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Small Intestinal Bacterial Overgrowth Affects the Responsiveness to Colchicine in Familial Mediterranean Fever
E Verrecchia1, L L Sicignano1, M La Regina1
1Periodic Fever Research Centre, Department of Internal Medicine, Policlinico Gemelli Foundation, Catholic University of Sacred Heart, Rome, Italy.
Objective:
Familial Mediterranean fever (FMF) is an autosomal recessive disease due to a MEFV gene mutation. Since Helicobacter pylori infection has been described to increase the severity and frequency of FMF attacks, we evaluate if overgrowth of small intestinal bacterial (SIBO), associated with a release of bacterial products, can affect the response to colchicine in FMF patients poorly responsive to colchicine.
Methods:
We revised our Periodic Fever Centre database to detect FMF patients who were poorly responsive to colchicine, without a well-defined cause of drug resistance. They were evaluated for SIBO presence, then treated with decontamination therapy.
Results:
Among 223 FMF patients, 49 subjects show colchicine resistance, and no other known causes of colchicine unresponsiveness has been found in 25 patients. All 25 patients underwent glucose breath test; 20 (80%) of them were positive, thus affected by SIBO. After a successful decontamination treatment, 11 patients (55%) did not show FMF attacks during the following three months (p < 0.01), while 9 of them revealed a significant reduction of the number of attacks compared to three months before (p < 0.01).
Conclusion:
The SIBO eradication improves laboratory and clinical features of FMF patients. Thus, patients with unresponsiveness to colchicine treatment should be investigated for SIBO.
Insights
Small intestinal bacterial overgrowth (SIBO) impacts Familial Mediterranean fever (FMF) treatment. Eradicating SIBO can improve colchicine response in FMF patients with poor drug responsiveness, suggesting SIBO screening for these individuals.
Area of Science:
- Genetics and Immunology
- Gastroenterology
- Microbiology
Background:
- Familial Mediterranean fever (FMF) is an inherited autoinflammatory disorder caused by MEFV gene mutations.
- Helicobacter pylori infection is linked to increased FMF attack severity and frequency.
- Small intestinal bacterial overgrowth (SIBO) may influence treatment efficacy through bacterial product release.
Purpose of the Study:
- To investigate the impact of SIBO on colchicine response in FMF patients.
- To determine if SIBO eradication improves clinical outcomes in colchicine-resistant FMF.
Main Methods:
- Retrospective analysis of FMF patients with unexplained colchicine resistance.
- SIBO diagnosis using glucose breath test.
- Treatment of diagnosed SIBO with decontamination therapy.
Main Results:
- Of 25 FMF patients with colchicine resistance, 20 (80%) were diagnosed with SIBO.
- Following SIBO treatment, 11 patients (55%) experienced no FMF attacks in three months.
- Nine patients showed a significant reduction in FMF attack frequency post-treatment.
Conclusions:
- SIBO eradication significantly improves clinical and laboratory features in FMF patients.
- SIBO is a potential factor contributing to colchicine resistance in FMF.
- Investigating SIBO is recommended for FMF patients unresponsive to colchicine.
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