Digestive Diseases and Sciences

, Volume 56, Issue 1, pp 155–160

Small Intestinal Clustered Contractions and Bacterial Overgrowth: A Frequent Finding in Obese Patients

  • Ana María Madrid
  • Jaime Poniachik
  • Rodrigo Quera
  • Carlos Defilippi
Original Article

Abstract

Background

Small intestinal bacterial overgrowth (SIBO) has been observed in several disorders of the gastrointestinal tract. Studies have shown abnormalities of motor function in obese patients, and there is indirect evidence suggesting that SIBO is present in them.

Aims

To study small intestinal motility and the prevalence of SIBO in obese patients and to determine whether there was any relationship between both parameters.

Methods

Thirty-nine patients scheduled for bariatric surgery were subjected to hydrogen breath test with lactulose and to a stationary small intestinal motility study with perfused catheters.

Results

SIBO was observed in 41% of obese patients and was not related to body mass index. Small intestinal manometry showed a marked increase of clustered contractions in obese patients with SIBO compared to obese subjects without SIBO, whereas all the other parameters of fasting cyclic activity were not different.

Conclusions

SIBO was a frequent finding in obese patients and was associated with an increased pattern of clustered contractions, which was not observed in absence of SIBO.

Keywords

Bacterial overgrowth Obesity Small intestine Gastrointestinal motility 

References

  1. 1.
    Bishop R, Anderson CM. The bacterial flora of the stomach and small intestine in children with intestinal obstruction. Arch Dis Child. 1960;35:487–491.CrossRefPubMedGoogle Scholar
  2. 2.
    Di Stefano M, Miceli E, Missanelli A, Mazzocchi S, Corazza GR. Absorbable vs. non-absorbable antibiotics in the treatment of small intestine bacterial overgrowth in patients with blind-loop syndrome. Aliment Pharmacol Ther. 2005;21:985–992.CrossRefPubMedGoogle Scholar
  3. 3.
    Skar V, Skar AG, Osnes M. The duodenal bacterial flora in the region of papilla of Vater in patients with and without duodenal diverticula. Scand J Gastroenterol. 1989;24:649–656.CrossRefPubMedGoogle Scholar
  4. 4.
    Vantrappen C, Janssens J, Hellemans J, Ghoos Y. The interdigestive motor complex of normal subjects and patients with bacterial overgrowth of the small intestine. Interdigestive motor complex and small intestinal bacterial overgrowth. J Clin Invest. 1997;59:1158–1166.CrossRefGoogle Scholar
  5. 5.
    Stotzer PO, Björnsson ES, Abrahamsson H. Interdigestive and postprandial motility in small intestinal bacterial overgrowth. Scand J Gastroenterol. 1996;31:875–880.CrossRefPubMedGoogle Scholar
  6. 6.
    Vincent B, Nieuwenhuijs MD, Verheem A, et al. The role of interdigestive small bowel motility in the regulation of gut microflora, bacterial overgrowth, and bacterial translocation in rats. Ann Surg. 1998;228:188–193.CrossRefGoogle Scholar
  7. 7.
    Chesta J, Defilippi Cl, Defilippi C. Abnormalities in proximal small bowel motility in patients with cirrhosis. Hepatology. 1993;17:828–832.PubMedGoogle Scholar
  8. 8.
    Madrid AM, Cumsille F, Defilippi C. Altered small bowel motility in patients with liver cirrhosis depends on severity of liver disease. Dig Dis Sci. 1997;42:738–742.CrossRefPubMedGoogle Scholar
  9. 9.
    Paerregaard A, Justesen T, Prytz H, Anderson B, Gudmand-Höyer E. Metronidazole treatment of bypass-enteropathy after jejunoileal shunt-operation for obesity. Acta Chir Scand. 1982;148:153–156.PubMedGoogle Scholar
  10. 10.
    Passaro E Jr, Drenick E, Wilson SE. Bypass enteritis. A new complication of jejunoileal bypass for obesity. Am J Surg. 1976;131:169–174.CrossRefPubMedGoogle Scholar
  11. 11.
    Nair S, Cope K, Terence RH, Mae A. Obesity and female gender increase breath ethanol concentration: potential implications for the pathogenesis of nonalcoholic steatohepatitis. Am J Gastroenterol. 2001;96:1200–1204.CrossRefPubMedGoogle Scholar
  12. 12.
    Cope K, Risby T, Diehl AM. Increased gastrointestinal ethanol production in obese mice: implications for fatty liver disease pathogenesis. Gastroenterology. 2000;119:1340–1347.CrossRefPubMedGoogle Scholar
  13. 13.
    Konturek PC, Konturek JW, Czesnikiewicz-Guzik M, Brzozowski T, Sito E, Konturek SJ. Neuro-hormonal control of food intake; basic mechanisms and clinical implications. J Physiol Pharmacol. 2005;56:5–25.Google Scholar
