PPI Methane.doc

Am J Gastroenterol 2012 May 107 5 730 5 doi 10 1038 ajg 2012 4 Epub 2012 Feb 14 Proton pump inhibitor therapy use does not predispose to small intestinal bacterial overgrowth Ratuapli SK Ellington TG O Neill MT Umar SB Harris LA Foxx Orenstein AE Burdick GE Dibaise JK Lacy BE Crowell MD Source Division of Gastroenterology Mayo Clinic Scottsdale Arizona USA Abstract OBJECTIVES Small intestinal bacterial overgrowth SIBO occurs due to alteration of the microbiota within the upper gastrointestinal tract Proton pump inhibitor PPI therapy has been suggested as a risk factor for SIBO however the published reports have yielded conflicting results on the association between PPI therapy and risk of developing SIBO The aim of this study was to compare the prevalence of SIBO as measured by glucose hydrogen breath testing GHBT in patients on PPI therapy compared with those not on PPI therapy METHODS A retrospective chart review was completed for all patients who underwent GHBT testing from 2004 to 2010 Breath samples for hydrogen H and methane CH were collected before and every 20 min for 120 min following ingestion of a 50 g oral glucose load We used the following criteria to define a positive GHBT a increase in H 20 parts per million p p m over baseline b sustained rise H 10 p p m over baseline c CH 15 p p m over baseline and d either rise H 20 p p m over baseline or CH 15 p p m RESULTS A total of 1 191 patients 70 female were included of whom 566 48 were on PPI therapy GHBT positivity did not differ significantly between PPI users and nonusers by any of the diagnostic criteria used and PPI use was not significantly associated with GHBT positivity using any of these criteria GHBT positivity was associated with older age odds ratio OR 1 03 95 confidence interval CI 1 01 1 04 and antidiarrheal use OR 1 99 95 CI 1 15 3 44 using H 20 older age OR 1 01 95 CI 1 00 1 02 and diarrhea OR 1 53 95 CI 1 13 2 09 using H 10 and older age OR 1 01 95 CI 1 00 1 02 using either H 20 or CH 15 PPI use was not significantly associated with GHBT positivity using any of these criteria CONCLUSIONS In this large adequately powered equivalence study PPI use was not found to be significantly associated with the presence of SIBO as determined by the GHBT Digestive Diseases and Sciences August 2010 Volume 55 Issue 8 pp 2302 2308 Proton Pump Inhibitor Therapy Does Not Affect Hydrogen Production on Lactulose Breath Test in Subjects with IBS David Law Mark Pimentel Look InsideGet Access Abstract Background Evidence suggests a role for small intestinal bacterial overgrowth SIBO in IBS Recently the question has arisen whether the lactulose breath test LBT is abnormal in IBS subjects due to overlapping GERD and proton pump inhibitor PPI usage Aim The aim of this study was to compare the prevalence of an abnormal LBT in IBS patients either receiving or not receiving PPI therapy Methods Consecutive Rome I positive IBS patients referred for LBT completed a questionnaire regarding their symptoms and medication use All subjects then underwent an LBT The prevalence of abnormal breath test results and hydrogen production were compared based on PPI usage Results Of a total of 555 429 female subjects 106 19 1 subjects reported current PPI use Among those on PPI 46 2 had a positive LBT This was not different from the 56 3 positive LBT in non PPI subjects OR 0 67 CI 0 436 1 017 P 0 06 No differences in hydrogen parameter were seen with PPI The average amplitude of rise first peak in PPI users was 28 0 35 3 ppm from baseline in non PPI users it was 27 5 29 1 ppm P 0 89 The average rise in the second peak in PPI users was 48 5 43 8 ppm from baseline in non PPI users it was 49 3 37 6 ppm P 0 87 The time to first peak in PPI users was 56 4 23 0 min in non PPI users it was 58 2 26 1 min P 0 58 However among subjects receiving PPI only 7 5 had methane detection on LBT which is significantly different from the 15 4 of subjects not taking PPI Conclusion PPI therapy does not effect hydrogen production on lactulose breath tests in IBS patients However there may be an effect on methane Adv Med Sci 2007 52 139 42 Results of small intestinal bacterial overgrowth testing in irritable bowel syndrome patients clinical profiles and effects of antibiotic trial Majewski M McCallum RW Source Department of Medicine Division of Gastroenterology University of Kansas Medical Center Kansas City KS 66061 USA Abstract PURPOSE Small intestinal bacterial overgrowth SIBO may coexist with irritable bowel syndrome IBS and eradication therapy has been reported as effective in reducing IBS symptoms Aims of this study were to 1 Assess the clinical profiles of IBS patients who underwent breath testing with a glucose substrate glucose breath test GBT 2 Evaluate hydrogen and methane