Surendra Sharma

Orocecal Transit Time and Small Intestinal Bacterial Overgrowth in Type 2 Diabetes Patients from North India

BACKGROUND Diarrhea, constipation, flatulence, and abdominal pain are common complaints in type 2 diabetes patients. Impaired intestinal motility is often followed by small intestinal bacterial overgrowth (SIBO). Therefore, this study was planned to determine the incidence of SIBO and its relation with orocecal transit time (OCTT) in type 2 diabetes patients. SUBJECTS AND METHODS SIBO and OCTT were measured by using noninvasive glucose and lactulose hydrogen breath tests, respectively. For this study, 84 patients with type 2 diabetes mellitus in the age range 30-65 years and 45 age-matched apparently healthy controls were enrolled. RESULTS The glucose hydrogen breath test was suggestive of SIBO in 15.5% of patients with type 2 diabetes mellitus but in one (2.2%) of controls. There was a significant increase (P<0.001) in OCTT in type 2 diabetes patients compared with controls. It was also observed that OCTT in type 2 diabetes patients with SIBO was significantly delayed (P<0.001) compared with type 2 diabetes patients without SIBO. CONCLUSION This study indicates that SIBO in diabetes patients may be due to delayed OCTT.

Relationship of cytokines, oxidative stress and GI motility with bacterial overgrowth in ulcerative colitis patients

BACKGROUND Ulcerative colitis (UC) is idiopathic, chronic and relapsing inflammatory bowel disease. Factors which initiate and perpetuate UC are not well understood. It is still unclear if any relationship exists between cytokines, oxidative stress, gastrointestinal (GI) motility, and small intestinal bacterial overgrowth (SIBO) in UC patients. GOALS To examine the relationship between these factors among UC patients. METHODS A total of 120 UC patients and 125 age and sex matched controls with no GI symptoms were enrolled. Plasma levels of IL-6, IL-8, TNF-α and IL-10 were measured in all subjects by using ELISA. Lipid peroxidation (LPO) and reduced glutathione (GSH) were measured by standard methods. Orocecal transit time (OCTT) and SIBO were measured by lactulose and glucose hydrogen breath tests respectively. RESULTS Out of the 120 UC patients, 74 were male with mean±SD age of 45.6±17.5years. Plasma levels of IL-6, IL-8, TNF-α and IL-10 in UC patients were significantly higher (p<0.01) as compared to controls. LPO in UC patients was significantly increased (p<0.01) while GSH was significantly decreased (p<0.01) as compared to controls. OCTT and SIBO were significantly higher in UC patients as compared to controls. UC patients with elevated inflammatory cytokines showed delayed OCTT and increased SIBO. It was also observed that there was a significant correlation between SIBO with IL-6, IL-8, TNF-α, and IL-10, LPO and GSH. CONCLUSION This study indicates that increase in cytokines and decrease in anti-oxidants in UC patients would have resulted in oxidative stress causing delayed GI motility leading to SIBO.

Prolonged orocecal transit time enhances serum bile acids through bacterial overgrowth, contributing factor to gallstone disease.

Background: Gallstones (GS) are associated with slow intestinal transit but the effect of altered transit time on physiological changes in gastrointestinal tract among GS patients is poorly understood. Goals: To investigate the association of gallstone disease with change in intestinal motility and how motility alters serum bile acid (SBA) levels. Study: A total of 333 subjects were enrolled, of which 183 were GS patients and 150 age-matched and sex-matched controls. Intestinal transit time was assessed by measuring orocecal transit time (OCTT). Breath tests were used to evaluate OCTT and small intestinal bacterial overgrowth (SIBO). Total SBA levels were measured by enzymatic colorimetric assay. A linear regression analysis was performed to look for interrelationship between OCTT and SBA levels. Results: Orocecal transit time was significantly delayed (P<0.001) in GS patients (134.8±30.64 min) compared with controls (85.35±19.81 min). SIBO was observed to be significantly higher (P<0.01) in patients (15%) compared with controls (0.7%). OCTT was further delayed significantly (P<0.01) in GS patients with SIBO (165.6±33.9 min) compared with patients lacking SIBO. Total SBA levels were found to be significantly higher (P<0.05) in GS patients (5.3±2.7 &mgr;mol/L) compared with controls (3.7±1.8 &mgr;mol/L). SBA levels were also significantly higher (P<0.05) in SIBO-positive GS patients (6.4±2.8 &mgr;mol/L) compared with SIBO-negative patients (4.8±2.4 &mgr;mol/L). There was positive correlation between OCTT and SBA levels in SIBO-positive patients. Conclusions: The findings indicate that delayed OCTT leads to SIBO and thus enhance SBA levels in etiology underlying GSs.

Effect of Post-Cholecystectomy on Small Intestinal Bacterial Overgrowth and Orocecal Transit Time in Gallstone Patients

Background: Effect of duration of cholecystectomy on orocecal transit time and small intestinal bacterial overgrowth in gallstone patients is poorly understood. Method: 128 gallstone patients of either sex, aged between 25-68 years were enrolled. 79/128 followed after 4-6 months of cholecystectomy. 49 patients had undergone cholecystectomy 2 - 15years before study and reported gastrointestinal symptoms, classified as late post-cholecystectomy. Orocecal transit time (OCTT) and small intestinal bacterial overgrowth (SIBO) were measured by non-invasive lactulose and glucose breath tests respectively. Results: OCTT increased significantly (p < 0.01) from 125.9 ± 28.6 to 145.8 ± 30.5 minutes after 4-6 months of cholecystectomy. Among late post-cholecystectomy patients, OCTT was observed to be 159.2 ± 37.8 minutes, which was significantly higher when compared with OCTT in pre-cholecystectomy patients. SIBO was present in 10/79 (12.7%) gallstone patients pre-cholecystectomy and 11/79 (13.9%) in gallstone patients post-cholecystectomy. Presence of SIBO after 4-6 months of cholecystectomy was not significantly different compared to pre-cholecystectomy in gallstone patients. However, SIBO was present in 13 / 49 (26.5%) late post-cholecystectomy patients with duration of 2-15years, which was significantly (p < 0.05) higher compared to pre-cholecystectomy and 4-6months post-cholecystectomy patients. Conclusion: The study signifies that longer duration of post-cholecystectomy can lead to delayed OCTT and cause SIBO in gallstone patients. This can be mitigated by giving pro-kinetics to post-cholecystectomy patients.