  14. 14.
    Tack J, Depoortere I, Bisschops R, et al. Influence of ghrelin on interdigestive gastrointestinal motility in humans. Gut. 2006;55:327–333.CrossRefPubMedGoogle Scholar
  15. 15.
    Suematsu M, Katsuki A, Sumida Y, et al. Decreased circulating levels of active ghrelin are associated with increased oxidative stress in obese subjects. Eur J Endocrinol. 2005;153:403–407.CrossRefPubMedGoogle Scholar
  16. 16.
    Xing J, Chen JDZ. Alterations of gastrointestinal motility in obesity. Obes Res. 2004;12:1723–1732.CrossRefPubMedGoogle Scholar
  17. 17.
    Tosetti C, Corinaldesi R, Stanghellini V, et al. Gastric emptying of solids in morbid obesity. Int J Obes Relat Metab Disord. 1996;20:200–205.PubMedGoogle Scholar
  18. 18.
    McCallum RW, Jones TF, Lin Z, Sarosiek I, Moncure M. Assessment of gastric emptying, myoelectric activity in the morbidly obese patient. Gastroenterology. 2001;120:A-290.Google Scholar
  19. 19.
    Basilisco G, Camboni G, Bozzani A, Vita P, Doldi S, Bianchi PA. Orocecal transit delay in obese patients. Dig Dis Sci. 1989;34:509–512.CrossRefPubMedGoogle Scholar
  20. 20.
    Wisen O, Johansson C. Gastrointestinal function in obesity: motility, secretion, and absorption following a liquid test meal. Metabolism. 1992;41:390–395.CrossRefPubMedGoogle Scholar
  21. 21.
    French SJ, Murray B, Rumsey RD, Sepple CP, Read NW. Preliminary studies on the gastrointestinal responses to fatty meals in obese people. Int J Obes Relat Metab Disord. 1993;17:295–300.PubMedGoogle Scholar
  22. 22.
    Pieramico O, Malfertheiner P, Nelson DK, Glasbrenner B, Ditschuneit H. Interdigestive gastroduodenal motility and cycling of putative regulatory hormones in severe obesity. Scand J Gastroenterol. 1992;27:538–544.CrossRefPubMedGoogle Scholar
  23. 23.
    Simrén M, Stotzer P-O. Use and abuse of hydrogen breath test. Gut. 2006;55:291–303.CrossRefGoogle Scholar
  24. 24.
    Summers RW, Anuras S, Green J. Jejunal manometry patterns in health, partial intestinal obstruction, and pseudoobstruction. Gastroenterology. 1983;85:1290–1300.PubMedGoogle Scholar
  25. 25.
    Madrid AM, Hurtado C, Venegas M, Cumsille F, Defilippi C. Long-term treatment with cisapride and antibiotics in liver cirrhosis: effect on small intestinal motility, bacterial overgrowth, and liver function. Am J Gastroenterol. 2001;96:1251–1255.CrossRefPubMedGoogle Scholar
  26. 26.
    Madrid AM, Brahm J, Buckel E, Silva G, Defilippi C. Orthotopic liver transplantation improves small bowel motility disorders in cirrhotic patients. Am J Gastroenterol. 1997;92:1044–1045.PubMedGoogle Scholar
  27. 27.
    Kellow JE, Phillips SF. Altered small bowel motility in irritable bowel syndrome is correlated with symptoms. Gastroenterology. 1987;92:1885–1893.PubMedGoogle Scholar
  28. 28.
    Pimentel M, Chow EJ, Lin HC. Eradication of small intestinal overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol. 2000;95:3503–3506.CrossRefPubMedGoogle Scholar
  29. 29.
    Pimentel M, Chow EJ, Lin HC. Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome, a double-blind, randomized, placebo-controlled study. Am J Gastroenterol. 2003;98:412–419.PubMedGoogle Scholar
  30. 30.
    Posserud I, Stotzer P-O, Björnosson ES, Abrahamsson H, Simrén M. Small intestinal bacterial overgrowth in patients with irritable bowel syndrome. Gut. 2007;56:802–808.CrossRefPubMedGoogle Scholar
  31. 31.
    Schmidt T, Eberle R, Pfeiffer A, Kaess H. Effect of ethanol on postprandial duodenojejunal motility in humans. Dig Dis Sci. 1997;42:1628–1633.CrossRefPubMedGoogle Scholar
  32. 32.
    Bäckhned F, Ding H, Wang T, et al. The gut microbiota as an environmental factor that regulates fat storage. PNAS. 2004;101:15718–15723.CrossRefGoogle Scholar
  33. 33.
    Bäckhned F, Manchester JK, Semenkovich CF, Gordon JI. Mechanisms underlying the resistance to diet-induced obesity in germ-free mice. PNAS. 2007;104:979–984.CrossRefGoogle Scholar
  34. 34.
    Vanner S. The small intestinal bacterial overgrowth. Irritable bowel syndrome hypothesis: implications for treatment. Gut. 2008;57:1315–1321.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Ana María Madrid
    • 1
  • Jaime Poniachik
    • 1
  • Rodrigo Quera
    • 1
  • Carlos Defilippi
    • 1
  1. 1.Section of GastroenterologyUniversity Hospital of University of Chile, University of ChileSantiagoChile

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