Monitoring and antibacterial treatment for postoperative bacterial overgrowth in Crohn's disease

Citation
Y. Funayama et al., Monitoring and antibacterial treatment for postoperative bacterial overgrowth in Crohn's disease, DIS COL REC, 42(8), 1999, pp. 1072-1077
Citations number
14
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Gastroenerology and Hepatology
Journal title
DISEASES OF THE COLON & RECTUM
ISSN journal
0012-3706 → ACNP
Volume
42
Issue
8
Year of publication
1999
Pages
1072 - 1077
Database
ISI
SICI code
0012-3706(199908)42:8<1072:MAATFP>2.0.ZU;2-V
Abstract
PURPOSE: Bacterial overgrowth sometimes complicates the clinical course of Crohn's disease and may lead to inappropriate treatment. To clarify the eff ect of antibiotic therapy, we monitored the hydrogen concentration in expir atory breath after fasting. METHODS: We evaluated 18 patients (15 males; me dian age, 32.7; range, 22.3-60 years) for postoperative bacterial overgrowt h symptoms and for intestinal dilation by plain abdominal x-ray. Five patie nts had ileitis and 13 patients had ileocolitis. Various intestinal resecti ons were performed in all, and strictureplasties were done at the same time in 13 patients. The median postoperative period was 10.2 (range, 1.2-102) months. Nine patients, who had symptoms such as bloating, nausea, vomiting, or pain, were classified as the symptomatic group, whereas nine other pati ents, who had no symptoms, were classified as the symptom-free group. Sixte en patients who bad undergone intestinal resections for noninflammatory bow el disease served as the control group. After overnight fasting, hydrogen c oncentration in end-expiratory breath was measured with gas chromatography. At the same time clinical examinations of white blood cell count, hemoglob in, total protein, serum albumin, iron, sialic acid, and C-reactive protein in the peripheral blood were performed. To assess the effect of antibacter ial treatment, changes in symptoms were assessed in eight patients who rece ived antibacterial treatment. Hydrogen concentration was measured repeatedl y before and after treatment in six patients. RESULTS: The symptomatic grou p had an expiratory hydrogen concentration level significantly higher (medi an, 40; range, 20-139 ppm) than the control group (median, 3; range, 1-6 pp m) and the symptom-free group (median, 4; range, 1-10 ppm). After the antib iotic treatment the symptoms were improved in all of the patients, and the hydrogen concentration level was significantly reduced (median, 4.5; range, 2-13 ppm). CONCLUSIONS: Antibacterial treatment was useful in the postoper ative patients whose assessments were complicated by bacterial overgrowth. Using a hydrogen breath test, bacterial overgrowth was effectively monitore d and managed, effecting a change in clinical symptoms.