Normal GI motility involves a complex, tightly coordinated series of events designed to move material through the GI tract. 18 These disparate results may represent a true medication effect or, alternatively, reflect the small number of patients studied and differences in assay techniques. 17 Twenty patients treated with 4 weeks of omeprazole had a significant increase in duodenal bacterial counts (compared to baseline) as measured by endoscopic aspirate.
16 A prospective study of 47 outpatients treated with either omeprazole (20 mg/day) or cimetidine (800 mg/day) found that bacterial overgrowth was present in 53% of patients who received omeprazole, compared to 17% who received cimetidine ( P<.05).
Treatment with H2RAs led to SIBO in 18 adult patients, as measured by bile acid breath tests and jejunal aspirates. 15 Inhibition of acid secretion via histamine type 2 receptor blockers (H2RAs) or proton-pump inhibitors (PPIs) may predispose to SIBO, although conflicting results are found in the published literature. pylori diagnosis using urea-based testing given the presence of urease-positive bacterial strains. 12– 14 Interestingly, bacterial overgrowth can lead to a false positive H. Diminished acid production (hypochlorhydria) is a risk factor for SIBO, and can develop after colonization with Helicobacter pylori or as a consequence of aging. Gastric acid suppresses the growth of ingested bacteria, thereby limiting bacterial counts in the upper small intestine. 9 In summary, although data are limited, the prevalence rates of SIBO in young and middle-aged adults appear to be low, whereas prevalence rates appear to be consistently higher in the older patient (14.5–15.6%) these rates, however, are dependent upon the diagnostic test used (see below). 8 Finally, in a study of 111 patients with irritable bowel syndrome (IBS), 20% of healthy age- and sex-matched controls were found to have an abnormal lactulose breath test suggestive of SIBO. 7 Healthy elderly volunteers from the United Kingdom had a 14.5% prevalence rate for SIBO based on a positive glucose breath test. 5 A study of healthy older adults from Japan (mean age 74.7 years) found no patient with SIBO using a glucose breath test 6 an Australian study detected SIBO from duodenal aspirates in 0% of healthy controls (mean age 59), although 13% were positive for SIBO using a lactulose breath test.
In a study of 294 nonhospitalized older adults in which 34 younger adults (mean age 33.6 years) served as healthy controls, the prevalence of SIBO, as determined by glucose breath test, was 5.9% in the control group versus 15.6% in the older group. Only limited data are available regarding the prevalence of SIBO in healthy populations. Only published manuscripts are included in this review abstracts are not included.Īn extensive literature search was unable to identify a study evaluating the incidence of SIBO in healthy volunteers. All identified articles were then manually searched for other relevant studies. For PubMed (no time limit), a similar search process was followed. For Ovid MEDLINE (1966 to December 2006, English language only) three primary search terms (bacterial overgrowth, small intestine overgrowth, and small intestine bacterial overgrowth) were individually coupled with a larger number of secondary search terms (epidemiology, incidence, prevalence, populations at risk, symptoms, pathogenesis, pathophysiology, inflammation, malabsorption, complications, vitamin deficiency, motility disorders, scleroderma, gastroparesis, chronic intestinal pseudo-obstruction, celiac disease, irritable bowel syndrome, renal failure, cirrhosis, alcohol abuse, elderly, aging, diabetes, hypochlorhydria, surgery, malnutrition, diarrhea, evaluation, diagnosis, breath testing, duodenum, jejunum, aspirates, breath tests, lactulose, treatment, antibiotics, rifaximin, tetracycline, metronidazole, ciprofloxacin, amoxicillin/clavulanate, probiotics, duration, resistance). Ovid MEDLINE and PubMed databases were used to search the published literature.
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