A306 SIBO AND ASSOCIATION WITH IBD ACTIVITY.

SIBO is when there is an excess number of bacteria in the small intestine or when bacteria normally found in the colon are found in the small intestine. Excessive infiltration by bacteria into the small intestine is usually prevented by a number of mechanisms including an intact ileocaecal valve, gastric and bile acid secretion, antegrade peristalsis, digestion by proteolytic enzymes, IgA production and an intact mucus layer. Patients with Inflammatory Bowel Disease are believed to be at increased risk of developing SIBO. An excess number of bacteria in the small intestine can provoke diarrhoea, cause gas, and lead to malabsorption of micronutrients. Medical and surgical therapy for IBD is expensive and we may be over-treating patients with symptoms who actually have SIBO. There has only been a handful of published studies looking at the prevalence of SIBO in IBD, with no studies looking at disease activity or other clinical features. The purpose of this pilot study is to estimate the prevalence of SIBO in IBD and to see if there are any clinical features associated with an increased likelihood of SIBO in CD or UC. Participants are asked to do a SIBO breath test at St Joseph’s Hospital. Two days prior to the test, participants are asked to eat a low fermentable carbohydrate diet, and to fast 10 hours prior. Participants provide a baseline breath sample. Then, after consuming the glucose drink (75g in 200ml water), breath samples are taken every 15 minutes for 2 hours. Concentration of hydrogen and methane in the breath are measured on the Quintron machine. Participants are deemed to have SIBO if they have an increase in either hydrogen or methane of 12 parts per million from the baseline level. We use previous information from the patients chart as well as a history from the patient to obtain data for disease history and severity using MAYO for UC and CDAI for CD. Fresh fecal and urine samples are collected in DNA/RNA free bags and sterile containers and stored at -80C. A total of 13 patients were recruited to participate in this pilot study. 7 patients conducted the SIBO testing, 4 with CD and 3 with UC. Of those tested, 1 was positive for SIBO and 1 had a sustantially elevated baseline hydrogen level. Both of these patients were CD patients with a previous history of small bowel resection. They were 2 of 4 with previous surgeries, the other two having an end iliostomy. These two patients also had lower CDAI scores of the 4 with CD. This study aligns with previous studies and shows that patients with IBD have an increased risk of SIBO. It also shows that previous small bowel resection appears to be a risk factor for SIBO. Disease activity does not seem to play a role, but further studies need to be done. With a look into the stool and urine samples collected on these patients, we hope to be able to identify particular microbiota that may be associated with SIBO in IBD. None

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