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Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
e187
Background and aim:
SIBO is a frequent condition, the diagnosis
of which is commonly carried out by lactulose or glucose breath
test, or both. The treatment of this condition is largely empirical and
based on antibiotics and probiotics. The aim of the study is to assess,
in a group of patients who hade a positive lactulose breath test for
SIBO, the medium-term response to a three month treatment with a
combined regimen of nonabsorbable antibiotics and probiotics.
Material and methods:
123 patients (87 females, 78%), with a mean
age of 43 yrs, all presenting with symptoms suggestive of SIBO
(abdominal bloating, abdominal pain, diarrhea, constipation) and
a a positive lactulose breath test for SIBO (defined as >10-20 ppm
after ingestion of 85 ml of water, containing 66 g of lactulose), were
treated with rifaximin at a dose of 200 mg, 2 tablets 3 times a day,
for one week each month, for 3 months and followed by a probiotic,
namely Genefilus F19, 1 sachet a day during the next 2 weeks.
Results:
At baseline, patients complained of the following symptoms:
bloating in 88 cases (71.5%), abdominal pain in 62 (50%), diarrhea in
64 (52%) and constipation in 14 cases (11.4%). Sixmonths after the end
of therapy bloating was still present in 32.5% of subjects, abdominal
pain in 23.6%, diarrhea in 21.1%, and constipation in 5%, whereas the
majority of patients (54.5%) had a complete resolution of symptoms,
as opposed to 22% who showed only a partial improvement, and 23.5
who did not respond to therapy. No correlation between symptoms
response and body weighth change was observed.
Conclusions:
In this prospective, uncontrolled study, we found that
patients with SIBOI defined on the basis of a a positive lactulose
breath test might be treated successfully with nonabsorbable
antibiotics and probiotics in more than half of cases. Whether the
partial or complete refractoriness to this regimen is due to persistent
SIBO or not was not tested in our study.
P.12.8
INTESTINAL FERMENTATION IN SELF-REPORTED NON-CELIAC
GLUTEN SENSITIVITY: A COMPARISON WITH IRRITABLE BOWEL
SYNDROME AND HEALTHY VOLUNTEERS
Di Stefano M., Valvo B.*, Bergonzi M., Craviotto V., Saputo E.,
Bresciani M., Pagani E., Corazza G.R.
1st Department of Internal Medicine, IRCCS. Matteo Hospital
Foundation, Pavia, Italy
Background and aim:
The presence of non-celiac patients claiming
a strict correlation between gluten ingestion and intestinal and/or
extraintestinal symptoms is an increasingly frequent occurrence in
outpatient clinics. This clinical condition has been named non-celiac
gluten sensitivity (NCGS) (Sapone, BMC Medicine 2012) and many
doubts have been raised about the algorithm for its identification.
In our experience, the administration of gluten in a double-blind,
placebo-controlled protocol in non-celiac patients claiming
severe gluten-related symptoms showed that this condition has
a low frequency (Di Sabatino, CGH 2015). A simplified diagnostic
test, based on symptom monitoring during a period of gluten
withdrawal from diet according to an unblinded protocol and
configuring a sort of self-reported NCGS, was recently proposed
(Fasano, Gastroenterology 2015). The clinical presentation of this
condition overlaps the irritable bowel syndrome (IBS), a condition
characterized by an impairment of intestinal sensorimotor activity.
In both NCGS and IBS, many abdominal symptoms may occur
and all these symptoms could share the same pathophysiological
mechanism. Therefore, we focused on breath hydrogen excretion
after oral administration of lactulose, in self-reported NGCS subjects
compared to a group of IBS patients and healthy volunteers (HV).
Material and methods:
Eighteen consecutive self-reported NCGS
patients (14 F, 4 M, mean age 34±8 yrs) complaining of severe
symptoms after gluten ingestion took part in the study. The presence
of organic gastrointestinal and systemic disorders was ruled out in all
subjects. Twenty-seven IBS patients diagnosed according to Rome III
criteria (17 IBS-C and 10 IBS-D) and a group of 20 HV, both matched
for gender and age, were considered for the comparison of results.
All the subjects underwent breath hydrogen excretion measurement
after oral lactulose administration. Ten grams of lactulose in 400
mL water solution were administered orally in fasting condition
and air samples were then collected every 15 min for a 7-h period.
Parameters of interest were cumulative H2 excretion and peak of H2
excretion.
Results:
None of the measured parameters showed a significant
difference between the three groups of subjects. Cumulative
H2 excretion was 9109±4800 ppm x min in self-reported NCGS,
11325±9282ppm x min in IBS and 10376±7572 ppm x min in HV
(ANOVA=NS). Peak of H2 excretion was 55±28 ppm in self-reported
NCGS, 65±43 ppm in IBS and 36±25 ppm in HV (ANOVA=NS).
Conclusions:
Breath hydrogen excretion after lactulose did not
show any difference between self-reported NCGS, IBS and HV.
Accordingly, it seems that no differences of intestinal fermentation
occur among these subjects. The definition of this disorder based
only on self-reporting does not, however, seem correct: a more
objective diagnostic test should be adopted for the diagnosis of
NCGS.
P.12.9
INTENSIVE COMBINED TREATMENT IN REFRACTORY MORBID
OBESITY: OUR EXPERIENCE WITH A GROUP OF PATIENTS NOT
ELIGIBLE FOR BARIATRIC SURGERY
Noè D.*, Lanzi P., Nicolai E., Spiti R., Tagliabue V., Miola F.,
Miragoli P., Combi S., Marini M., Barsi M., Masi F., Soncini M.
A.O. San Carlo Borromeo, Milano, Italy
Background and aim:
Morbid obesity is difficult to treat. Often
conventional outpatient diet therapy is not effective and bariatric
surgery not eligible. We thus examined the effects of an intense
combined treatment (diet, psychological, peer group support,
physical exercise) in a group of refractory morbid obese patients.
Material and methods:
From June 2014 to July 2015, 14 severe
obese pts (7M, 7W, mean age 49yrs), not eligible for surgery, were
selected for a nutritional rehabilitation programme as twice weekly
daily sessions in groups of 3-4 pts, for a mean time of 8.9 months.
At the beginning/periodically during the treatment, weight, BMI,
Table
(abstract P.12.9)
Basal
At 3 months
At 6 months
At 9 months
Weight kg BMI kg/m
2
N.
Δ kg
Δ %
N
Δ kg
Δ %
N.
Δ kg
Δ %
Group
136.6±30
47.9±9
14
-11±7
-8±5
11
-20.5±11
-14±7
7
32.2±17
-22±9
(97 to 182) (40 to 68)
(-0.5 to -26) (-0.4 to -19)
(-3 to -37)
(-3 to -25)
(-16 to -64) (-9 to -36)
Men
151.6±24
47.7±7
7
-11.9±7
-8±5
5
-26.1±9.6
-17±7
4
-37.8±20.4
-25±12
(126 to 182) (40 to 57)
(-0.5 to -21) (-0.4 to -13)
(-14 to -37) (-8 to -25)
(-16 to -64) (-9 to -36)
Women 121.5±28 48.1±11
7
-10.1±8
-8±6
6
-15.8±9.8
-12±6
3
-24.8±7.9
-19±4
(97 to 172)
(40 to 68)
(-1 to -26)
(-1 to -19)
(-3 to -29)
(-3 to -17)
(-17 to -32) (-16 to -24)
Values are shown as mean ± SD (range)