parameters in various IBS groups 3 Assess the role of inhibition of gastric acid in contributing to SIBO 4 Investigate efficacy and safety of non absorbable antibiotic rifamixin for eradication and symptom relief METHODS 204 IBS patients met the ROME II criteria for IBS 170F mean age 46 4 range 18 88 and underwent GBT 8 of these patients with positive GBT were treated with rifaximin 200 mg 4 times a day for 1 month and symptom assessments and GBT were repeated RESULTS 93 46 had a positive GBT 68 73 of these 93 IBS diarrhea dominant IBS D 12 13 were constipation dominant IBS C and 13 14 IBS with alternating bowel pattern 48 of SIBO positive patients were receiving PPI therapy compared to 40 of IBS patients with negative GBT 61 66 produced only hydrogen 27 29 methane only and 5 5 both hydrogen and methane There were more methane producers in IBS C then IBS D group 58 vs 28 while IBS D had more hydrogen formers 71 vs 42 8 patients with SIBO 7F mean age 55 range 31 85 received rifamixin 800 mg day Repeat GBT was normal in 6 75 1 patient 12 5 normalized according to hydrogen criteria but methaneremained positive Symptoms score improved in 7 87 5 patients and no adverse events were noted CONCLUSIONS 1 SIBO was present in nearly half of this large cohort of IBS patients based on the results of GBT 2 Chronic PPI use was not associated with SIBO 3 Methane formers on the GBT are more likely to be constipated 4 Rifaximin is effective in treatment of SIBO in IBS and controlled trials are warranted Am J Med Sci 2007 May 333 5 266 70 Efficacy of rifaximin a nonabsorbed oral antibiotic in the treatment of small intestinal bacterial overgrowth Majewski M Reddymasu SC Sostarich S Foran P McCallum RW Source Department of Internal Medicine Center for Gastrointestinal Nerve and Muscle Function School of Medicine The University of Kansas Medical Center Kansas City Kansas USA Abstract INTRODUCTION Rifamixin is an orally administrated nonabsorbed antibiotic whose utility in eradication of small intestinal bacterial overgrowth SIBO is currently being evaluated PURPOSE The aim of this study was to investigate efficacy and safety of rifaximin in relieving symptoms and normalizing the glucose breath test GBT in patients with SIBO METHODS Symptom score assessment consisting of frequency and severity of bloating gas abdominal pain and bowel movements and the GBT were performed before and after treatment with rifaximin 800 mg d for 4 weeks SUBJECTS Twenty consecutive symptomatic patients 16 women and 4 men mean age 47 8 years range 19 to 85 years who had a positive GBT were prospectively studied in an open labeled fashion Fourteen patients 70 0 presented with diarrhea 3 15 0 with bloating and gas and 3 15 0 with constipation as the dominant symptom RESULTS Eleven patients were hydrogen producers 8 exclusively methane and 1 patient produced both gases by the GBT Among patients with diarrhea 12 of 14 85 7 reported improvement in symptom scores of more than 50 1 between 25 and 50 1 had no response after 4 weeks of rifamixin Among patients with bloating and gas or constipation as the main symptom 2 of 6 33 3 had improvement between 50 and 75 3 50 had 25 to 50 improvement and 1 16 7 had no response Repeat GBT at the end of the 4 weeks showed that 54 5 of hydrogen formers and 50 0 of methane producers were eradicated and there was a significant reduction P 0 05 in the area under the concentration time curve and peak values No adverse effects were observed CONCLUSIONS Rifaximin in a dose of 800 mg per day for 4 weeks 1 was safe and effective treatment in reducing symptoms in patients with SIBO of multiple etiologies especially when diarrhea was the dominant symptom and 2 normalized the GBT in approximately 50 of patients Data support a future therapeutic role for rifaximin in SIBO Eur J Clin Invest 2011 Apr 41 4 380 6 doi 10 1111 j 1365 2362 2010 02419 x Epub 2010 Dec 3 Effects of long term PPI treatment on producing bowel symptoms and SIBO Compare D Pica L Rocco A De Giorgi F Cuomo R Sarnelli G Romano M Nardone G Source Department of Clinical and Experimental Medicine Gastroenterology Unit University of Naples Federico II Naples Italy Abstract BACKGROUND Gastroesophageal reflux disease GERD including erosive reflux disease and non erosive reflux disease NERD is a chronic disease with a significant negative effect on quality of life State of the art treatment involves proton pump inhibitors PPIs However relapse of symptoms occurs in the majority of the patients who require recurrent or continuous therapy Although PPIs are well tolerated little information is available about gastrointestinal side effects AIM To evaluate the effects of long term PPI treatment on development of bowel symptoms and or small intestinal bacterial overgrowth SIBO METHODS Patient