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Sa1783 The Impact of Medications on Small Intestinal Bacterial Overgrowth
AGA Abstracts
compared with MZO. Combo had higher ICU requirement (68.6%, 38.5%, p<0.01), 30day colectomy (5.7%, 0.0%, p<0.05), sepsis within 30-days (31.4%, 10.2%, p< 0.001) and 30-day mortality (34.3%, 8.2%, p<0.001) with a lower readmission rate within 90-days (31.4%, 49.0%, p<0.01) compared with VCO. Conclusions: Solitary therapy with VCO for those with higher WBC and/or recurrent disease and MTZ for the less severe resulted in similar overall outcomes. It is likely clinicians judgment to keep pts on one therapy reflects appropriate response and this might predict these outcomes. As would be expected with the most severe disease, Combo therapy was associated with worse outcomes and these pts require more aggressive management. Sa1783 The Impact of Medications on Small Intestinal Bacterial Overgrowth Sheevani Bhalsod, Seth Lipka, Roshanak Rabbanifard, Jennifer Leigh, Jae Chung, Marc Levin, Kiran Joglekar, Ambuj Kumar, Jay J. Mamel Introduction: Small intestinal bacterial overgrowth (SIBO) occurs when native/non-native bacteria exceed 105 colony-forming units per milliliter in the small intestine. Currently, there is little data regarding a relationship between SIBO and statin therapy, PPI, probiotic, and opioids. The purpose of this study is to evaluate the effect of medications on SIBO status. Methods: We conducted a retrospective cohort study using the electronic health records of 416 patients that underwent SIBO lactulose hydrogen and methane breath testing. Charts were reviewed for demographics (age, sex, race, and BMI) and medications such as statins, PPI, probiotics, and opioids. T-test and logistic regression assessed association between dependent and independent variables. The results were summarized as mean difference (MD) and standard deviation (SD), or odds ratio(OR) and 95% confidence intervals (CI). Results: Of the 416 patients enrolled in this study, 198 (47%) tested positive for SIBO. The mean age of SIBO(+ve) patients was 51.9 +/- 18.6 and SIB-(-ve) patients was 53.9 +/- 17.6. The mean BMI of SIBO(+ve) patients was 26.5 +/- 6.4 vs 26.1 +/- 6.6 in SIBO(-ve). 49 (24.7%) of the SIBO(+ve) patients were male compared to 55 (25.2%) of the SIBO(-ve) patients. Our data indicated no significant association between the use of statins, PPI, probiotics or opioids on SIBO status. 103 (24.7%) patients used statin therapy with a 29.8% incidence of SIBO compared to 19.7% without SIBO. Of the 186 (44.7%) patients on PPI, there were 41.4% SIBO(+ve) vs 47.7% SIBO(-ve). 50 (12%) patients used probiotics, with an 11.6% incidence of SIBO(+ve) vs 12.3% SIBO(-ve). Of the 59 (14.2%) patients on opioids, there were 12.6% SIBO(+ve) vs 15.6% SIBO(-ve). Conclusion: In this retrospective study, our data did not reveal a significant association between statins, PPI, probiotics, and opioids on SIBO status. Prior published data have yielded conflicting results on association between PPI and risk of developing SIBO and our data supports no association between PPI use and risk of developing SIBO. In addition, even though it is well known that opioids can induce bowel dysfunction, our data does not signify a risk of developing SIBO for patients on opioids.
