Efficacy Of Probiotics In Patients With Irritable Bowel Syndrome Complicated With Small Intestinal Bacterial Overgrowth

Objective:Using a methane-hydrogen breath test to measure the levels of hydrogen and methane exhaled by irritable bowel Syndrome(IBS)patients,To evaluate the incidence of small intestinal bacterial overgrowth(SIBO)in patients with IBS,and to compare the incidence of SIBO in patients with different subtypes of IBS and the concentrations of methane and hydrogen in exhaled gas at each time point.To investigate the efficacy of probiotics in patients with IBS complicated with SIBO.Methods:1.Patients with IBS meeting the Roman IV diagnostic criteria(including 50 patients with IBS-D and 40 patients with IBS-C)who visited the department of Gastroenterology outpatient department of Qinghai Provincial People’s Hospital from December 1,2020 to July 1,2021 were selected as the study subjects.All patients improved IBS clinical symptom Severity Scale(IBS-SSS);2.All patients were tested by Methane-hydrogen breath test(MHBT).According to the test results,patients with SIBO positive IBS-D and SIBO positive IBS-C were classified into group A1 and group B1.Both groups were given probiotics for continuous oral treatment for 2 weeks;3.Two weeks after treatment,patients in group A1 and B1underwent MHBT again.According to the test results,patients still positive for SIBO in the two groups were classified as group A2 and group B2,respectively.4.Group A2and B2 were given probiotics for another 2 weeks,so that the course of treatment in both groups reached 4 weeks.MHBT and IBS-SSS scores were performed again after the treatment.Results:1.The positive rate of SIBO was 68.9%(62/90)in patients with IBS by methane-hydrogen breath test.2.The positive rate of SIBO in IBS-D patients was higher than that in IBS-C patients(78%vs.57.5%,χ2=4.357,P<0.05).The positive rate of hydrogen breath test in IBS-D patients was higher than that in IBS-C patients(66%vs.35%,χ2=8.559,P<0.05),and the positive rate of methane breath test in IBS-C patients was higher than that in IBS-D patients(47.5%vs.18%,X~2=9.023,P<0.05).3.The values of hydrogen exhaled in PATIENTS with IBS-D at 40 and 60minutes were higher than those in patients with IBS-C(P<0.05),and the values of methane exhaled in patients with IBS-C at fasting,20,80 and 100 minutes were higher than those in patients with IBS-D(P<0.05).4.There was no statistically significant difference between IBS-D and IBS-C patients in IBS patients(P>0.05),and no statistically significant difference between SIBO positive patients and SIBO negative patients in IBS patients(P>0.05).After 2 weeks of probiotics treatment,the symptom score of SIBO positive group was lower than that of non-positive group(130.00±27.67points vs.162.73±31.04points,Z=-3.869,P<0.05).After 4 weeks of probiotics treatment,the symptom score of SIBO negative group was lower than that of non-negative group(112.50±10.35points vs.136.67±16.70points,Z=-2.956,P<0.05).5.There was no statistical significance in the total effective rate,symptom score and negative conversion rate of IBS-D patients with SIBO and IBS-C patients with SIBO after 2 weeks and 4 weeks of treatment(P>0.05).6.Symptom score of PATIENTS with IBS combined with SIBO positive after 2 weeks of probiotics treatment was lower than that before treatment(142.41±32.89points vs.204.82±31.64points,T=22.061,P<0.05).Symptom scores after 4 weeks of probiotics treatment were lower than those after 2 weeks(127.00±18.67vs.168.00±27.07,Z=-3.868,P<0.05).7.Fifty-eight patients with IBS complicated with SIBO were treated with probiotics for two weeks,and 36 of them turned negative(62.1%);The 22 positive patients who did not turn negative were treated with probiotics for 2 weeks,2 lost patients were excluded,and 8 patients turned negative,with a conversion rate of 40%.Conclusions:1.The positive rate of SIBO is high in IBS patients.2.The positive rate of SIBO in IBS-D patients was higher than that in IBS-C patients,the positive rate of hydrogen breath test in IBS-D patients was higher than that in IBS-C patients,and the positive rate of methane breath test in IBS-C patients was higher than that in IBS-D patients.3.The severity of symptoms is similar in patients with different subtypes of IBS,and there is no significant difference in the severity of symptoms in patients with IBS regardless of SIBO,After probiotic treatment,IBS patients with SIBO negative conversion had better symptoms than those without.4.There was no significant difference in the therapeutic efficacy of probiotics for patients with different subtypes of IBS complicated with SIBO.5.Probiotics can improve the digestive symptoms of patients with IBS complicated with SIBO,and increase the negative rate of SIBO.Increasing the course of probiotics may make the effect more significant.