[Note: the lactulose breath test measures the levels of hydrogen and methane in the breath – two gases produced by fermented bacteria. Nonabsorbable antibiotics are taken orally and do not pass the gastrointestinal wall into the blood stream. Prokinetic agents are used to speed movement of food through the GI tract.]
Purpose: Interstitial cystitis (IC) often coexists with irritable bowel syndrome (IBS). IBS may be explained by small-intestinal bacterial overgrowth (SIBO), which increases immune activation and visceral hypersensitivity.
This prospective pilot study tested hypotheses that IC patients with gastrointestinal (GI) symptoms have SIBO, that nonabsorbable antibiotic use improves symptoms, and that improvement is sustained by prokinetic therapy.
Methods: Consecutive IC patients with GI symptoms had lactulose breath testing (LBT). Those with abnormal results received rifaximin 1,200-1,800 mg/day for 10 days then tegaserod 3 mg/nightly. Questionnaires addressed IC and GI global improvement.
Results: Of 21 patients, 17 (81%) had abnormal LBTs. Of 15 patients treated, GI global improvement was moderate to great in 11 (73%) and sustained in ten (67%). IC global improvement was moderate to great in six (40%) and sustained in seven (47%).
Conclusions: A majority of IC patients and GI symptoms had an abnormal lactulose breath test suggesting small intestinal bacterial overgrowth. Rifaximin improved symptoms, which was sustained by tegaserod.
Source: Digestive Diseases and Sciences. 2007 Oct 12; [Epub ahead of print] PMID: 17932763, by Weinstock LB, Klutke CG, Lin HC. Washington University School of Medicine, St. Louis, MO, USA.