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Rheumatology Advance Access originally published online on August 20, 2009
Rheumatology 2009 48(10):1314-1319; doi:10.1093/rheumatology/kep226
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Small intestinal bacterial overgrowth in systemic sclerosis

Isabelle Marie1, Philippe Ducrotté2, Philippe Denis3, Jean-François Menard4 and Hervé Levesque1

1Department of Internal Medicine, 2Department of Gastroenterology, 3Department of Digestive Physiology and 4Department of Biostatistics, Rouen University Hospital, Rouen Cedex, France.

Correspondence to: Isabelle Marie, Department of Internal Medicine, Rouen University Hospital, 76301 Rouen Cedex, France. E-mail: isabelle.marie{at}chu-rouen.fr


  Abstract

Objectives. The aims of this study were to: (i) determine the prevalence of small intestinal bacterial overgrowth (SIBO) in unselected patients with SSc; (ii) assess both clinical presentation and outcome of SIBO; and (iii) make predictions about which SSc patients are at risk for SIBO.

Methods. Fifty-one consecutive patients with SSc underwent glucose hydrogen and methane (H2/CH4) breath test. All SSc patients also completed a questionnaire for intestinal symptoms, and a global symptomatic score (GSS) was calculated. SSc patients with SIBO were given rotating courses of antibiotics (norfloxacin/metronidazole) for 3 months; glucose H2/CH4 breath test was performed at 3-month follow-up.

Results. The prevalence of SIBO was 43.1% in our SSc patients. After logistic regression, we identified the following risk factors for SIBO: presence of diarrhoea and constipation. Interestingly, we observed a marked correlation between values of GSS of digestive symptoms (>=5) and the presence of SIBO (P = 10–6); indeed, both sensitivity and specificity of GSS >=5 to predict SIBO were as high as 0.909 and 0.862, respectively. Finally, eradication of SIBO was obtained in 52.4% of the SSc patients with a significant improvement of intestinal symptoms.

Conclusion. Our study underscores that SIBO often occurs in SSc patients. We further suggest that GSS may be systematically performed in SSc patients; since we found a correlation between GSS of digestive symptoms >=5 and SIBO, we suggest that glucose H2/CH4 breath test may be performed in the subgroup of SSc patients exhibiting GSS >=5.

KEY WORDS: Small intestinal bacterial overgrowth, Gastrointestinal involvement, Glucose H2/CH4 breath test, Diagnosis, Outcome, Therapy, Systemic sclerosis

Submitted 23 March 2009; revised version accepted 30 June 2009.
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