| Objective: To analysis the specific role and the mechanism of small intestinal bacterial overgrowth(SIBO) in post-infectious irritable bowel syndrome(PI-IBS) by comparison of the difference of clinical symptom scores between patients with PI-IBS and health volunteers without any symptoms associated with irritable bowel syndrome(IBS) who were diagnosed with acute gastroenteritis and had been cured within 12 months, and comparison of the differences of clinical symptom scores and concentration of serum inflammatory cytokines between PI-IBS patients with SIBO positive and negative groups, and search for safe and effective treatment of rifaximin combined with lactobacillus complex capsules for SIBO, further indiciating that SIBO could play an important role in the pathophysiology of PI-IBS.Methods: From January 2014 to June 2015, 120 paitients with PI-IBS met with Rome Ⅲ criteria, all of whom had suffered from acute infectious diarrhea within 12 months and underwent blood routine test, blood biochemical examination,urine routine test, stool routine test,fecal occult blood test, ultrasound of liver,gallbladder,pancreas and spleen, ultrasound of kidney,ureter and bladder, full gastrointestinal contrast and colonoscopy to exclude organic diseases, in our hospital were chosen as the observation group, and 80 healthy volunteers who had suffered from acute infectious diarrhea within 12 months in the physical examination center were enrolled as the control group. All subjects underwent lactulose hydrogen combined with methane breath test, concentration detection of serum inflammatory cytokines(IL-1β, IL-18, IL-10) and questionnaire including IBS symptom scores designed by ourselves. The differences of SIBO positive rate and concentration of serum inflammatory cytokines were compared between PI-IBS group and control group.Based on the result of lactulose hydrogen combined with methane breath test, all patients with PI-IBS were divided into SIBO negative group and positive group, in which patients with PI-IBS were randomly divided into three groups(group A, group B and group C). Patients in group A received two-week treatment of rifaximin combined with lactobacillus complex capsules and then two-week treatment of lactobacillus complex capsules.Patients in group B received four-week treatment with lactobacillus complex capsules, while patients in group C were treated with placebo for four weeks. At the end of treatment, all patients in the three groups were required to complete lactulose hydrogen combined with methane breath test, concentration detection of serum inflammatory cytokines(IL-1β, IL-18, IL-10) and questionnaire once again. The differences of concentration of serum inflammatory cytokines(IL-1β, IL-18, IL-10) were compared between patients with SIBO positive and negative groups.The differences of symptom scores and concentration of serum inflammatory cytokines(IL-1β, IL-18, IL-10) of PI-IBS patients with SIBO positive were compared between before treatment and after treatment. The differences of treatment efficacy, SIBO turning-negative rate, symptom integral after treatment and concentration of serum inflammatory cytokines were compared respectively among group A, group B and group C. The differences of symptom integral and concentration of serum inflammatory cytokines after treatment were compared between SIBO-turning negative group and SIBO-remaining positive group.Results: The SIBO positive rate(75.00% vs 17.50%) and concentration of serum inflammatory cytokines(pg/ml)(IL-1β:91.13±3.97 vs 28.05±8.10,IL-18:138.94±4.48 vs 71.10±7.86,IL-10:39.44±3.78 vs 123.48±6.09)between PI-IBS patients and healthy volunteers who had suffered from acute infectious diarrhea within 12 months had statistical differences(P < 0.05); The concentration of serum inflammatory cytokines-1beta, inflammatory cytokines-18 and inflammatory cytokines-10 between patients with SIBO positive and negative group had statistical differences(P<0.05); The treatment efficacy and turning-negative rate in both group A and group B were obviously higher than that in group C(P<0.05), and what is more, the treatment efficacy and turning-negative rate of group A were superior to that of group B(P<0.05);The symptom integral and concentration of serum inflammatory cytokines-1beta and inflammatory cytokines-18 in both group A and group B after treatment were obviously lower than that before treatment, and what is more, the level in group A decreased significantly; The concentration of serum inflammatory cytokines-10 in both group A and group B after treatment were obviously higher than that before treatment, and what is more, the level in group A increased significantly;No obvious changes in the index of group C were observed; The symptom integral and concentration of serum inflammatory cytokines-1beta and inflammatory cytokines-18 of SIBO-turning negative group after treatment were significantly lower than that before treatment,while the concentration of serum inflammatory cytokines-10 of SIBO-turning negative group after treatment were significantly higher than that before treatment; Obvious changes in the index of SIBO-turning negative group were superior to SIBO-remaining positive group.Conclusion: There was a high incidence of SIBO,lower serum concentration of pro-inflammatory cytokines—inflammatory cytokines-1beta and inflammatory cytokines-18 and higher serum concentration of anti-inflammatory cytokines—inflammatory cytokines-10 in patients with PI-IBS,which indicated that SIBO played a specific role in the pathophysiological mechanisms of PI-IBS. Treatment for SIBO could relieve clinical symptom in patients with PI-IBS, which further indicates that SIBO is associated with PI-IBS.The differences of serum inflammatory cytokines between patients with PI-IBS and healthy volunteers who had suffered from acute infectious diarrhea within 12 months had statistical differences, so it is with the differences between SIBO-turning negative and SIBO-remaining positive groups, which suggested that SIBO might be associated with intestinal immune response in patients with PI-IBS. Rifaximin combined with probiotics for SIBO is effective and worthy of promotion, which could relieve abdominal discomfort, effectively suppress the production of pro-inflammatory cytokines and promote the production of anti-inflammatory cytokines. |
PDF Full Text Request