Effectiveness of Saccharomyces boulardii and Metronidazole for Small Intestinal Bacterial Overgrowth in Systemic Sclerosis
Effectiveness of Saccharomyces boulardii and Metronidazole for Small Intestinal Bacterial Overgrowth in Systemic Sclerosis
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DOI：
10.1007/s10620-019-05830-0
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发表时间：
2020-04-01
影响因子：
3.1
通讯作者：
Cruz-Dominguez, Maria Pilar
中科院分区：
文献类型：
--
作者：
Garcia-Collinot, Grettel;Madrigal-Santillan, Eduardo Osiris;Cruz-Dominguez, Maria Pilar
小肠细菌过度生长（SIBO）影响高达60%的系统性硬化症（SSc）患者，抗生素可改善这种情况。添加益生菌可能会导致更好的结果。目的评价布拉酵母菌（SB）、甲硝唑（M）、M + SB治疗SSc 2个月的有效性和安全性，以减少消化道症状和氢呼气试验评估的SIBO。方法在40例签署知情同意书的SIBO和SSc患者中进行开放性先导性临床试验（ACR-EULAR 2013）。分为三组：M、SB和M + SB，持续2个月。用氢呼吸试验以百万分率测量氢以评估SIBO。应用美国国立卫生研究院患者报告结局测量信息系统（NIH-PROMIS）问卷对胃肠道症状进行量化，原始评分为8个症状。本研究在ClinicalTrials.gov上注册，ID为：NCT 03692299。结果两组基线特征相似。平均年龄为53.2 +/- 9.3岁，SSc的演变为13.5（1-34）年。治疗2个月后，55%的M + SB组SIBO被根除：SB组33%，M组25%。SB和M + SB组的腹泻、腹痛和胀气/腹胀/肠胃气胀减少，但M保持不变。在第一个月和第二个月，在45至60分钟时呼出氢的减少如下：M + SB分别为48%和44%，M为18%和20%，SB为53%和60%（p < 0.01）。不良反应为上腹部烧灼感和便秘，M组（53%）和M + SB组（36%），SB组（22%）为肠胃气胀/腹泻。结论甲硝唑治疗SIBO部分有效，S。布拉地单药治疗或联合治疗可改善SSc患者的胃肠道结局。
Background Small intestinal bacterial overgrowth (SIBO) affects up to 60% of patients with systemic sclerosis (SSc), and it improves with antibiotics. The addition of probiotics could lead to better results. Aims To evaluate the efficacy and safety of Saccharomyces boulardii (SB) versus metronidazole (M) versus M + SB for 2 months, to reduce gastrointestinal symptoms and SIBO assessed with hydrogen breath test in SSc. Methods An open pilot clinical trial performed in forty patients with SIBO and SSc (ACR-EULAR 2013) who signed informed consent. Three groups were assigned: M, SB, and M + SB, for 2 months. Hydrogen was measured in parts per million with a hydrogen breath test to evaluate SIBO. The National Institutes of Health Patient-Reported Outcomes Measurement Information System (NIH-PROMIS) questionnaire was applied to quantify gastrointestinal symptoms with a raw score of eight symptoms. This study is registered in ClinicalTrials.gov with the following ID: NCT03692299. Results Baseline characteristics were similar between groups. The average age was 53.2 +/- 9.3 years, and the evolution of SSc was 13.5 (1-34) years. After 2 months of treatment, SIBO was eradicated in 55% of the M + SB group: 33% of SB, and 25% of M. The SB and M + SB groups had decreased diarrhea, abdominal pain, and gas/bloating/flatulence, but M remained unchanged. Reductions in expired hydrogen at 45 to 60 min were as follows: M + SB 48% and 44%, M 18% and 20%, and SB 53% and 60% at the first and second months, respectively (p < 0.01). Adverse effects were epigastric burning and constipation in M (53%) and M + SB (36%), and flatulence/diarrhea in SB (22%). Conclusions Metronidazole treatment is partially effective in SIBO, but S. boulardii in monotherapy or in combination improves the gastrointestinal outcomes in SSc.