Look Further; SIBO May Explain Failure of Enzyme Therapy in Severe Chronic Pancreatitis

Bret T. Petersen, MD, FASGE reviewing Lee AA, et al. Am J Gastroenterol 2019 April 16.

Small intestinal bacterial overgrowth (SIBO) may occur in patients with chronic pancreatitis (CP), complicating interpretation and management of overlapping symptoms. In this study, the authors confirmed CP (by Mayo Score) in 98 of 273 adult patients with presumptive CP who had also undergone a glucose breath test. Concurrent SIBO was present in 40.8% of the CP patients. Retrospective evaluation of 5 defining variables and 41 investigational variables identified 5 variables predictive for SIBO, including use of opiates, total Mayo score, presence of diabetes, and reduced serum levels of zinc and albumin. The serum zinc level was a strong independent predictor of SIBO (p<0.001). Symptomatic improvement was noted in 26 of 33 patients (78.8%) for whom a response to antibiotics could be interpreted in the record.

Comment:
Persistent steatorrhea, bloating, and weight loss in patients taking oral enzymes for chronic pancreatitis often generate investigation and counseling on enzyme timing, dosing, and compliance. Among CP patients with severe disease, reflected by presence of diabetes and low serum zinc, and those with opiate use, SIBO should be considered as a contributor or potential major cause of these symptoms. While symptoms are not predictive of SIBO in the setting of CP, they often respond to antibiotic therapy.

Bret T. Petersen, MD, FASGE
Bio and Disclosures

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Citation(s):
Lee AA, Baker JR, Wamsteker EJ, Saad R, DiMagno MJ. Small intestinal bacterial overgrowth is common in chronic pancreatitis and associates with diabetes, chronic pancreatitis severity, low zinc levels, and opiate use. Am J Gastroenterol 2019 April 16. (Epub ahead of print) (https://doi.org/10.14309/ajg.0000000000000200)