| Aims:To examine the incidence and the potential clinical predictors of small intestinal bacterial overgrowth(SIBO)in patients with functional dyspepsia(FD) by analyzing the results of lactulose hydrogen breath test(LHBT),and to investigate the effects of short-term digestive enzyme on the symptoms and on the results of LHBT in patients with FD overlapping SIBO.Methods:A total of 112 FD patients based on Rome Ⅲ criteria were enrolled, including 88 patients with FD alone(PDS 27,EPS 36,PDS+EPS 25),and 24 with FD overlapping IBS(FD+IBS). A questionair was finished to collect the clinical datas and the gastrointestinal symptoms, and the first LHBT(f-LHBT) was underwent to assess SIBO. The correlations between the results of f-LHBT and the clinical features were analysied,and then the clinical predictors of a positive result of LHBT were evaluated by Logistic regression. The patients with a positive result of f-LHBT were divided into two groups: group Enz whose treatment including Tablet Oryz-Aspergillus Enzyme and Pancreatin(Tab OAEP), and group non-Enz whose not including Tab OAEP. The LHBT was finished at the end of two-week therapy(LHBT-2w). All positive LHBT-2w patients received the another two-week treatment including Tab OAEP. The LHBT was finished at the end of the another two-week therapy(LHBT-4w). The gastrointestinal symptoms were scored respectively at the end of the 2-week and 4-week threapy. And then the relactionships between LHBT and FD symptoms were analysised.Results:(1) Of 112 FD patients, 33(29.46%) had positive f-LHBT, and the positive rate in the group of FD alone(30.7%)was similar to that in group of FD+IBS(25.0%,p>0.05). However, the positive f-LHBT rate in PDS(55.6%)was significantly higher than in EPS(25.0%,p=0.013) and in PDS+EPS(12.0%, p=0.001) respectively. The degree of upper abdominal bloating(OR=1.759,95%CI 1.187-2.609) and nausea(OR=1.634,95%CI 1.029-2.594) were independent predictors of a positive result of LHBT in patients with FD by Logistic regression analysis.(2) Of 26 patients with positive f-LHBT, 17 patients(65.38%) had negative LHBT-2w at the end of 2-week treatment and showed a 75.87± 22.08% improvement of their symptoms, which was clearly higher than that in the patients with remaining positive LHBT-2w(46.52± 30.33%,t=-2.833,p=0.009).(3) After two-week treatment, the symptoms had 75.89± 21.92% improvement in group Enz(n=14) and 53.84± 31.39% in group non-Enz(n=12) respectively, and the difference was significant(t=2.100,p=0.046). The negative LHBT-2w rate was 71.4% in group Enz and 58.3% in group non-Enz(p=0.683).The basic hydrogen levels had no statistically significantce between the two groups(u=-0.183,p=0.855), however, the decrement rate of the peak hydrogen levels was significantly higher in group Enz than in group non-Enz(u=-2.315,p= 0.021).(4) Of 7 patients with positive LHBT-2w received another two-week treatment with Tab OAEP, 4 patients had negative LHBT at the end of the 4th week(LHBT-4w), accompanied with an improvement of symptoms. Another 3 patients remained positive LHBT-4w, however, their peak of hydrogen levels declined.Conclusion: About 29% FD patients have a positive LHBT, which indicates an overlapping with SIBO. The degree of upper abdominal bloating and of nausea are the independent predictors of SIBO. Eradicating SIBO may result in a significant improvement of dyspeptic symptoms, shows that there is some association between FD and SIBO. A short-term treatment with Tab OAEP may achieve an improvement of symptoms in FD patients overlapping with SIBO, which suggesting the Tab OAEP may reduce the bacterial overgrowth. |
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