Sa1785 The Impact of Hypertension, Hyperlipidemia, Diabetes, and Psychiatric History on Small Intestinal Bacterial Overgrowth Sheevani Bhalsod, Seth Lipka, Roshanak Rabbanifard, Jennifer Leigh, Jae Chung, Marc Levin, Kiran Joglekar, Ambuj Kumar, Jay J. Mamel Introduction: Small intestinal bacterial overgrowth (SIBO) occurs when native/non-native bacteria exceed 105 colony-forming units per milliliter in the small intestine. Currently, there is little data regarding a relationship between SIBO and certain factors such as age, sex, race, BMI and medical conditions such as hypertension, hyperlipidemia, diabetes, and psychiatric history. The purpose of this study is to evaluate the association between specific medical conditions and SIBO. Methods: We conducted a retrospective cohort study using electronic health records of 416 patients that underwent SIBO lactulose hydrogen and methane breath testing. Charts were reviewed for demographics (age, sex, BMI, race) and past medical histories including hypertension, hyperlipidemia, diabetes, and psychiatric history. T-test and logistic regression assessed association between dependent and independent variables. The results were summarized as mean difference (MD) and standard deviation (SD), or odds ratio (OR) and 95% confidence intervals (CI). Results: Of the 416 patients enrolled in this study, 198 (47%) tested positive for SIBO. The mean age of SIBO(+ve) patients was 51.9 +/- 18.6 and SIBO(-ve) patients was 53.9 +/- 17.6. The mean BMI of SIBO(+ve) patients was 26.5 +/- 6.4 vs 26.1 +/- 6.6 in SIBO(-ve). Fourty-nine (24.7%) of the SIBO(+ve) patients were male compared to 55 (25.2%) of the SIBO(-ve) patients. In our database, there were 58 (13.9%) diabetic patients and of those 13.1% SIBO(+ve) vs 14.7% SIBO(-ve). Comparing the 87 (21%) patients with hypertension, there were 15.7% SIBO(+ve) vs 25.7% SIBO(-ve) with OR 0.54(0.33, 0.88; p=0.01). Of the 147 (35.3%) patients with hyperlipidemia, 39.4% SIBO(+ve) vs 31.4% SIBO(-ve). Of the 119 (28.6%) patients with a psychiatric history, 26.3% SIBO(+ve) vs 30.7% SIBO(-ve). Conclusion: In this retrospective study, there was a protective effect against SIBO in the hypertensive patients. Whether this is related to hypertension itself, or medications used to treat hypertension remains to be further delineated in future studies. Sex, age, race, BMI, hyperlipidemia, diabetes, and psychiatric history did not signify a risk for SIBO.
Sa1784 Gallstones, Lactose Malabsorption and Methanogenic Flora: A Strange Trio Francesca Mangiola, Fabio Del Zompo, Daniela Feliciani, Teresa Di Rienzo, Giovanna D'Angelo, Cristiana sensi, Roberto Persiani, Domenico D'ugo, Francesco Franceschi, Antonio Gasbarrini, Veronica Ojetti BACKGROUND AND AIM Cholelithiasis, is defined as the presence of stones in the gallbladder and is one of the most common digestive diseases, affecting 9-19% of the general population, with a female prevalence. The most common symptom is postprandial biliary colic,. Cholecystectomy, usually laparoscopic, is the definitive treatment of choice. The altered composition and excretion of bile in the duodenum is very irritating for the intestinal mucosa, altering the brush border with a possible interference on the lactose absorption. The aim of this study was to assess the prevalence of lactose malabsorption through a H2/ CH4 lactose breath test (LBT) in subjects affected by gallstones. MATERIAL AND METHODS Twenty (4M/16F; mean age 55±8yrs) subjects, scheduled to undergo cholecystectomy in the following month for gallstones, have performed a H2/CH4 LBT in our Gastroenterology Unit according to the guidelines. We have considered a positive LBT when there was a peak of H2>20 ppm over baseline. RESULTS 14 out of 20 (70%) pts resulted lactose malabsorbers with an H2 mean peak value of 73±23 ppm (Table 1). The most interesting data was that 90% (18/20) of these pts produced high levels of CH4, with a mean basal value of 8±5 ppm and a mean peak value of 28 ± 12 ppm (Table 2). CONCLUSION We found a high prevalence of lactose malabsorption in patients affected by gallstones, confirming the hypothesis that an alteration of bile composition could destroy the lactase enzyme on the brush border. The high prevalence of methanogenic flora observed in these pts could be a cause or a consequence of the formation of gallbladder stones. Further studies are needed to better understand these interesting findings.
Sa1786 Loss of PTPN2 in the Intestinal Epithelium of Mice Only Fractionally Affects Inflammation in DSS Colitis but Leads to Epithelial Transformations When Repeatedly Treated With DSS Stephanie Kasper, Marianne R. Spalinger, Irina Leonardi, Alexandra Gerstgrasser, Kirstin Atrott, Isabelle Frey-Wagner, Michael Fried, Gerhard Rogler, Michael Scharl Background: Mice featuring a knock-out of the inflammatory bowel disease (IBD) susceptibility gene protein tyrosine phosphatase non-receptor type 2 (PTPN2), die from systemic inflammation. We have previously shown that T-cell specific loss of PTPN2 leads to more severe DSS colitis and systemic inflammation. To examine the role of PTPN2 in the colonic epithelium in vivo, we generated mice exhibiting a loss of PTPN2 in intestinal epithelial cells (IEC) and induced DSS colitis. Methods: PTPN2flox/floxxVilCre mice and control littermates were used. Acute colitis was induced by either 2% or 2.5% DSS treatment for 7 days.
