Small Intestinal Bacterial Overgrowth in Patients with Interstitial Cystitis and Gastrointestinal Symptoms
Purpose Interstitial cystitis (IC) often coexists with irritable bowel syndrome (IBS). IBS may be explained by small-intestinal bacterial overgrowth (SIBO), which increases immune activation and visceral hypersensitivity. This prospective pilot study tested hypotheses that IC patients with gastrointestinal (GI) symptoms have SIBO, that nonabsorbable antibiotic use improves symptoms, and that improvement is sustained by prokinetic therapy. Methods Consecutive IC patients with GI symptoms had lactulose breath testing (LBT). Those with abnormal results received rifaximin 1,200–1,800 mg/day for 10 days then tegaserod 3 mg/nightly. Questionnaires addressed IC and GI global improvement. Results Of 21 patients, 17 (81%) had abnormal LBTs. Of 15 patients treated, GI global improvement was moderate to great in 11 (73%) and sustained in ten (67%). IC global improvement was moderate to great in six (40%) and sustained in seven (47%). Conclusions A majority of IC patients and GI symptoms had an abnormal LBT suggesting SIBO. Rifaximin improved symptoms, which was sustained by tegaserod.
KeywordsSIBO Interstitial cystitis IBS Rifaximin
Dr. Lin’s work is supported by the Jill and Tom Barad Family Fund. No commercial financial support was received for the conduct of this study. Speaker’s Bureau: Salix and Novartis (Weinstock, Lin); IP rights (Lin).
- 1.Nickel JC (2004) Interstitial cystitis: a chronic pelvic pain syndrome. Med Clin North Am 88:467–481Google Scholar
- 2.Giamberardino M (2000) Sex-related and hormonal modulation of visceral pain. In: Fillingim R (ed) Sex gender and pain, vol 17. IASP Press, SeattleGoogle Scholar
- 4.Ritchie J (1973) Pain from distension of the pelvic colon by inflating a balloon in the irritable bowel syndrome. Gut 6:105–112Google Scholar
- 10.Pimentel M, Chow EJ, Lin HC (2000) Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol 95:3505–3506Google Scholar
- 14.Lee HR, Low K, Chatterjee S et al (2006) In the treatment of IBS, the clinical response to rifaximin is determined by the normalization of the lactulose breath test. Am J Gastroenterol 110:A1223Google Scholar
- 23.Di Stefano M, Vos R, Janssens J et al (2003) Effect of tegaserod, a 5-HT4 receptor partial agonist, on interdigestive and postprandial gastrointestinal motility in healthy volunteers. Gastroenterology 126:A105412Google Scholar
- 25.Weinstock LB, Tordorczuk JT, Fern SE et al (2006) Comprehensive SIBO therapy of IBS patients. Am J Gastroenterol 110:A1123Google Scholar
- 26.Weinstock LB, Tordorczuk JT, Fern SE et al (2006) Comprehensive SIBO therapy of functional bowel patients. Am J Gastroenterol 110:A1124Google Scholar
- 37.Coelho AM, Fioramonti J, Bueno L (2000) Systemic lipopolysaccharide influences rectal sensitivity in rats: role of mast cells, cytokines and vagus nerve. Am J Physiol Gastrointestinal Liver Physiol 279:G781–G790Google Scholar