A Prospective Evaluation of Ileocecal Valve Dysfunction and Intestinal Motility Derangements in Small Intestinal Bacterial Overgrowth
A Prospective Evaluation of Ileocecal Valve Dysfunction and Intestinal Motility Derangements in Small Intestinal Bacterial Overgrowth
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DOI：
10.1007/s10620-017-4726-4
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发表时间：
2017-12-01
影响因子：
3.1
通讯作者：
Pasricha, Pankaj Jay
中科院分区：
文献类型：
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作者：
Roland, Bani Chander;Mullin, Gerard E.;Pasricha, Pankaj Jay
小肠细菌过度生长（SIBO）是一种日益被认识的临床综合征，然而，其病因却知之甚少。我们假设胃酸丢失、肠传输延迟和回盲瓣功能障碍可能导致该综合征的发生。我们的主要目的是使用无线动力胶囊（WMC）测试评估这些参数，并将其与SIBO的存在或不存在相关联。我们前瞻性地评估了三级护理中心的30名疑似SIBO的连续患者，通过乳果糖氢呼气试验（LBT）和小肠抽吸微生物学诊断。患者进行WMC测试，以评估回盲部压力（ICJP），小肠通过时间（SBTT），和区域胃肠道pH.30例患者完成了测试，15例阳性LBT，11例阳性吸出物培养。与LBT阴性患者相比，ICJP较低（27.8 vs. 72.7 mmHg，p = 0.027），SBTT较长（10.0 vs. 1.1 h，p = 0.004），胃pH较高（3.63 vs. 2.42，p < 0.01），小肠pH较高（6.96 vs. 6.61，p = 0.05）。与LBT阴性患者相比，LBT阳性患者中膨胀性ICJP（< 46.61 mmHg）更普遍（73.3% vs. 14.29%，p = 0.003）。Logistic回归模型用于评估每个测量的WMC参数的大小和SIBO的存在。与没有SIBO的患者相比，具有SIBO的患者具有显著较低的ICJP、延长的SBTT和较高的胃肠道pH。这些异常可能在SIBO的发病机制中发挥不同的作用，从而促进更有针对性的治疗，以防止SIBO的复发。
Small intestinal bacterial overgrowth (SIBO) is an increasingly recognized clinical syndrome; however, its etiophathogenesis is poorly understood. We hypothesized that loss of gastric acid, a delayed intestinal transit, and ileocecal valve dysfunction may contribute to the genesis of this syndrome.Our primary aim was to assess these parameters using wireless motility capsule (WMC) testing and to correlate them with the presence or absence of SIBO.We prospectively evaluated 30 consecutive patients at a tertiary care center with suspected SIBO, diagnosed by lactulose hydrogen breath testing (LBT), and small bowel aspirate microbiology. Patients underwent WMC testing to assess ileocecal junction pressure (ICJP), small bowel transit time (SBTT), and regional gastrointestinal pH.Thirty patients completed testing; 15 had a positive LBT, and 11 had a positive aspirate culture. As compared with LBT-negative patients, ICJP was lower (27.8 vs. 72.7 mmHg, p = 0.027), SBTT was longer (10.0 vs. 1.1 h, p = 0.004), gastric pH was higher (3.63 vs. 2.42, p < 0.01), and small bowel pH was higher (6.96 vs. 6.61, p = 0.05). A hypotensive ICJP (< 46.61 mmHg) was more prevalent in LBT-positive patients as compared with LBT-negative patients (73.3 vs. 14.29%, p = 0.003). Logistic regression models were used to assess the magnitude of each measured WMC parameter and the presence of SIBO. p values ae0.05 were considered statistically significant.Patients with SIBO have significantly lower ICJP, prolonged SBTT, and a higher gastrointestinal pH as compared to those without SIBO. These abnormalities may play different roles in the pathogenesis of SIBO, facilitating more targeted treatment to prevent recurrences of SIBO.