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AGA Abstracts
compared with MZO. Combo had higher ICU requirement (68.6%, 38.5%, p<0.01), 30day colectomy (5.7%, 0.0%, p<0.05), sepsis within 30-days (31.4%, 10.2%, p< 0.001) and 30-day mortality (34.3%, 8.2%, p<0.001) with a lower readmission rate within 90-days (31.4%, 49.0%, p<0.01) compared with VCO. Conclusions: Solitary therapy with VCO for those with higher WBC and/or recurrent disease and MTZ for the less severe resulted in similar overall outcomes. It is likely clinicians judgment to keep pts on one therapy reflects appropriate response and this might predict these outcomes. As would be expected with the most severe disease, Combo therapy was associated with worse outcomes and these pts require more aggressive management. Sa1783 The Impact of Medications on Small Intestinal Bacterial Overgrowth Sheevani Bhalsod, Seth Lipka, Roshanak Rabbanifard, Jennifer Leigh, Jae Chung, Marc Levin, Kiran Joglekar, Ambuj Kumar, Jay J. Mamel Introduction: Small intestinal bacterial overgrowth (SIBO) occurs when native/non-native bacteria exceed 105 colony-forming units per milliliter in the small intestine. Currently, there is little data regarding a relationship between SIBO and statin therapy, PPI, probiotic, and opioids. The purpose of this study is to evaluate the effect of medications on SIBO status. Methods: We conducted a retrospective cohort study using the electronic health records of 416 patients that underwent SIBO lactulose hydrogen and methane breath testing. Charts were reviewed for demographics (age, sex, race, and BMI) and medications such as statins, PPI, probiotics, and opioids. T-test and logistic regression assessed association between dependent and independent variables. The results were summarized as mean difference (MD) and standard deviation (SD), or odds ratio(OR) and 95% confidence intervals (CI). Results: Of the 416 patients enrolled in this study, 198 (47%) tested positive for SIBO. The mean age of SIBO(+ve) patients was 51.9 +/- 18.6 and SIB-(-ve) patients was 53.9 +/- 17.6. The mean BMI of SIBO(+ve) patients was 26.5 +/- 6.4 vs 26.1 +/- 6.6 in SIBO(-ve). 49 (24.7%) of the SIBO(+ve) patients were male compared to 55 (25.2%) of the SIBO(-ve) patients. Our data indicated no significant association between the use of statins, PPI, probiotics or opioids on SIBO status. 103 (24.7%) patients used statin therapy with a 29.8% incidence of SIBO compared to 19.7% without SIBO. Of the 186 (44.7%) patients on PPI, there were 41.4% SIBO(+ve) vs 47.7% SIBO(-ve). 50 (12%) patients used probiotics, with an 11.6% incidence of SIBO(+ve) vs 12.3% SIBO(-ve). Of the 59 (14.2%) patients on opioids, there were 12.6% SIBO(+ve) vs 15.6% SIBO(-ve). Conclusion: In this retrospective study, our data did not reveal a significant association between statins, PPI, probiotics, and opioids on SIBO status. Prior published data have yielded conflicting results on association between PPI and risk of developing SIBO and our data supports no association between PPI use and risk of developing SIBO. In addition, even though it is well known that opioids can induce bowel dysfunction, our data does not signify a risk of developing SIBO for patients on opioids.
