- Among patients with chronic pancreatitis (CP), low zinc level, diabetes, and higher Mayo score are associated with increased risk for small intestinal bacterial overgrowth (SIBO).
- Empiric treatment may be reasonable for patients with SIBO risk factor(s), especially those with steatorrhea or weight loss despite pancreatic enzyme replacement therapy (PERT), authors suggest.
Why this matters
- PERT improves many outcomes in patients with exocrine pancreatic insufficiency (EPI).
- Steatorrhea despite PERT may be related to SIBO.
- Previous studies have not clearly established SIBO prevalence in CP.
- 40 (40.8%) had SIBO.
- None of 10 gastrointestinal symptoms predicted SIBO.
- Univariate risk factors included low zinc level, diabetes, opiate use, Mayo score, low albumin.
- On multivariate analysis, low zinc level independently predicted positive glucose breath test (GBT): OR, 0.0001; P=.03.
- Diabetes+opiate use had a positive predictive value of 72.5%.
- Retrospective study, tertiary referral center (n=98).
- Participants: patients with CP diagnosed via Mayo clinical criteria who underwent GBT for SIBO, 1989-2017.
- Patients had no history of upper gastrointestinal surgery (SIBO risk factor).
- Authors assessed 46 variables for predictive power.
- Outcome: SIBO prevalence; predictive variables.
- Funding: NIH-funded authors.
- Unknown if SIBO is contingent upon EPI.
- Potential bias, confounding.