P0382 - SIBO and SIFO Prevalence in Patients With Ehlers-Danlos Syndrome Based on Duodenal Aspirates/Culture

Sunday, October 24, 2021

3:30 PM – 7:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Pearl Uy, MD

Medical College of Georgia
Augusta, GA, United States

Pearl Uy, MD¹, Asad Jehangir, MBBS¹, John Erikson Yap, MD², Satish Rao, MD, PhD¹
¹Medical College of Georgia, Augusta, GA; ²Medical College of Georgia at Augusta University, Augusta, GA

Introduction: Ehlers Danlos syndrome (EDS) is an inherited connective tissue disorder characterized by joint hypermobility, skin hyperextensibility and fragility. The hyperelasticity also affects gut smooth muscle causing gastrointestinal motility dysfunction as reported previously. Gastrointestinal (GI) symptoms are common. Previous studies have suggested a prevalence of 35-38.5% based on a positive breath test for small intestinal bacterial overgrowth (SIBO) among symptomatic EDS patients. We determined the diagnostic yield of duodenal aspirates for SIBO/small intestinal fungal overgrowth (SIFO) among EDS patients with GI symptoms.

Methods: Adult EDS patients referred to our tertiary care center from January 2012 to December 2020 with unexplained GI symptoms of more than 1 year and suspected to have SIBO/SIFO underwent endoscopy with duodenal aspirates with aerobic, anaerobic, and fungal cultures obtained under aseptic conditions using the Rao technique and a 3mm Liguory catheter (Videogie;https://doi.org/10.1016/j.vgie.2020. 11.008). A colony count >10³CFU/mL was considered diagnostic for SIBO/SIFO. The diagnostic yield and microbial characteristics were assessed.

Results: Twenty-four patients (all females) were included in this study, of whom 12 (50%) had positive duodenal aspirates culture for SIBO/SIFO. Three patients (25%) had both SIBO and SIFO, 7 (58%) had SIBO only and 2 (17%) had SIFO only. The predominant organisms cultured were Streptococcus, Haemophilus, Rothia, Neisseria, multiple anaerobes, and Candida albicans. Among the positive aspirates group, abdominal pain, bloating, fullness, nausea, and flatulence were commonly reported but their prevalence were similar to the negative aspirates group. There was no significant difference in the medical comorbidities (gastroparesis, delayed small bowel transit, constipation), GI surgeries, use of PPI and opiates between the positive and negative aspirates group.

Discussion: We found a diagnostic yield of 50% using duodenal aspirates for the diagnosis of SIBO/SIFO compared to the historical yield of 35-38.5% using a glucose breath test. There was no difference in the comorbidities between the two groups and symptoms were poor predictors for the diagnosis of SIBO/SIFO. Duodenal aspirates may facilitate an accurate diagnosis and treatment of SIBO/SIFO in EDS patients and provide guidance for treatments such as antibiotic susceptibility. EDS patients with GI symptoms should be evaluated for an underlying GI motility disorder including SIBO/SIFO.

	Positive Aspirates for SIBO/SIFO N=12	Negative Aspirates for SIBO/SIFO N=12	P value
Age (years old) Mean (standard deviation)	35.33 (12.53)	36.08 (14.66)
Race Caucasian African American Hispanic Asian	12 (100%) 0 0 0	12 (100%) 0 0 0
Gender Male Female	0 12 (100%)	0 12 (100%)
BMI (Kg/m2) Mean (standard deviation)	24.15 (5.29)	24.98 (4.8)
Comorbidities Diabetes Scleroderma Gastroparesis Delayed small bowel transit Constipation POTS Mast cell activation	1 0 3 2 6 1 0	0 1 7 1 6 2 2	0.164092 0.164092 0.053077 0.278733 0.5 0.278733 0.076098
Dietary intolerance (based on breath test) Fructose intolerance Lactose intolerance Fructan intolerance	3 2 2	1 1 0	0.146781 0.278733 0.076098
Disaccharidase Normal Lactase deficiency Pan-disaccharidase deficiency None obtained	4 3 0 5	9 0 2 1	0.021014 0.034302 0.076098 0.031638
Proton pump inhibitor (PPI) Probiotics Opiates	3 1 1	3 1 1	0.5 0.5 0.5
Gastric bypass Intestine surgery (small bowel and colon)	2 5	0 4	0.076098 0.344625
Abdominal symptoms (scale 0 -9) Abdominal pain Belching Bloating Fullness Nausea Gas/Flatulence	8.12 4.83 7.83 7.83 8.00 6.67	8.12 6.67 8.00 7.75 5.92 5.75	0.5 0.144925 0.441254 0.461071 0.08529 0.236528
Positive aspirates Both SIBO and SIFO Only SIBO Only SIFO	12 3 (20%) 7 (58%) 2 (17%)
Aerobes Coagulase negative Staphylococcus Staphylococcus aureus Streptococcus Neisseria Haemophilus Klebsiella Rothia Corynebacterium diphtheroids Bifidobacterium	2 (5.9%) 2 (5.9%) 10 (29.4%) 3 (8.8%) 5 (14.7%) 1 (2.9%) 5 (14.7%) 1 (2.9%) 1 (2.9%)
Anaerobes Multiple anaerobes	4 (11.8%)
Fungal organisms Candida albicans Candida glabratta Candida dublinienses	6 (75%) 1 (12.5%) 1 (12.5%)

Table: Title: Demographic Characteristics of the Study Population and Microbial Culture Results of the Duodenal Aspirates

Abbreviation: SIBO- small intestinal bacterial overgrowth, SIFO- small intestinal fungal overgrowth, POTS- postural orthostatic tachycardia syndrome

Disclosures:

Pearl Uy indicated no relevant financial relationships.

Asad Jehangir indicated no relevant financial relationships.

John Erikson Yap indicated no relevant financial relationships.

Satish Rao indicated no relevant financial relationships.

Pearl Uy, MD¹, Asad Jehangir, MBBS¹, John Erikson Yap, MD², Satish Rao, MD, PhD¹. P0382 - SIBO and SIFO Prevalence in Patients With Ehlers-Danlos Syndrome Based on Duodenal Aspirates/Culture, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.