Sa1785 The Impact of Hypertension, Hyperlipidemia, Diabetes, and Psychiatric History on Small Intestinal Bacterial Overgrowth Sheevani Bhalsod, Seth Lipka, Roshanak Rabbanifard, Jennifer Leigh, Jae Chung, Marc Levin, Kiran Joglekar, Ambuj Kumar, Jay J. Mamel Introduction: Small intestinal bacterial overgrowth (SIBO) occurs when native/non-native bacteria exceed 105 colony-forming units per milliliter in the small intestine. Currently, there is little data regarding a relationship between SIBO and certain factors such as age, sex, race, BMI and medical conditions such as hypertension, hyperlipidemia, diabetes, and psychiatric history. The purpose of this study is to evaluate the association between specific medical conditions and SIBO. Methods: We conducted a retrospective cohort study using electronic health records of 416 patients that underwent SIBO lactulose hydrogen and methane breath testing. Charts were reviewed for demographics (age, sex, BMI, race) and past medical histories including hypertension, hyperlipidemia, diabetes, and psychiatric history. T-test and logistic regression assessed association between dependent and independent variables. The results were summarized as mean difference (MD) and standard deviation (SD), or odds ratio (OR) and 95% confidence intervals (CI). Results: Of the 416 patients enrolled in this study, 198 (47%) tested positive for SIBO. The mean age of SIBO(+ve) patients was 51.9 +/- 18.6 and SIBO(-ve) patients was 53.9 +/- 17.6. The mean BMI of SIBO(+ve) patients was 26.5 +/- 6.4 vs 26.1 +/- 6.6 in SIBO(-ve). Fourty-nine (24.7%) of the SIBO(+ve) patients were male compared to 55 (25.2%) of the SIBO(-ve) patients. In our database, there were 58 (13.9%) diabetic patients and of those 13.1% SIBO(+ve) vs 14.7% SIBO(-ve). Comparing the 87 (21%) patients with hypertension, there were 15.7% SIBO(+ve) vs 25.7% SIBO(-ve) with OR 0.54(0.33, 0.88; p=0.01). Of the 147 (35.3%) patients with hyperlipidemia, 39.4% SIBO(+ve) vs 31.4% SIBO(-ve). Of the 119 (28.6%) patients with a psychiatric history, 26.3% SIBO(+ve) vs 30.7% SIBO(-ve). Conclusion: In this retrospective study, there was a protective effect against SIBO in the hypertensive patients. Whether this is related to hypertension itself, or medications used to treat hypertension remains to be further delineated in future studies. Sex, age, race, BMI, hyperlipidemia, diabetes, and psychiatric history did not signify a risk for SIBO.
Sa1784 Gallstones, Lactose Malabsorption and Methanogenic Flora: A Strange Trio Francesca Mangiola, Fabio Del Zompo, Daniela Feliciani, Teresa Di Rienzo, Giovanna D'Angelo, Cristiana sensi, Roberto Persiani, Domenico D'ugo, Francesco Franceschi, Antonio Gasbarrini, Veronica Ojetti BACKGROUND AND AIM Cholelithiasis, is defined as the presence of stones in the gallbladder and is one of the most common digestive diseases, affecting 9-19% of the general population, with a female prevalence. The most common symptom is postprandial biliary colic,. Cholecystectomy, usually laparoscopic, is the definitive treatment of choice. The altered composition and excretion of bile in the duodenum is very irritating for the intestinal mucosa, altering the brush border with a possible interference on the lactose absorption. The aim of this study was to assess the prevalence of lactose malabsorption through a H2/ CH4 lactose breath test (LBT) in subjects affected by gallstones. MATERIAL AND METHODS Twenty (4M/16F; mean age 55±8yrs) subjects, scheduled to undergo cholecystectomy in the following month for gallstones, have performed a H2/CH4 LBT in our Gastroenterology Unit according to the guidelines. We have considered a positive LBT when there was a peak of H2>20 ppm over baseline. RESULTS 14 out of 20 (70%) pts resulted lactose malabsorbers with an H2 mean peak value of 73±23 ppm (Table 1). The most interesting data was that 90% (18/20) of these pts produced high levels of CH4, with a mean basal value of 8±5 ppm and a mean peak value of 28 ± 12 ppm (Table 2). CONCLUSION We found a high prevalence of lactose malabsorption in patients affected by gallstones, confirming the hypothesis that an alteration of bile composition could destroy the lactase enzyme on the brush border. The high prevalence of methanogenic flora observed in these pts could be a cause or a consequence of the formation of gallbladder stones. Further studies are needed to better understand these interesting findings.
Sa1786 Loss of PTPN2 in the Intestinal Epithelium of Mice Only Fractionally Affects Inflammation in DSS Colitis but Leads to Epithelial Transformations When Repeatedly Treated With DSS Stephanie Kasper, Marianne R. Spalinger, Irina Leonardi, Alexandra Gerstgrasser, Kirstin Atrott, Isabelle Frey-Wagner, Michael Fried, Gerhard Rogler, Michael Scharl Background: Mice featuring a knock-out of the inflammatory bowel disease (IBD) susceptibility gene protein tyrosine phosphatase non-receptor type 2 (PTPN2), die from systemic inflammation. We have previously shown that T-cell specific loss of PTPN2 leads to more severe DSS colitis and systemic inflammation. To examine the role of PTPN2 in the colonic epithelium in vivo, we generated mice exhibiting a loss of PTPN2 in intestinal epithelial cells (IEC) and induced DSS colitis. Methods: PTPN2flox/floxxVilCre mice and control littermates were used. Acute colitis was induced by either 2% or 2.5% DSS treatment for 7 days.
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AGA Abstracts