High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal - PubMed
High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal
Antonio Tursi et al. Am J Gastroenterol. 2003 Apr.
Abstract
Objective: Celiac disease is a gluten-sensitive enteropathy with a broad spectrum of clinical manifestation, and most celiac patients respond to a gluten-free diet (GFD). However, in some rare cases celiacs continue to experience GI symptoms after GFD, despite optimal adherence to diet. The aim of our study was to evaluate the causes of persistence of GI symptoms in a series of consecutive celiac patients fully compliant to GFD.
Methods: We studied 15 celiac patients (five men, 10 women, mean age 36.5 yr, range 24-59 yr) who continued to experience GI symptoms after at least 6-8 months of GFD (even if of less severity). Antigliadin antibody (AGA) test, antiendomysial antibody (EMA) test, and sorbitol H2-breath test (H2-BT), as well as esophagogastroduodenoscopy (EGD) with histological evaluation, were performed before starting GFD. Bioptic samples were obtained from the second duodenal portion during EGD, and histopathology was expressed according to the Marsh classification. To investigate the causes of persistence of GI symptoms in these patients, we performed AGA and EMA tests, stool examination, EGD with histological examination of small bowel mucosa, and sorbitol-, lactose-, and lactulose H2-breath tests.
Results: Histology improved in all patients after 6-8 months of GFD; therefore, refractory celiac disease could be excluded. One patient with Marsh II lesions was fully compliant to his diet but had mistakenly taken an antibiotic containing gluten. Two patients showed lactose malabsorption, one patient showed Giardia lamblia and one patient Ascaris lumbricoides infestation, and 10 patients showed small intestinal bacterial overgrowth (SIBO) by lactulose H2-BT. We prescribed a diet without milk or fresh milk-derived foods to the patient with lactose malabsorption; we treated the patients with parasite infestation with mebendazole 500 mg/day for 3 days for 2 consecutive wk; and we treated the patients with SIBO with rifaximin 800 mg/day for 1 wk. The patients were re-evaluated 1 month after the end of drug treatment (or after starting lactose-free diet); at this visit all patients were symptom-free.
Conclusions: This study showed that SIBO affects most celiacs with persistence of GI symptoms after gluten withdrawal.
Comment in
-
Small bowel bacterial overgrowth, celiac disease, and IBS: what are the real associations?
O'Leary C, Quigley EM. O'Leary C, et al. Am J Gastroenterol. 2003 Apr;98(4):720-2. doi: 10.1111/j.1572-0241.2003.07395.x. Am J Gastroenterol. 2003. PMID: 12738446 No abstract available.
Similar articles
-
Tursi A, Brandimarte G, Giorgetti GM, Elisei W, Inchingolo CD, Monardo E, Aiello F. Tursi A, et al. Endoscopy. 2006 Jul;38(7):702-7. doi: 10.1055/s-2006-925178. Endoscopy. 2006. PMID: 16810593 Clinical Trial.
-
Diagnosing mild enteropathy celiac disease: a randomized, controlled clinical study.
Kurppa K, Collin P, Viljamaa M, Haimila K, Saavalainen P, Partanen J, Laurila K, Huhtala H, Paasikivi K, Mäki M, Kaukinen K. Kurppa K, et al. Gastroenterology. 2009 Mar;136(3):816-23. doi: 10.1053/j.gastro.2008.11.040. Epub 2008 Nov 24. Gastroenterology. 2009. PMID: 19111551 Clinical Trial.
-
Vahedi K, Mascart F, Mary JY, Laberenne JE, Bouhnik Y, Morin MC, Ocmant A, Velly C, Colombel JF, Matuchansky C. Vahedi K, et al. Am J Gastroenterol. 2003 May;98(5):1079-87. doi: 10.1111/j.1572-0241.2003.07284.x. Am J Gastroenterol. 2003. PMID: 12809831
-
Monitoring nonresponsive patients who have celiac disease.
Krauss N, Schuppan D. Krauss N, et al. Gastrointest Endosc Clin N Am. 2006 Apr;16(2):317-27. doi: 10.1016/j.giec.2006.03.005. Gastrointest Endosc Clin N Am. 2006. PMID: 16644460 Review.
-
[Treatment and management of celiac disease].
Holtmeier W. Holtmeier W. Z Gastroenterol. 2006 Nov;44(11):1167-75. doi: 10.1055/s-2006-927125. Z Gastroenterol. 2006. PMID: 17115359 Review. German.
Cited by
-
Celiac disease is associated with restless legs syndrome.
Weinstock LB, Walters AS, Mullin GE, Duntley SP. Weinstock LB, et al. Dig Dis Sci. 2010 Jun;55(6):1667-73. doi: 10.1007/s10620-009-0943-9. Dig Dis Sci. 2010. PMID: 19731029
-
Abdominal bloating: pathophysiology and treatment.
Seo AY, Kim N, Oh DH. Seo AY, et al. J Neurogastroenterol Motil. 2013 Oct;19(4):433-53. doi: 10.5056/jnm.2013.19.4.433. Epub 2013 Oct 7. J Neurogastroenterol Motil. 2013. PMID: 24199004 Free PMC article. Review.
-
Caio G, Lungaro L, Segata N, Guarino M, Zoli G, Volta U, De Giorgio R. Caio G, et al. Nutrients. 2020 Jun 19;12(6):1832. doi: 10.3390/nu12061832. Nutrients. 2020. PMID: 32575561 Free PMC article. Review.
-
Probiotics and the Microbiome in Celiac Disease: A Randomised Controlled Trial.
Harnett J, Myers SP, Rolfe M. Harnett J, et al. Evid Based Complement Alternat Med. 2016;2016:9048574. doi: 10.1155/2016/9048574. Epub 2016 Jul 21. Evid Based Complement Alternat Med. 2016. PMID: 27525027 Free PMC article.
-
Esposito I, de Leone A, Di Gregorio G, Giaquinto S, de Magistris L, Ferrieri A, Riegler G. Esposito I, et al. World J Gastroenterol. 2007 Dec 7;13(45):6016-21. doi: 10.3748/wjg.v13.45.6016. World J Gastroenterol. 2007. PMID: 18023092 Free PMC article. Clinical Trial.
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Research Materials
Miscellaneous