Small intestinal bacterial overgrowth is common after gastrectomy but with little impact on nutritional status

• Published in: Gastroenterología y Hepatología (English Edition) 2019-01, Vol.42 (1), p.1-10
• Main Authors: Pérez Aisa, Angeles, García Gavilán, Mari Carmen, Alcaide García, Julia, Méndez Sánchez, Isabel María, Rivera Irigoin, Robin, Fernández Cano, Francisco, Pereda Salguero, Teresa, Rivas Ruiz, Francisco
• Format: Article
• Language: English
• Subjects: Antibiotic treatment failure; Bacterial overgrowth; Gastrectomy; Gastrectomía; Malnutrición; Malnutrition; Multifracaso antibiótico; Sobrecrecimiento bacteriano
• ISSN: 2444-3824; 2444-3824
• DOI: 10.1016/j.gastre.2019.01.007

Available evidence assessing the impact of small intestinal bacterial overgrowth (SIBO) following gastrectomy is limited. To evaluate the prevalence of SIBO after gastrectomy and its association with malnutrition. To describe the antibiotic treatment required to correct it and if nutritional status improves. A prospective cohort study was performed at the Agencia Sanitaria Costa del Sol (Costa del Sol Health Agency) from 2012 to 2015. A hydrogen-methane breath test with oral glucose overload was performed. Demographic variables and nutritional parameters were collected at baseline and one month after effective treatment of SIBO. The antibiotic regimens and the number of treatment lines used were assessed. Sixty gastrectomy patients were analysed, 58.3% of which were male. A sub-analysis of the curve was performed at 45min to minimise possible false positives, and SIBO was identified in 61.6% of cases. SIBO patients tended to have a lower BMI, although this trend was not statistically significant. After treatment with rifaximin, 94.6% of patients were still positive for SIBO, which fell to 85.7% after metronidazole. The rate of total antibiotic treatment failure was 67.6%. No statistically significant changes were found in nutritional parameters after treatment. SIBO was identified in 61.6% of patients after gastrectomy. No correlation was found with any malnutrition parameter. Rifaximin and metronidazole were found to be largely ineffective in eradicating SIBO. When treatment was effective, the impact on malnutrition was negligible and may have been associated with other factors. La evidencia disponible que evalúa el impacto de la presencia de sobrecrecimiento bacteriano de intestino delgado (SIBO) después de una gastrectomía es escasa. Evaluar la frecuencia de SIBO tras gastrectomía y su asociación con malnutrición. Describir las líneas antibióticas necesarias para su corrección y si mejora el estado nutricional. Estudio de cohortes prospectivo en el ámbito de la Agencia Sanitaria Costa del Sol desde 2012 hasta 2015. Se realizó test del aliento en hidrógeno y en metano espirado con sobrecarga oral de glucosa. Recogida de variables demográficas y valoración nutricional, basal y al mes del tratamiento eficaz del SIBO. Se evaluaron las pautas antibióticas y el número de tratamientos. Se analizaron 60 pacientes gastrectomizados, 58,3%varones. Se realizó un subanálisis de la curva a los 45min para minimizar los posibles falsos positivos con una frecuencia de S