Small Intestinal Bacterial Overgrowth Is Common in Chronic Pancreatitis and Associates With Diabetes, Chronic Pancreatitis Severity, Low Zinc Levels, and Opiate Use
Small Intestinal Bacterial Overgrowth Is Common in Chronic Pancreatitis and Associates With Diabetes, Chronic Pancreatitis Severity, Low Zinc Levels, and Opiate Use
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DOI：
10.14309/ajg.0000000000000200
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发表时间：
2019-07-01
影响因子：
9.8
通讯作者：
DiMagno, Matthew J.
中科院分区：
文献类型：
--
作者：
Lee, Allen A.;Baker, Jason R.;DiMagno, Matthew J.
目的：小肠细菌过度生长（SIBO）通常存在于慢性胰腺炎（CP）伴持续性脂肪肝的患者中，尽管接受了胰酶替代治疗。通过葡萄糖呼气试验（GBT）诊断的SIBO的总体患病率在0%至40%之间变化，但在没有上消化道（GI）手术的患者中为0%-21%。我们调查了无上消化道手术的CP患者SIBO的患病率和非手术独立预测因素。方法：1989年至2017年期间，273例≥ 18岁的患者被推定诊断为CP和GBT。我们根据马约评分（0-16）>= 4定义CP，根据罗马共识标准定义SIBO的阳性GBT，并回顾性收集5个先验变量的数据（年龄、阿片类药物、饮酒、糖尿病（DM）、胃轻瘫）和41个研究变量（人口统计学、GI症状、合并症、CP病因和辅因子、CP症状持续时间、马约评分和非糖尿病组分，生化变量）。结果：273例患者中有98例有明确的CP，40.8%有SIBO。46个变量中有5个预测了SIBO：阿片类药物，P = 0.005; DM，P = 0.04;总马约评分，P < 0.05;锌，P = 0.005;白蛋白，P < 0.05）。3个非相关变量的多变量分析确定锌水平（优势比= 0.0001; P = 0.03）是SIBO的唯一独立预测因子（模型C-统计量= 0.89; P < 0.001）。讨论：SIBO，GBT诊断，发生在40.8%的CP患者没有上消化道手术。在CP患者中，更严重的CP标志物（低锌水平、DM和马约评分增加）和阿片类药物使用应引起临床怀疑SIBO，特别是在尽管接受胰酶替代治疗但持续脂肪增多或体重减轻的患者中。
OBJECTIVES: Small intestinal bacterial overgrowth (SIBO) is often present in patients with chronic pancreatitis (CP) with persistent steatorrhea, despite pancreatic enzyme replacement therapy. Overall prevalence of SIBO, diagnosed by glucose breath test (GBT), varies between 0% and 40% but 0%-21% in those without upper gastrointestinal (GI) surgery. We investigated the prevalence and nonsurgical independent predictors of SIBO in CP without upper GI surgery. METHODS: Two hundred seventy-three patients >= 18 years old had a presumptive diagnosis of CP and a GBT between 1989 and 2017. We defined CP by Mayo score (0-16) >= 4 and a positive GBT for SIBO by Rome consensus criteria and retrospectively collected data for 5 a priori variables (age, opiates, alcohol use, diabetes mellitus (DM), gastroparesis) and 41 investigational variables (demographics, GI symptoms, comorbidities, CP etiologies and cofactors, CP symptom duration, Mayo score and nondiabetes components, and biochemical variables). RESULTS: Ninety-eight of 273 patients had definite CP and 40.8% had SIBO. Five of 46 variables predicted SIBO: opiates, P = 0.005; DM, P = 0.04; total Mayo score, P < 0.05; zinc, P = 0.005; and albumin, P < 0.05). Multivariable analysis of 3 noncorrelated variables identified zinc level (odds ratio = 0.0001; P = 0.03) as the sole independent predictor of SIBO (model C-statistic = 0.89; P < 0.001). DISCUSSION: SIBO, diagnosed by GBT, occurs in 40.8% of patients with CP without upper GI surgery. In patients with CP, markers of more severe CP (low zinc level, DM and increased Mayo score) and opiate use should raise clinical suspicion for SIBO, particularly in patients with persistent steatorrhea or weight loss despite pancreatic enzyme replacement therapy.