Review article: Small intestinal bacterial overgrowth, bile acid malabsorption and gluten intolerance as possible causes of chronic watery diarrhoea

Alimentary Pharmacology and Therapeutics

Volumn 29, Issue 10, 2009, Pages 1069-1077

  Fan, X ^a   Sellin, J H ^b  

^a University of Texas Medical Branch School of Medicine   (United States)

^b BAYLOR COLLEGE OF MEDICINE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ACTIVATED CARBON; AMOXICILLIN; BILE ACID; CIPROFLOXACIN; COLESTIPOL; COLESTYRAMINE; DOXYCYCLINE; METRONIDAZOLE; NEOMYCIN; NORFLOXACIN; PROTON PUMP INHIBITOR; RIFAXIMIN; TETRACYCLINE;

ANTIBIOTIC THERAPY; BACTERIAL OVERGROWTH; BILE ACID MALABSORPTION; BLOATING; CHRONIC DIARRHEA; CLINICAL RESEARCH; CLINICAL TRIAL; DIAGNOSTIC TEST; DISEASE ASSOCIATION; DRUG EFFICACY; DRUG MEGADOSE; ENTEROPATHY; FECES ANALYSIS; FLATULENCE; GLUTEN RESPONSIVE ENTEROPATHY; HUMAN; HYDROGEN BREATH TEST; INTESTINAL DYSMOTILITY; INTESTINE FLORA; INTESTINE INFECTION; IRRITABLE COLON; MALABSORPTION; PRIORITY JOURNAL; RADIOIMMUNOASSAY; REVIEW; SMALL INTESTINE; SYSTEMATIC REVIEW; TRAVELLER DIARRHEA;

BACTERIAL INFECTIONS; BILE ACIDS AND SALTS; CHRONIC DISEASE; DIARRHEA; GLUTENS; HUMANS; INTESTINE, SMALL; MALABSORPTION SYNDROMES;

EID: 64849089859     PISSN: 02692813     EISSN: 13652036     Source Type: Journal    
DOI: 10.1111/j.1365-2036.2009.03970.x     Document Type: Review

References (74)

