Chronic pancreatitis: zinc deficiency predicts SIBO

  • Lee AA & al.
  • Am J Gastroenterol
  • 16 Apr 2019

  • International Clinical Digest
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Takeaway

  • 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. 

Key results

  • 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%.

Study design

  • 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.

Limitations

  • Unknown if SIBO is contingent upon EPI.
  • Potential bias, confounding.

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