SMALL-BOWEL BACTERIAL OVERGROWTH IN SYSTEMIC-SCLEROSIS - DETECTION USING DIRECT AND INDIRECT METHODS AND TREATMENT OUTCOME

Twenty-four patients with proven systemic sclerosis and with symptoms suggestive of malabsorption (i.e. chronic diarrhoea and weight loss) w ere investigated for small bowel bacterial overgrowth. Of the patients selected, six were suffering from the diffuse form of the disease. Je junal aspiration was performed in all patients, and in nine normal vol unteers. A specially designed double-lumen sterile catheter was used f or this purpose and was introduced via a gastroscope. Twenty of these patients underwent a glucose hydrogen breath test. Eight patients (33% ) had significant bacterial counts: > 10(5) colony forming units per m l (cfu/ml) of jejunal fluid. Less than 10(2) cfu/ml were found in the jejunal fluid from the nine control subjects. Glucose hydrogen breath testing was positive in seven patients, all of whom had significant je junal bacterial growth. Diarrhoea rather than weight loss was shown to be the symptom which correlated best with the presence of bacterial o vergrowth. Ciprofloxacin was used in six patients whose diarrhoeal sym ptoms ceased dramatically within 48 h of commencing the antibiotic. Tr imethoprim produced a partial response despite bacterial sensitivity. A disadvantage of the hydrogen breath test is that subsequent antibact erial therapy cannot be specific, as bacterial species, antibiotic sen sitivity and resistance are unknown. Systemic sclerosis involving the small intestine in the past has been said to more prevalent in patient s with diffuse disease, whereas this study showed a preponderance of p atients with long-standing limited cutaneous systemic sclerosis and sm all bowel involvement.