small intestinal bacterial overgrowth and intestinal permeability
TRANSCRIPT
Scandinavian Journal of Gastroenterology, 2010; 45: 1131–1132
LETTER TO THE EDITOR
Small intestinal bacterial overgrowth and intestinal permeability
ERNESTO CRISTIANO LAURITANO1, VENANZIO VALENZA2, LUCIA SPARANO1,EMIDIO SCARPELLINI1, MAURIZIO GABRIELLI1, ALESSIA CAZZATO1,PIETRO MANUEL FERRARO3 & ANTONIO GASBARRINI1
1Internal Medicine Department, Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy, 2Nuclear MedicineDepartment, Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy, and 3Division of Nephrology andDialysis, Renal Program, Columbus-Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
The gastrointestinal tract is characterized by selec-tive and dynamic permeability allowing the passageof nutrients and fluids and preventing the penetra-tion of intruders such as microorganisms, toxins andother luminal antigens. The gut barrier integrity isessential to maintain human health and homeostasis.A derangement of intestinal permeability (IP) seemsto be involved in the pathogenesis of several intes-tinal and systemic disorders [1]. Several structuresincluding mucous coat, secretory IgA, epitheliallayer, intercellular tight junctions, gut immunesystem and gut microflora contribute to maintainthe integrity of such barrier.Small intestinal bacterial overgrowth (SIBO) is
a common clinical condition due to an increase inthe level of microorganisms to >106 colony formingunits/ml of intestinal aspirate and/or of colonic-type bacteria within the small intestine. This abnor-mally high bacterial population could affect intestinalbarrier through a direct bacterial injury or an immunesystem activation resulting in the release of severalinflammatory mediators and cytokines [2].Aim of this study was to assess IP in patients with
SIBO and the effect of SIBO decontamination.Twenty patients affected by SIBO as assessed by
hydrogen glucose breath test (GBT) (mean age 46.3 ±7.8 years, M/F 9/11) and 21 controls withoutSIBO (mean age 45.1 ± 8.1 years, M/F 9/12) wereenrolled after written informed consent. The test wasconsidered as an indicative of SIBO when the peak,
that is the increase over baseline hydrogen levels,was > 12 parts per million [3]. Exclusion criteriawere all factors known to impair IP: gastrointestinaldisorders and infections, use of non-steroidal anti-inflammatory and immunosuppressive drugs, alcoholconsumption, allergic diseases and HIV infection.
51Chromium ethylene-diamine-tetra-acetate (51Cr-EDTA) absorption test was performed in all patientsto assess IP. The test methodology was the same asdescribed in a previous study by our group [4]. The24-h urinary excretion of 51Cr-EDTA was expressedas a fraction of the oral administered dose and con-sidered abnormal if ‡ 3% [4].All patients were treated by rifaximin (Normix�
200 mg tablets, Alfa-Wassermann) 1200 mg per day(2 tablets t.i.d.) for 7 days [5] and underwent GBTand 51Cr-EDTA absorption test 4 weeks after the endof the therapy.An IP derangement was observed in 11 out of
20 SIBO patients (55%, mean 51Cr-EDTA urinaryexcretion rate: 3.47 ± 0.30) compared to 1 out of21 controls (4.8%, mean 51Cr-EDTA urinary excre-tion rate: 2.17 ± 0.16; p = 0.002).Among SIBO patients with deranged IP, IP nor-
malized in 6 out of 8 successfully decontaminated(75%) compared to 2 out of 3 non-decontaminatedpatients (66%, p = ns). The mean 51Cr-EDTA urinaryexcretion rate significantly decreased after successfuldecontamination (2.28 ± 0.38 vs. 3.7 ± 0.58, ANOVAp < 0.005).
Address for Correspondence: Antonio Gasbarrini, MD, Internal Medicine Department, Gemelli Hospital, Catholic University of Sacred Heart, Largo A.Gemelli 8, 00168 Rome, Italy. Tel: +39 06 3015 4294. Fax: +39 06 3550 2775. E-mail: [email protected]
(Received 8 April 2010; accepted 8 April 2010)
ISSN 0036-5521 print/ISSN 1502-7708 online � 2010 Informa HealthcareDOI: 10.3109/00365521.2010.485325
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These preliminary data suggest for the first timethat IP may be significantly deranged in patientsaffected by SIBO and it is partially restored by suc-cessful decontamination therapy. The small samplesize of our study may underestimate the real impactof SIBO decontamination on IP. The present dataneed to be confirmed by future interventional studieson a larger population.
Acknowledgement
This work was supported by an unrestrictedgrant provided by Fondazione Ricerca in Medicina,Bologna, Italy.
Declaration of interest: The authors declare nopotential conflicts of interest.
References
[1] Arrieta MC, Bistritz L, Meddings JB. Alterations in intestinalpermeability. Gut 2006;55:1512–20.
[2] Gasbarrini A, Lauritano EC, Gabrielli M, Scarpellini E,Lupascu A, Ojetti V, et al. Small intestinal bacterial over-growth: diagnosis and treatment. Dig Dis 2007;25:237–40.
[3] Gasbarrini A, Corazza GR, Gasbarrini G, Montalto M,Di Stefano M, Basilisco G, et al. Methodology and indicationsof H2-breath testing in gastrointestinal diseases: the Rome Con-sensus Conference. Aliment Pharmacol Ther 2009;30:29:1–49.
[4] Scarpellini E, Valenza V, Gabrielli M, Lauritano EC,Perotti G, Merra G, et al. Intestinal permeability in cirr-hotic patients with and without spontaneous bacterial peri-tonitis: is the ring closed? Am J Gastroenterol 2010;105:323–7.
[5] Lauritano EC, Gabrielli M, Lupascu A, Santoliquido A,Nucera G, Scarpellini E, et al. Rifaximin dose-finding studyfor the treatment of small intestinal bacterial overgrowth.Aliment Pharmacol Ther 2005;1;22:31–5.
1132 Letter to the Editor
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