1. Donowitz M, Kokke FT, Saidi R. Evaluation of patients with chronic diarrhea. N Engl J Med 1995 332 : 725 9.
2. Wald A, Back C, Bayless TM. Effect of caffeine on the human small intestine. Gastroenterology 1976 71 : 738 42.
3. Abraham B, Sellin JH. Drug-induced diarrhea. Curr Gastroenterol Rep 2007 9 : 365 72.
4. Wildt S, Nordgaard-Lassen I, Bendtsen F, Rumessen JJ. Metabolic and inflammatory faecal markers in collagenous colitis. Eur J Gastroenterol Hepatol 2007 19 : 567 74.
5. Shepherd SJ, Parker FC, Muir JG, Gibson PR. Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence. Clin Gastroenterol Hepatol. 2008 6 : 765 71.
6. Gibson PR, Newnham E, Barrett S, Shepherd J, Muir JG. Review article: fructose malabsorption and the bigger picture. Aliment Pharmacol Ther 2006 25 : 349 63.
7. Read NW, Krejs GJ, Read MG, Santa Ana CA, Morawski SG, Fordtran JS. Chronic diarrhea of unknown origin. Gastroenterology 1980 78 : 264 71.
8. Schiller LR, Rivera LM, Santangelo WC, Little KH, Fordtran JS. Diagnostic value of fasting plasma peptide concentrations in patients with chronic diarrhea. Dig Dis Sci 1994 39 : 2216 22.
9. Koch TR, Michener SR, Go VL. Plasma vasoactive intestinal polypeptide concentration determination in patients with diarrhea. Gastroenterology 1991 100 : 99 106.
10. Lin HC, Pimentel M. Bacterial concepts in irritable bowel syndrome. Rev Gastroenterol Disord. 2005 5 : S3 9.
11. Walters B, Vanner SJ. Detection of bacterial overgrowth in IBS using the lactulose H2 breath test: comparison with 14C-D-xylose and healthy controls. Am J Gastroenterol 2005 100 : 1566 70.
12. Parisi G, Leandro G, Bottona E, et al. Small intestinal bacterial overgrowth and irritable bowel syndrome. Am J Gastroenterol 2003 98 : 2572.
13. Posserud I, Ringström G, Stotzer PO, et al. Small intestinal bacterial overgrowth (SIBO) in irritable bowel syndrome (IBS). Neurogastroenterol Motil 2004 16 : 839.
14. Kerlin P, Wong L. Breath hydrogen testing in bacterial overgrowth of the small intestine. Gastroenterology 1988 95 : 982.
15. MacMahon M, Gibbons N, Mullins E, et al. Are breath hydrogen tests valid in the elderly? Gerontology 1996 42 : 40.
16. Bauer TM, Schwacha H, Steinbruckner B, et al. Diagnosis of small intestinal bacterial overgrowth in patients with cirrhosis of the liver: Poor performance of the glucose breath hydrogen test. J Hepatol 2000 33 : 382.
17. Stotzer PO, Kilander AF. Comparison of the 1-gram 14C-d-xylose breath test and the 50 gram hydrogen glucose breath test for diagnosis of small intestinal bacterial overgrowth. Digestion 2000 61 : 165.
18. Rhodes JM, Middleton P, Jewell DP. The lactulose hydrogen breath test as a diagnostic test for small bowel bacterial overgrowth. Scand J Gastroenterol 1979 14 : 333.
19. Riordan SM, McIver CJ, Walker BM, et al. The lactulose breath hydrogen test and small intestinal bacterial overgrowth. Am J Gastroenterol 1996 91 : 1795.
20. Corazza GR, Menozzi MG, Strocchi A, et al. The diagnosis of small bowel bacterial overgrowth. Reliability of jejunal culture and inadequacy of breath hydrogen testing. Gastroenterology 1990 98 : 302.
21. Rhodes JM, Jewell DP. Lactulose hydrogen breath test in the diagnosis of bacterial overgrowth. Gastroenterology 1990 99 : 1547.
22. Pimentel M, Kong Y, Park S. Breath testing to evaluate lactose intolerance in irritable bowel syndrome correlates with lactulose testing and may not reflect true lactose malabsorption. Am J Gastroenterol 2003 98 : 2700 4.
23. Posserud I, Stotzer PO, Björnsson ES, Abrahamsson H, Simrén M. Small intestinal bacterial overgrowth in patients with irritable bowel syndrome. Gut 2007 56 : 802 8.
24. Esposito I, de Leone A, Di Gregorio G, et al. Breath test for differential diagnosis between small intestinal bacterial overgrowth and irritable bowel disease: an observation on non-absorbable antibiotics. World J Gastroenterol 2007 13 : 6016 21.
25. Hirakawa M, Iida M, Kohrogi N, et al. Hydrogen breath test assessment of orocecal transit time: comparison with barium meal study. Am J Gastroenterol 1988 83 : 1361 3.
26. Holgate AM, Read NW. Relationship between small bowel transit time and absorption of a solid meal. Influence of metoclopramide, magnesium sulfate, and lactulose. Dig Dis Sci 1983 28 : 812 9.
27. Fan X, Scott LD, Sellin JH. Correlation of hydrogen breath test to clinical response after antibiotics treatment. The American J of Gastroenterology 2008 103 : S116.
