Clinical Trials Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2017; 23(48): 8591-8596
Published online Dec 28, 2017. doi: 10.3748/wjg.v23.i48.8591
Association between acute pancreatitis and small intestinal bacterial overgrowth assessed by hydrogen breath test
Mei Zhang, Hong-Ming Zhu, Fang He, Bang-Yi Li, Xiao-Cui Li
Mei Zhang, Hong-Ming Zhu, Fang He, Bang-Yi Li, Xiao-Cui Li, Department of Gastroenterology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Author contributions: Zhang M designed the research; Zhu HM and He F performed the research; Li BY and Li XC analyzed the data; Zhang M wrote the paper.
Supported by Wu Jieping Medical Foundation, No. 320.6750.12120.
Institutional review board statement: The study was reviewed and approved by the Department of Gastroenterology of Xuanwu Hospital, Capital Medical University.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: None of the authors has a conflict of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mei Zhang, MD, Professor, Chief Physician, Department of Gastroenterology, Xuanwu Hospital, Capital Medical University No. 45, Changchun Street, Xicheng District, Beijing 100053, China. zhang2955@sina.com
Telephone: +86-10-83198438 Fax: +86-10-83198438
Received: November 28, 2017
Peer-review started: November 28, 2017
First decision: December 6, 2017
Revised: December 12, 2017
Accepted: December 13, 2017
Article in press: December 13, 2017
Published online: December 28, 2017
Processing time: 29 Days and 6.1 Hours
Abstract
AIM

To elucidate the effects of small intestinal bacterial overgrowth (SIBO) on the severity and complications of acute pancreatitis (AP).

METHODS

In total, 208 patients with AP as defined by the revised Atlanta classification were admitted to Xuanwu Hospital of Capital Medical University from 2013 to 2016. All patients were admitted within 72 h of AP onset. The hydrogen breath test was performed 7 d after AP onset to detect hydrogen production and evaluate the development of SIBO. The incidence of SIBO was analyzed in patients with AP of three different severity grades. The association between SIBO and complications of AP was also assessed.

RESULTS

Of the 27 patients with severe AP (SAP), seven (25.92%) developed SIBO. Of the 86 patients with moderately severe AP (MSAP), 22 (25.58%) developed SIBO. Of the 95 patients with mild AP (MAP), eight (8.42%) developed SIBO. There were significant differences in the rates of SIBO among patients with AP of different severities. Additionally, more severe AP was associated with higher rates of SIBO positivity (P < 0.05). SIBO in patients with AP mainly occurred within 72 h of the onset of AP. The incidence of organ failure was significantly higher in patients with SIBO than in those without (P < 0.05).

CONCLUSION

SIBO occurs more frequently in patients with MSAP or SAP than in those with MAP, usually ≤ 72 h after AP onset. Additionally, SIBO is associated with organ failure.

Keywords: Severe acute pancreatitis; Small intestinal bacterial overgrowth; Hydrogen breath test; Complication

Core tip: The research on small intestinal bacterial overgrowth (SIBO) in acute pancreatitis is mostly confined to animal experiments. The traditional method of diagnosing SIBO is to take small intestinal fluid for bacterial culture, but it is difficult to achieve in clinical patients. In this study, a portable hydrogen expiratory detector was used to detect the patients’ expired hydrogen concentration to diagnose SIBO. It was found that there were differences in the positive rates of SIBO in acute pancreatitis with different severity grades. Patients with more severe pancreatitis had a higher positive rate of SIBO. SIBO occurred mainly within 72 h of onset. Patients with SIBO were more prone to organ failure complications.