Wendy Zhou, DO1, Thomas Zikos, MD2, Leila Neshatian, MD3, Linda Nguyen, MD3; 1Santa Clara Valley Medical Center, San Jose, CA; 2Stanford University School of Medicine, Campbell, CA; 3Stanford University School of Medicine, Redwood City, CA
Introduction: Gastrointestinal symptoms are common in patients with hypermobile Ehlers Danlos Syndrome (EDS). Prior studies suggest a link between EDS and small intestinal bacteria overgrowth (SIBO), but risk factors have not been defined. We aim to identify such risk factors for SIBO in patients with hypermobile EDS. Methods: We conducted a retrospective review of patients at our institution who were diagnosed with hypermobile EDS (type 3) and underwent a breath test for evaluation of SIBO. Patient demographics and breath test results were extracted. Diagnosis of SIBO was defined by a positive breath test per 2017 North American Consensus. We compared demographics and GI symptoms between patients meeting diagnostic criteria for SIBO and those without SIBO. Two-sample-t-testing, chi2 testing, and Wilcoxon rank sum testing were used to identify risk factors of SIBO in patients with EDS. Multiple logistic regression was used to evaluate for confounders. Results: A total of 75 patients with hypermobile EDS were studied (33 with glucose breath testing, 42 with lactulose breath testing). Mean age was 33.9 (range 15-68). Based on breath testing, 26 (35%) had SIBO while the other 49 did not. Of those with SIBO, 92% were methane positive, while only 35% were hydrogen positive. EDS patients with SIBO were more likely to have constipation (50.00% vs 26.53%, p=0.042) and be Caucasian (88.46% vs 67.35%, p=0.045) compared to EDS patients without SIBO. Multiple logistic regression evaluating Caucasian ethnicity and constipation as predictors of SIBO showed similar results (odds-ratio for constipation=2.82, p=0.048, odds-ratio for Caucasian ethnicity=3.80, p =0.057). Of the 21 patients who underwent a wireless motility capsule study, there was no clear association between gastric, small bowel, or colonic transit times and a positive breath test. Of the 55 patients who had a GES, there was no relationship between gastric emptying times and a positive breath test. Discussion: Our data suggests that EDS patients with SIBO are more likely to be constipation predominant than the more classical diarrhea predominant seen in general population. This could be explained by high prevalence of methane positive SIBO, which can be associated with constipation. This suggests that breath testing of both methane and hydrogen should be considered in patients with EDS and bowel symptoms, even if the predominant symptom is constipation. Further prospective evaluation with higher sample sizes and evaluation of confounders is needed.
Risk factors for small bowel bacterial overgrowth
Disclosures: Wendy Zhou indicated no relevant financial relationships. Thomas Zikos indicated no relevant financial relationships. Leila Neshatian indicated no relevant financial relationships. Linda Nguyen indicated no relevant financial relationships.