28. Sellin JH, Hart R. Glucose malabsorption associated with rapid intestinal transit. Am J Gastroenterol 1992 87 : 584 9.
29. Pimentel M, Soffer EE, Chow EJ, Kong Y, Lin HC. Lower frequency of MMC is found in IBS subjects with abnormal lactulose breath test, suggesting bacterial overgrowth. Dig Dis Sci 2002 47 : 2639 43.
30. Cann PA, Read NW, Brown C, Hobson N, Holdsworth CD. Irritable bowel syndrome: relationship of disorders in the transit of a single solid meal to symptom patterns. Gut 1983 24 : 405 11.
31. Gorard DA, Vesselinova-Jenkins CK, Libby GW, Farthing MJ. Migrating motor complex and sleep in health and irritable bowel syndrome. Dig Dis Sci 1995 40 : 2383 9.
32. Mathias JR, Clench MH. Review: pathophysiology of diarrhea caused by bacterial overgrowth of the small intestine. Am J Med Sci 1985 289 : 243 8.
33. Scarpellini E, Gabrielli M, Lauritano CE, et al. High dosage rifaximin for the treatment of small intestinal bacterial overgrowth. Aliment Pharmacol Ther 2007 25 : 781 6.
34. Di Stefano M, Strocchi A, Malservisi S, Veneto G, Ferrieri A, Corazza GR. Non-absorbable antibiotics for managing intestinal gas production and gas-related symptoms. Aliment Pharmacol Ther, 2000 14 : 1001 8.
35. Sharara Al, Aoun E, Abdul-Baki H, Mounzer R, Sidani S, ElHajj I. A randomized double-blind placebo-controlled trial of rifaximin in patients with abdominal bloating and flatulence. Am J Gastroenterol, 2006 101 : 326 33.
36. Yang J, Lee HR, Low K, Chatterjee S, Pimentel M. Rifaximin versus other antibiotics in the primary treatment and retreatment of bacterial overgrowth in IBS. Dig Dis Sci 2008 53 : 169 74.
37. Pimentel M, Park S, Mirocha J, Kane SV, Kong Y. The effect of a nonabsorbed oral antibiotic (rifaximin) on the symptoms of the irritable bowel syndrome: a randomized trial. Ann Intern Med, 2006 145 : 557 63.
38. Pimentel M, Chow EJ, Lin HC. Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome: a doubleblind, randomized, placebo-controlled study. Am J Gastroenterol 2003 98 : 412 9.
39. Pimentel M, Chatterjee S, Chow EJ, Park S, Kong Y. Neomycin improves constipation- predominant irritable bowel syndromein a fashion that is dependent on the presence of methane gas: subanalysis of a double-blind randomized controlled study. Dig Dis Sci 2006 51 : 1297 301.
40. Pimentel M, Chow EJ, Lin HC. Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol 2000 95 : 3503 6.
41. Di Stefano M, Strocchi A, Malservisi S, Veneto G, Ferrieri A, Corazza GR. Non-absorbable antibiotics for managing intestinal gas production and gas-related symptoms. Aliment Pharmacol Ther 2000 14 : 1001 8.
42. Kahn IJ, Jeffries GH, Sleisenger MH. Malabsorption in intestinal scleroderma: correction by antibiotics. N Engl J Med 1966 274 : 1339 44.
43. Bjorneklett A, Fausa O, Midtvedt T. Bacterial overgrowth in jejunal and ileal disease. Scand J Gastroenterol 1983 18 : 289 98.
44. Attar A, Flourie B, Rambaud JC, Franchisseur C, Ruszniewski P, Bouhnik Y. Antibiotic efficacy in small intestinal bacterial overgrowth related chronic diarrhea: a crossover, randomized trial. Gastroenterology 1999 117 : 794 7.
45. Bratten JR, Spanier J, Jones MP. Lactulose breath testing does not discriminate patients with irritable bowel syndrome from healthy controls. Am J Gastroenterol 2008 103 : 958 63.
46. Spiegel BM, Chey WD, Chan L. Bacterial overgrowth and irritable bowel syndorme: unifying hypothesis or a spurious consequence of proton pump inhibitors. Am J Gastro 2008 103 : 2972 6.
47. Singh VV, Toskes PP. Small bowel bacterial overgrowth: presentation, diagnosis and treatment. Curr Gastro Reports 2003 5 : 365 72.
48. Teo M, Chung S, Chitti L, et al. Small bowel bacterial overgrowth is a common cause of chronic diarrhea. J Gastroenterol Hepatol 2004 19 : 904 9.
49. Riordan SM, McIver CJ, Wakefield D, Bolin TD, Duncombe VM, Thomas MC. Small intestinal bacterial overgrowth in the symptomatic elderly. Am J Gastroenterol 1997 92 : 47 51.
50. Mekjian HS, Phillips SF, Hofmann AF. Colonic secretion of water and electrolytes induced by bile acids: perfusion studies in man. J Clin Invest 1971 50 : 1569 77.
51. Fromm H, Tunuguntla AK, Malavolti M, Sherman C, Ceryak S. Absence of significant role of bile acids in diarrhea of a heterogeneous group of postcholecystectomy patients. Dig Dis Sci 1987 32 : 33 44.
52. Breuer NF, Jaekel S, Dommes P, Goebell H. Fecal bile acid excretion pattern in cholecystectomized patients. Dig Dis Sci 1986 31 : 953 60.
