| Background and aimCrohn’s disease(CD)is a chronic non-specific intestinal inflammatory disease,with an unknown cause and a tendency to relapse for life.Gut microbiome is known to play a key role in the onset and development of CD.Small intestinal bacterial overgrowth(SIBO),as a manifestation of gut microbiome dysbiosis,may influence the onset and prognosis of CD.A small number of studies have assessed the prevalence of SIBO and related factors in patients with CD,but the results are inconsistent.Furthermore,the relationship between SIBO and clinical relapse of CD has not been evaluated.The aim of this study was to explore(i)the prevalence and related factors of SIBO in quiescent CD;and(ii)the predictive value of SIBO for clinical relapse in CD patients.MethodsThis retrospective observational research included consecutive patients with quiescent CD and healthy controls matched for patient age and gender during the same period managed at Jinling Hospital in China from January 2016 to June 2020.All enrolled subjects underwent lactulose hydrogen-methane breath test to diagnose SIBO.Baseline data of patients were collected,including general conditions,clinical data,laboratory indicators,endoscopic data and lactulose hydrogen-methane breath test results(SIBO+/-).All patients were followed up for 18 months and any clinical relapse was recorded.ResultsA total of 73 patients with quiescent CD and 73 healthy controls were included in this study.Part Ⅰ:(ⅰ)SIBO positivity rate:the positive rate of SIBO in CD patients was 46.6%,with a significantly higher prevalence of SIBO than in healthy controls.(ⅱ)Factors associated with SIBO in CD patients:the rate of patients with a history of proton pump inhibitors(PPIs)used in the past 3 months(32.4%vs 7.7%,P=0.015)and diarrhea(11.8%vs 0%,P=0.043)was significantly higher in the SIBO-positive group than in the SIBO-negative group.Multivariate logistic regression analysis showed that a history of PPIs use in the past 3 months was an independent risk factor for the development of SIBO in patients with CD(OR:5.03,95%CI 1.06-23.81,P=0.042).Part Ⅱ:(ⅰ)The clinical relapse rate of CD:27 patients(37.0%)experienced clinical relapse within 18 months of follow-up.(ⅱ)The relationship between SIBO and clinical relapse of CD:At 6 months(26.5%vs 7.7%,P=0.031)and 18 months(50.0%vs 25.6%,P=0.032)follow-up,the clinical relapse rate was significantly higher in patients with SIBO than in those without SIBO.In addition,Kaplan-Meier analysis of clinical relapse curve showed that the cumulative clinical relapse rate was significantly higher in patients with SIBO than in those without SIBO at 18 months of follow-up(log-rank,P=0.034).Furthermore,multivariate Cox regression analysis showed that SIBO was an independent risk factor for clinical relapse of CD(HR:2.79,95%CI 1.20-6.51,P=0.017).(ⅲ)Other factors related to clinical relapse of CD:Penetrating disease behavior(HR:3.66,P=0.040)was also an independent risk factor for clinical relapse of CD.Moreover,perianal disease,C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),interleukin-6(IL-6),hemoglobin(Hb),albumin(Alb)and endoscopic disease activity were associated with clinical relapse of CD.Conclusion1.The prevalence of SIBO in patients with CD is significantly higher than that in healthy people.2.A history of PPIs use in the past 3 months is an independent risk factor for the development of SIBO in patients with CD.3.Patients with SIBO are more likely to suffer from diarrhea than those without SIBO in patients with CD.4.SIBO is an independent risk factor for clinical relapse of CD,and timely detecting and monitoring SIBO in patients with quiescent CD may be a valuable option for their prognosis. |
