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Small Intestinal Bacterial Overgrowth Is Common in Chronic Pancreatitis and Associates With Diabetes, Chronic
Allen A Lee1, Jason R Baker1, Erik J Wamsteker1
1Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
Objectives:
Small intestinal bacterial overgrowth (SIBO) is often present in patients with chronic pancreatitis (CP) with persistent steatorrhea, despite pancreatic enzyme replacement therapy. Overall prevalence of SIBO, diagnosed by glucose breath test (GBT), varies between 0% and 40% but 0%-21% in those without upper gastrointestinal (GI) surgery. We investigated the prevalence and nonsurgical independent predictors of SIBO in CP without upper GI surgery.
Methods:
Two hundred seventy-three patients ≥18 years old had a presumptive diagnosis of CP and a GBT between 1989 and 2017. We defined CP by Mayo score (0-16) ≥4 and a positive GBT for SIBO by Rome consensus criteria and retrospectively collected data for 5 a priori variables (age, opiates, alcohol use, diabetes mellitus (DM), gastroparesis) and 41 investigational variables (demographics, GI symptoms, comorbidities, CP etiologies and cofactors, CP symptom duration, Mayo score and nondiabetes components, and biochemical variables).
Results:
Ninety-eight of 273 patients had definite CP and 40.8% had SIBO. Five of 46 variables predicted SIBO: opiates, P = 0.005; DM, P = 0.04; total Mayo score, P < 0.05; zinc, P = 0.005; and albumin, P < 0.05). Multivariable analysis of 3 noncorrelated variables identified zinc level (odds ratio = 0.0001; P = 0.03) as the sole independent predictor of SIBO (model C-statistic = 0.89; P < 0.001).
Discussion:
SIBO, diagnosed by GBT, occurs in 40.8% of patients with CP without upper GI surgery. In patients with CP, markers of more severe CP (low zinc level, DM and increased Mayo score) and opiate use should raise clinical suspicion for SIBO, particularly in patients with persistent steatorrhea or weight loss despite pancreatic enzyme replacement therapy.
Insights
Small intestinal bacterial overgrowth (SIBO) affects 40.8% of chronic pancreatitis patients without prior GI surgery. Low zinc levels independently predict SIBO in these patients, indicating disease severity.
Area of Science:
- Gastroenterology
- Internal Medicine
- Microbiology
Background:
- Small intestinal bacterial overgrowth (SIBO) is a common complication in chronic pancreatitis (CP) patients, often presenting with persistent steatorrhea.
- Prevalence rates of SIBO in CP patients without prior upper gastrointestinal surgery are not well-established.
Purpose of the Study:
- To determine the prevalence of SIBO in patients with chronic pancreatitis (CP) who have not undergone upper gastrointestinal surgery.
- To identify independent predictors of SIBO in this patient population.
Main Methods:
- A retrospective analysis of 273 patients with a presumptive diagnosis of CP and a positive glucose breath test (GBT) for SIBO.
- Data collected included demographics, symptoms, comorbidities, CP etiology, and biochemical variables. CP was defined by a Mayo score ≥4.
Main Results:
- Of 273 patients, 98 had definite CP, and 40.8% of these were diagnosed with SIBO.
- Multivariable analysis identified low zinc levels as the sole independent predictor of SIBO (OR=0.0001, P=0.03).
- Other factors associated with SIBO included opiate use, diabetes mellitus, higher Mayo score, and lower albumin levels.
Conclusions:
- SIBO is prevalent in 40.8% of CP patients without upper GI surgery.
- Markers of CP severity (low zinc, diabetes mellitus, increased Mayo score) and opiate use should prompt suspicion for SIBO.
- Low zinc levels are a significant independent predictor of SIBO in CP patients.
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