53. Fort JM, Azpiroz F, Casellas F, Andreu J, Malagelada JR. Bowel habit after cholecystectomy: physiological changes and clinical implications. Gastroenterology 1996 111 : 617 22.
54. Oelkers P, Kirby LC, Heubi JE, Dawson PA. Primary bile acid malabsorption caused by mutations in the ileal sodium-dependent bile acid transporter gene (SLC10A2). J Clin Invest 1997 99 : 1880 7.
55. Montagnani M, Abrahamsson A, Gälman C, et al. Analysis of ileal sodium/bile acid cotransporter and related nuclear receptor genes in a family with multiple cases of idiopathic bile acid malabsorption. World J Gastroenterol 2006 12 : 7710 4.
56. Montagnani M, Love MW, Rössel P, Dawson PA, Qvist P. Absence of dysfunctional ileal sodium-bile acid cotransporter gene mutations in patients with adult-onset idiopathic bile acid malabsorption. Scand J Gastroenterol 2001 36 : 1077 80.
57. Sadik R, Abrahamsson H, Ung KA, Stotzer PO. Accelerated regional bowel transit and overweight shown in idiopathic bile acid malabsorption. Am J Gastroenterol 2004 99 : 711 8.
58. Schiller LR, Hogan RB, Morawski SG, et al. Studies of the prevalence and significance of radiolabeled bile acid malabsorption in a group of patients with idiopathic chronic diarrhea. Gastroenterology 1987 92 : 151 60.
59. Williams AJ, Merrick MV, Eastwood MA. Idiopathic bile acid malabsorption - a review of clinical presentation, diagnosis, and response to treatment. Gut 1991 32 : 1004 6.
60. Sciarretta G, Fumo A, Morrone B, Malaguti P. Absence of histopathological changes of ileum and colon in functional chronic diarrhea associated with bile acid malabsorption, assessed by SeHCAT test: A prospective study. Am J Gastroenterol 1994 89 : 1058 61.
61. Fernandez-Bañares F, Esteve M, Salas A, et al. Bile acid malabsorption in microscopic colitis and in previously unexplained functional chronic diarrhea. Dig Dis Sci 2001 46 : 2231 8.
62. Wildt S, Nørby Rasmussen S, Lysgård Madsen J, Rumessen JJ. Bile acid malabsorption in patients with chronic diarrhoea: clinical value of SeHCAT test. Scand J Gastroenterol 2003 38 : 826 30.
63. Müller M, Willén R, Stotzer PO. Colonoscopy and SeHCAT for investigation of chronic diarrhea. Digestion 2004 69 : 211 8.
64. Fernández-Bañares F, Esteve M, Salas A, et al. Systematic evaluation of the causes of chronic watery diarrhea with functional characteristics. Am J Gastroenterol 2007 102 : 2520 8.
65. Fellous K, Jian R, Haniche M, et al. Measurement of ileal absorption of bile salts with the selenium 75 labelled homotaurocholic acid test. Validation and clinical significance. Gastroenterol Clin Biol 1994 18 : 865 72.
66. van Tilburg AJ, de Rooij FW, van den Berg JW, Kooij PP, van Blankenstein M. The selenium-75-homocholic acid taurine test reevaluated: combined measurement of fecal selenium-75 activity and 3 alpha-hydroxy bile acids in 211 patients. J Nucl Med 1991 32 : 1219 24.
67. Nyhlin H, Merrick MV, Eastwood MA, Brydon WG. Evaluation of ileal function using 23-Selena-25-homotaurocholate,a 7-labeledconjugated bile acid (initial clinical assessment). Gastroenterology 1983 84 : 63 8.
68. Thaysen EH, Orholm M, Arnfred T, Carl J, Rodbro P. Assessment of ileal function by abdominal counting ofthe retention ofa gamma emitting bile acid analogue. Gut 1982 23 : 862 5.
69. Merrick MV, Eastwood MA, Ford MI. Is bile acid malabsorption under diagnosed? An evaluation of accuracy of diagnosis by measurement of SeHCAT retention. Br Med J 1985 290 : 665 8.
70. Orholm M, Pedersen JO, Arnfred T, Rødbro P, Thaysen EH. Evaluation of the applicability of the SeHCAT test in the investigation of patients with diarrhoea. Scand J Gastroenterol 1988 23 : 113 7.
71. Sanders DS, Carter MJ, Hurlstone DP, et al. Association of adult coeliac disease with irritable bowel syndrome: a case-control study in patients fulfilling ROME II criteria referred to secondary care. Lancet 2001 358 : 1504 8.
72. Wahnschaffe U, Ullrich R, Riecken EO, et al. Celiac disease like abnormalities in a subgroup of patients with irritable bowel syndrome. Gastroenterology 2001 121 : 1329 38.
73. Wahnschaffe U, Schulzke JD, Zeitz M, Ullrich R. Predictors of clinical response to gluten-free diet in patients diagnosed with diarrhea-predominant irritable bowel syndrome. Clin Gastroenterol Hepatol. 2007 5 : 844 50.
74. Collin P, Wahab PJ, Murray JA. Intraepithelial lymphocytes and coeliac disease. Best Pract Res Clin Gastroenterol 2005 19 : 341 50.