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169PREDICTORS OF SMALL BOWEL BACTERIAL OVERGROWTH (SBBO) IN AN ACADEMIC GASTROENTEROLOGY CENTRE
A Xuan, C James, C Yuan, D Armstrong
Division of Gastroenterology, McMaster University, Hamilton, Ontario
AIM: Clinical predictors for SBBO have not been well studied despite its recognized association with a number of GI conditions. Glucose hydrogen breath test (GHBT) has been used to diagnose SBBO. It is more sensitive and equally specific to the 14C-D-xylose breath test with added advantages of simplicity and nonradioactivity. We undertook a review of 96 consecutive patients undergoing GHBT from January 7 to December 21, 2004 in one of the largest breath test laboratories in Canada to discern useful predictive characteristics.
METHODS: A rise in breath hydrogen
³20 ppm over baseline defined a positive GHBT. Test results and clinical parameters from patient records were extracted into a secure Access database. Association between variables and test results were analyzed by c2 test using SPSS 11.0.
RESULTS: Characteristics of our patient population are summarized below:
| Test result |
Patients n |
Average age (yr) |
Female (%) |
GI symptoms (%)* |
Diarrhea (%) |
Constipation (%) |
| + |
25 |
48 |
84 |
79 |
76 |
40 |
| - |
71 |
49 |
66 |
75 |
56 |
42 |
*One or more symptoms of gas, bloating, cramping and abdominal pain
| Test result |
Wt loss (%) |
LOS >2 yr (%) |
Crohn's disease (%) |
UC (%) |
IBS (%) |
Symptom after test |
Smoker (%) |
| + |
36 |
63 |
24 |
4 |
24 |
48 |
8 |
| - |
23 |
59 |
15 |
3 |
23 |
37 |
13 |
| Test result |
History of small bowel or gastric surgery (%) |
Motility disorder (%) |
Liver or pancreatic disease (%) |
| + |
64 |
12 |
0 |
| - |
10 |
10 |
0 |
SUMMARY: A history of surgery to the stomach or small bowel is the only significant predictor for positive GHBT for SBBO (P<0.0001), with an OR of 19.4 (95% CI 6.2 to 61.2). Its effect is also independent of other variables in each group. Duration and types of symptom before or after GHBT were found not to be predictive. Reported associations of SBBO with chronic pancreatitis and liver disease were not observed in this study sample.
CONCLUSIONS: Screening for SBBO in patients with a gastric or small bowel surgical history may be an effective strategy but, in the absence of such clear predictors, GHBT is still appropriate based on clinical suspicion.