Small intestinal bacterial overgrowth mimicking acute flare as a pitfall in patients with Crohn's Disease
Small intestinal bacterial overgrowth mimicking acute flare as a pitfall in patients with Crohn's Disease
复制标题
DOI：
10.1186/1471-230x-9-61
复制
发表时间：
2009-07-30
影响因子：
2.4
通讯作者：
von Tirpitz, Christian C.
中科院分区：
文献类型：
--
作者：
Klaus, Jochen;Spaniol, Ulrike;von Tirpitz, Christian C.
背景：小肠细菌过度生长（Small intestinal bacterial overgrowth， SIBO）是以小肠结肠细菌种类过度增生为特征。SIBO的潜在病因包括瘘管、狭窄或运动障碍。因此，克罗恩病（CD）患者特别容易发生SIBO。因此，乳糜泻患者可能会出现吸收不良，并报告体重减轻、水样腹泻、腹泻、肠胃胀气和腹痛等症状，类似于这些患者的急性发作。方法：采用氢葡萄糖呼吸试验（HGBT）对150例报告大便频率增加、尿频和/或腹痛的CD患者进行SIBO前瞻性评估。结果：38例（25.3%）患者根据HGBT阳性结果诊断为SIBO。SIBO患者报告的腹部主诉率更高，排便频率增加（5.9对3.7次/天，p = 0.003），体重降低（63.6对70.4 kg, p = 0.014）。与克罗恩病活动指数没有相关性。SIBO在结肠部分切除或多次肠道手术患者中更为常见；回盲切除术患者也有明显的趋势，但没有达到统计学意义。结肠和小肠同时受影响的患者SIBO发生率也较高，而（新）回肠末端的炎症再次显示与SIBO的发展仅呈趋势相关。结论：SIBO是CD中一种经常被忽视但与临床相关的并发症，通常模拟急性发作。由于SIBO的症状往往难以与基础疾病引起的症状区分开来，因此建议对有相应临床体征和易感因素的患者进行针对性的检查。
Background: Small intestinal bacterial overgrowth (SIBO) is characterized by excessive proliferation of colonic bacterial species in the small bowel. Potential causes of SIBO include fistulae, strictures or motility disturbances. Hence, patients with Crohn's Disease (CD) are especially predisposed to develop SIBO. As result, CD patients may experience malabsorption and report symptoms such as weight loss, watery diarrhea, meteorism, flatulence and abdominal pain, mimicking acute flare in these patients.Methods: One-hundred-fifty patients with CD reporting increased stool frequency, meteorism and/or abdominal pain were prospectively evaluated for SIBO with the Hydrogen Glucose Breath Test (HGBT).Results: Thirty-eight patients (25.3%) were diagnosed with SIBO based on positive findings at HGBT. SIBO patients reported a higher rate of abdominal complaints and exhibited increased stool frequency (5.9 vs. 3.7 bowel movements/day, p = 0.003) and lower body weight (63.6 vs 70.4 kg, p = 0.014). There was no correlation with the Crohn's Disease Activity Index. SIBO was significantly more frequent in patients with partial resection of the colon or multiple intestinal surgeries; there was also a clear trend in patients with ileocecal resection that did not reach statistical significance. SIBO rate was also higher in patients with affection of both the colon and small bowel, while inflammation of the (neo) terminal ileum again showed only tendential association with the development of SIBO.Conclusion: SIBO represents a frequently ignored yet clinically relevant complication in CD, often mimicking acute flare. Because symptoms of SIBO are often difficult to differentiate from those caused by the underlying disease, targeted work-up is recommended in patients with corresponding clinical signs and predisposing factors.