Patients positive for bacterial overgrowth underwent a glucose breath test in order to confirm the result. Twenty further patients were considered ineligible because of diarrhoea and were excluded from the study. Patients and methodsįrom June 2000 to September 2002 we performed a lactulose hydrogen/methane breath test in 145 eligible consecutive patients affected by Crohn's disease who attended the Inflammatory Bowel Disease Clinic in our Department. The aim of this study was to investigate the efficacy of metronidazole and ciprofloxacin in the treatment of small bowel bacterial overgrowth in patients affected by Crohn's disease selected by the lactulose and glucose hydrogen/methane breath test. Metronidazole and ciprofloxacin are two drugs widely used in the treatment of active Crohn's disease, 12- 14 but their effectiveness in patients with small bowel bacterial overgrowth is not proven. 4, 9Īntibiotic therapy of bacterial overgrowth has been studied in patients with several conditions, 9- 11 while there are no specific data on treatment of bacterial overgrowth complicating Crohn's disease. The detection of bacterial overgrowth is important in the clinical management of these patients because it can contribute to the worsening of intestinal symptoms (diarrhoea, abdominal pain and bloating) and because it is a treatable condition in most instances. 4 We also found that one of the possible reasons for the high prevalence of bacterial overgrowth can be the prolonged oro-colonic transit time, particularly in operated subjects. 1, 8 In a previous study we showed by a lactulose breath test that 23% of unselected patients with Crohn's disease presented bacterial overgrowth, and that this proportion was even higher in patients with previous surgery. Small bowel bacterial overgrowth is a frequent condition in patients affected by Crohn's disease, particularly in those with stenosis and entero-enteric fistula. 4, 5 The glucose breath test seems to be more specific although less sensitive than the lactulose breath test for bacterial overgrowth however, it does not allow for transit time assessment. 1, 4 The lactulose breath test allows for the simultaneous assessment of bacterial overgrowth and oro-coecal transit time, and has been previously evaluated in patients with Crohn's disease. Therefore, the appearance of an early increase in breath H 2 or CH 4 concentration indicates the presence of a small bowel bacterial overgrowth. 2, 3 The H 2 and CH 4 produced in the human body after lactulose or glucose ingestion derive entirely from intestinal bacterial fermentation.
The hydrogen/methane breath test has been proposed as a sensitive and simple tool for the diagnosis of bacterial overgrowth, 1 being non-invasive and inexpensive compared to a culture of intestinal aspirates and 14C-xylose breath test, respectively. In both groups antibiotic treatment induced an improvement of intestinal symptoms: bloating (Group A 85% and Group B 83%), stool softness (44% and 50%), and abdominal pain (50% and 43%).Ĭonclusions : Small bowel bacterial overgrowth is a frequent condition in Crohn's disease which can be effectively treated by metronidazole or ciprofloxacin. Breath test normalization occurred in 13 out of 15 patients treated by metronidazole and in all 14 patients treated by ciprofloxacin ( P = ns). Results : Bacterial overgrowth was present in 29 patients (20%). The clinical outcome after therapy was also recorded.
The glucose breath test was repeated at the end of treatment. These patients were randomized in two treatment groups: metronidazole 250 mg t.d.s. Patients positive to the lactulose breath test underwent a glucose breath test to confirm the overgrowth. Patients and methods : We performed the lactulose breath test in 145 consecutive patients affected by Crohn's disease. Metronidazole and ciprofloxacin are effective antibiotics in active Crohn's disease.Īim : To investigate the efficacy of metronidazole and ciprofloxacin in the treatment of bacterial overgrowth in patients with Crohn's disease. Background : Small bowel bacterial overgrowth is common in Crohn's disease but its treatment is not clearly defined.
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