P3190 - Delayed Gastric Emptying, but not Colonic Transit, Is Associated With SIBO Defined By Breath Test and Aspirate

Award: Presidential Poster Award

John Damianos, MD, Mauricio Jin, MD, Luis E. Ospina Velasquez, , Xiao Jing (Iris) Wang, MD
Mayo Clinic, Rochester, MN

Introduction: Small intestinal bacterial overgrowth (SIBO) describes an overabundance of bacteria within the small intestine. It arises as a consequence of loss of one or more physiologic mechanisms that normally protect against bacterial overgrowth. Intestinal dysmotility causes stasis, possibly predisposing to SIBO. We sought to assess association between dysmotility and SIBO.

Methods: We retrospectively identified all patients within the Mayo Clinic Health System who had both testing for SIBO (either via breath test or intestinal aspirate) and gastric, colonic, or whole gut transit scintigraphy (TS). SIBO positivity on breath test (BT) was defined in accordance with the North American consensus: a rise in hydrogen above baseline ≥ 20 ppm by 90 minutes or a methane level ≥ 10 ppm at any time point. Aspirate results were separately analyzed as positive if total bacterial count was ≥ 10³ or ≥ 10⁵. Delayed gastric emptying was defined by ≤ 75% emptied at 4 hours. Delayed colonic transit was defined as geometric center of Indium-111 colonic activity at the latest image obtained ( > 3.6 at 24 hours or > 4.9 at 48 hours).

Results: We identified 564 patients who underwent BT and gastric TS and 501 who underwent intestinal aspirate and gastric TS (Table 1). Delayed gastric emptying (n=165, 28.6%) was significantly associated with a positive breath test (OR 1.89, 95% CI 1.26-2.82, p = 0.002). Of those who had intestinal aspirates, 125 (25.0%) had delayed gastric emptying. Delayed gastric emptying was significantly associated with SIBO at a bacterial load of ≥ 10³ (OR 1.87,95% CI 1.20-2.95, p = 0.005), but not ≥ 10⁵ (OR 1.47, 95% CI 0.96-2.25, p = 0.07). Of the 184 patients who underwent BT and colonic TS, 48 (26.1%) had delayed colonic transit. There was no association between delayed colonic transit and SIBO (p = 0.83). 36 of 130 patients with both aspirate and colonic TS (27.7%) had delayed colonic transit. There was no association between delayed colonic transit and SIBO at a bacterial load of 10^{^}3 (p = 0.74), or 10^{^}5 (p = 0.83).

Discussion: Delayed gastric emptying was associated with SIBO on breath test and aspirate at a bacterial load of ≥ 10³ but not ≥ 10⁵. Delayed colonic transit was not associated with SIBO via either breath test or aspirate. The colonic transit data are limited by small numbers. Future research will investigate association of intestinal methanogen overgrowth with delayed transit and further characterize overgrowth populations.


Disclosures:


John Damianos, MD, Mauricio Jin, MD, Luis E. Ospina Velasquez, , Xiao Jing (Iris) Wang, MD. P3190 - Delayed Gastric Emptying, but not Colonic Transit, Is Associated With SIBO Defined By Breath Test and Aspirate, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.