group division | |
Diarrhea | 50% | 10.3% | ~ 27% | ~ 9% | 50% | 22% |
Abdominal pain Upper Lower | 86.4% | 31% | − 30% − 34% | − 34% − 29% | 50% | − 58% − 70% |
Bloating | 77.3% | 44.8% | ~ 57% | ~ 50% | 60% | 62% |
Constipation | 59.1% | 3.4% | No data | 33% | 46% | |
Nausea | 54.5% | 37.9% | ~ 27% | ~ 38% | 52% | |
Vomiting | 18.2% | 3.4% | ~ 4.5% | ~ 3% | No data | 20% |
Abdominal tenderness | 54.5% | 6.9% | ~ 54.5% | ~ 46% | No data | 40% |
Fever | 18.2% | 0 | 0 | 0 | No data | 10% |
Tenesmus | 13.6% | 0 | ~ 50% | ~ 46% | 40% | 4% |
Reflux | No data | No data | 93% | No data | ||
Dysphagia | No data | No data | 33% | 44% | ||
Early satiety | No data | No data | 25% | No data |