Award: Outstanding Research Award in the Functional Bowel Disease Category (Trainee)
Award: Presidential Poster Award
Adil Ghafoor, MD, Asad Jehangir, MD, Yun Yan, PhD, Amanda Laufer, PA-C, Amol Sharma, MD, Satish Rao, MD Augusta University, Augusta, GA
Introduction: Brain Fogginess (BF) may occur due to lactatemia (increased D/L-lactic acid) and may be associated with small intestinal bacterial overgrowth (SIBO). Aim: To examine the prevalence of probiotic use in patients with unexplained BF, gas, and bloating, and assess its association with SIBO and lactatemia.
Methods: Patients with chronic gas/bloating ( >6 months) were assessed for BF using a structured questionnaire. Also, gas/bloating-related symptoms were recorded with validated questionnaire, along with the use of probiotic. BF symptoms included mental confusion, feeling sleepy, forgetfulness, and difficulty focusing. Subjects underwent glucose breath test (GBT) and/or small bowel aspiration/culture for SIBO as well as urine D-lactic acid and serum L-lactic acid during GBT. SIBO was diagnosed based on a positive GBT (≥ 20 ppm rise) and/or bacterial count ≥ 103 cfu/mL. Lactatemia was defined as ≥0.22 mmol/L (D-lactic acid) and/or ≥2.2 mmol/L (L-lactic acid). Data were compared between patients with and without BF.
Results: Of 104 patients (f/m = 77/27, mean age = 45 years), 89 (85.6%) reported BF (BF group) and 15 (14.4%) had no BF (non-BF GROUP). Prevalence of flatulence (90.8%) vs 83.3%), bloating (92.3% vs 100%), belching (83.1%) vs 83.3%), and abdominal pain (84.6%) vs 83.3%) were similar between the two groups. Difficulty thinking (90.4%), difficulty focusing (90.4%), feeling sleepy (90.4%), and forgetfulness (88.1%) were the most prevalent BF symptoms. There was significantly higher prevalence of probiotic use in the BF group compared to non-BF group (85.4% vs 33.3%; p = < 0.0001) (Fig. 1). Also, the prevalence of SIBO was higher in the BF group compared to the non-BF GROUP (53.9% vs 26.7%; p=0.05). Among BF patients who also took probiotics, 43/76 (56.6%) had SIBO and 45/76 (59.2%) had lactatemia. Most non-BF patients did not use probiotics (10/15, 66.7%) and 9/10 (90%) were negative for SIBO. In the non-BF group that took probiotics, 3/5 (60%) had SIBO, one with lactatemia.
Discussion: BF is significantly associated with probiotic use and persistent gas/bloating and distention. These patients are significantly more likely to have SIBO as well as lactatemia compared to those without BF or history of probiotic use. In patients with unexplained gas/bloating, clinicians should, ask if they have BF and use probiotics, assess for lactatemia and SIBO, and recognize and manage this problem
Figure: Comparative prevalence of probiotic use and SIBO in BF VS non-BF
Disclosures:
Adil Ghafoor indicated no relevant financial relationships.
Asad Jehangir indicated no relevant financial relationships.
Yun Yan indicated no relevant financial relationships.
Amanda Laufer indicated no relevant financial relationships.
Amol Sharma indicated no relevant financial relationships.
