Digestive Diseases and Sciences

, Volume 59, Issue 3, pp 645–652

Small Intestinal Bacterial Overgrowth in Gastroparesis

  • Nina S. George
  • Abhinav Sankineni
  • Henry P. Parkman
Original Article

Abstract

Objective

To determine symptoms of small intestinal bacterial overgrowth (SIBO) in gastroparesis patients.

Methods

Patients undergoing LBT (lactulose breath test) for evaluation of SIBO were included. LBT was considered positive on the basis of three conventional criteria: (1) hydrogen level increase >20 ppm above baseline by 90 min (H2@90min); (2) dual hydrogen peaks (>10 ppm increase over baseline before second peak >20 ppm (DPHBT); and (3) breath methane increase of >20 ppm above baseline by 90 min. Results of gastric emptying scintigraphy (GES) were recorded. Patients completed the Patient Assessment of Upper Gastrointestinal Disorders-Symptom Severity Index.

Results

Of 740 patients who underwent LBT from December 2009 to August 2011, 471 underwent GES, with 201 having delayed GES. Of patients with delayed GES who underwent LBT 87 % were female, 23 % diabetic, 49 % used gastric acid suppressants, 29 % used opiate analgesics, 35 % used pro-motility medications, and 27 % had a history of gastrointestinal surgery. Overall, 79 (39 %) patients with gastroparesis had evidence of SIBO by LBT: 30 (15 %) had positive H2@90min, 53 (26 %) positive DPHBT, and 6 (3 %) positive breath methane test. In gastroparesis patients with positive H2@90min, there was increased severity of bloating (3.80 ± 0.20 vs 3.29 ± 0.12; P = 0.02), early satiety (3.57 ± 0.27 vs 3.05 ± 0.13; P = 0.045), and postprandial fullness (4.20 ± 0.18 vs 3.52 ± 0.12; P < 0.01) compared with negative H2@90min patients. No significant difference in symptom severity was seen between positive and negative DPHBT gastroparesis patients.

Conclusion

In our cohort, 39 % of gastroparesis patients tested positive for SIBO by LBT. Positive H2@90min testing by LBT was associated with increased symptoms of bloating and excessive fullness during and after meals.

Keywords

Small intestinal bacterial overgrowth Gastroparesis Abdominal pain Bloating Lactulose breath test 

Abbreviations

SIBO

Small intestinal bacterial overgrowth

LBT

Lactulose breath test

H2@90min

Hydrogen breath testing criteria over 90 min

DPHBT

Double peak hydrogen breath testing

GES

Gastric emptying scintigraphy

GCSI

Gastroparesis Cardinal Symptom Index

PAGI-SYM

Patient Assessment of Upper Gastrointestinal Disorders-Symptom Severity Index

References

  1. 1.
    Belkind-Gerson J, Kuo B. Gastroparesis: a comprehensive review. Ann Gastroenterol Hepatol. 2011;2:1–11.Google Scholar
  2. 2.
    Khayyam U, Sachdeva P, Gomez J, et al. Assessment of symptoms during gastric emptying scintigraphy to correlate symptoms to delayed gastric emptying. Neurogastroenterol Motil. 2010;22:539–545.PubMedGoogle Scholar
  3. 3.
    Reddymasu SC, McCallum RW. Small intestinal bacterial overgrowth in gastroparesis: are there any predictors? J Clin Gastroenterol. 2010;44:e8–e13.PubMedCrossRefGoogle Scholar
  4. 4.
    Bures J, Cyrany J, Kohoutova D, et al. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010;16:2978–2990.PubMedCrossRefGoogle Scholar
  5. 5.
    Pimental M, Chow EJ, Lin HC. Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol. 2000;95:3503–3506.CrossRefGoogle Scholar
  6. 6.
    Bouhnik Y, Alain S, Attar A, et al. Bacterial populations contaminating the upper gut in patients with small intestinal bacterial overgrowth syndrome. Am J Gastroenterol. 1999;94:1327–1331.PubMedCrossRefGoogle Scholar
  7. 7.
    Simren M, Stotzer PO. Use and abuse of hydrogen breath tests. Gut. 2006;55:297–303.PubMedCrossRefGoogle Scholar
  8. 8.
    Yu D, Cheeseman F, Vanner S. Combined oro-caecal scintigraphy and lactulose hydrogen breath testing demonstrate that breath testing detects oro-caecal transit, not small intestinal bacterial overgrowth in patients with IBS. Gut. 2011;60:334–340.PubMedCrossRefGoogle Scholar
  9. 9.
    Rhodes JM, Middelton P, Jewell P. The lactulose hydrogen breath test as a diagnostic test for small-bacterial overgrowth. Scand J Gastroenterol. 1979;14:333–367.PubMedCrossRefGoogle Scholar
  10. 10.
    King CE, Toskes PP. Comparison of the 1-gram [14C] xylose, 10-gram lactulose-H2, and 80 gram glucose-H2 breath tests in patients with small intestine bacterial overgrowth. Gastroenterology. 1986;91:1447–1451.PubMedGoogle Scholar
  11. 11.
    Hejazi RA, McCallum RW. Chapter 16: breath tests for small intestinal bacterial overgrowth. In: Parkman HP, McCallum RW, Rao SSC, eds. GI motility testing: a laboratory and office handbook. Thorofare, NJ: SLACK Incorporated; 2011:145–150.Google Scholar
  12. 12.
    Revick DA, Rentz AM, Dubois D, et al. Gastroparesis Cardinal Symptom Index (GCSI): development and validation of patient reported assessment of severity of gastroparesis symptoms. Qual Life Res. 2004;13:833–844.CrossRefGoogle Scholar
  13. 13.
    Ghoshal UC, Ghoshal U, Das K, Misra A. Utility of hydrogen breath tests in diagnosis of small intestinal bacterial overgrowth in malabsorption syndrome and its relationship with oro-cecal transit time. Indian Soc Gastroenterol. 2006;25:1–10.Google Scholar
  14. 14.
    Malagelada JR, Rees WDW, Mazzotta LJ, Go VLW. Gastric motor abnormalities in diabetic and postvagotomy gastroparesis: effect of metoclopramide and bethanecol. Gastroenterology. 1980;78:286–293.PubMedGoogle Scholar
  15. 15.
    Camilleri M, Malagelada JR. Abnormal intestinal motility in diabetics with gastroparesis syndrome. Eur J Clin Investig. 1984;14:420–427.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Nina S. George
    • 1
  • Abhinav Sankineni
    • 2
  • Henry P. Parkman
    • 2
  1. 1.Department of MedicineTemple University School of MedicinePhiladelphiaUSA
  2. 2.Department of Medicine, Section of GastroenterologyTemple University School of MedicinePhiladelphiaUSA

Personalised recommendations