ProtonPumpInhibitors.docVIP

Proton Pump Inhibitors, Irritable Bowel Syndrome, and Small Intestinal Bacterial Overgrowth: Coincidence or Newtons Third Law Revisited? William D. Chey, MD, Brennan Spiegel, MD Clin Gastroenterol Hepatol. 2010;8 6 :480-482. Abstract and Introduction Introduction The human gastrointestinal GI tract is home to 300 to 500 different bacterial species. The quantity and species of bacterial flora vary from the proximal to distal small intestine. Normal colony counts are approximately 102 colony-forming units/mL in the proximal small intestine and as high as 109 colony-forming units/mL in the terminal ileum. In the proximal small intestine, gram-positive, aerobic bacterial species are most common whereas gram-negative, anaerobic bacteria are more common distally. In healthy individuals, the normal gut microflora is maintained by 4 major mechanisms: gastric acid secretion, pancreatic enzyme secretion, small intestinal motility, and structural integrity of the GI tract. Disruption of any of these protective mechanisms can result in the development of small intestinal bacterial overgrowth SIBO . Irritable bowel syndrome IBS is a condition of unknown etiology that presents with recurrent abdominal pain or discomfort along with abnormalities in stool frequency or form[1] Because the symptoms of IBS overlap with SIBO, it has been hypothesized that many patients with IBS may have underlying SIBO.[2–6] This theory is supported by recent studies that have found that SIBO, as measured by lactulose or glucose hydrogen breath tests, is more prevalent in patients with IBS than matched controls.3,6 In addition, treating SIBO with antibiotics yields symptomatic improvements in some IBS patients, particularly those with significant bloating.[7] If one accepts that SIBO may provide an explanation for the development of symptoms in a subset of IBS sufferers, an interesting question is whether SIBO is truly fundamental to the pathophysiology of IBS, or a bystander or epiphenomenon of