Clinical Report: High Prevalence of SIBO After Oesophagogastric Cancer Resection
Overview
This study found a high prevalence (73.5%) of small intestinal bacterial overgrowth (SIBO) in patients following oesophagectomy or gastrectomy for oesophagogastric cancer. Despite this high prevalence, SIBO symptoms were nonspecific and did not significantly differ between patients with positive and negative glucose hydrogen breath tests (GHBT).
Background
Small intestinal bacterial overgrowth (SIBO) involves an abnormal increase or change in small intestinal bacteria and commonly occurs after gastroesophageal reconstruction. Symptoms are often nonspecific, ranging from bloating to malnutrition, complicating clinical diagnosis. The study aimed to assess the prevalence of SIBO in patients post-oesophagogastric cancer resection and to evaluate its impact on gastrointestinal symptoms and health-related quality of life (HRQoL).
Data Highlights
Parameter
Oesophagectomy (n=30)
Gastrectomy (n=15)
Total (n=45)
SIBO Positive (GHBT+)
73.33% (22)
73.33% (11)
73.5%
Mean Appetite Loss Score (GHBT+)
24.1 ± 31.9
Mean Appetite Loss Score (GHBT-)
9.1 ± 21.5
Key Findings
SIBO prevalence was high at 73.5% among patients ≥1 year post-oesophagectomy or gastrectomy for oesophagogastric cancer.
Rates of SIBO were equivalent between oesophagectomy and gastrectomy groups (both 73.33%).
No significant differences in digestive symptom scores or overall quality of life were observed between GHBT positive and negative patients.
There was a non-significant trend toward greater appetite loss in GHBT positive patients.
Variables such as time since surgery, chemotherapy, alcohol use, smoking, proton pump inhibitor use, and BMI did not significantly influence SIBO prevalence.
Glucose hydrogen breath test (GHBT) may underestimate SIBO prevalence due to low sensitivity, suggesting the true prevalence could be even higher.
Clinical Implications
Clinicians should be aware of the high likelihood of SIBO in patients following oesophagogastric cancer surgery, even in the absence of specific symptoms. Given the nonspecific symptom profile and potential underdiagnosis with current breath tests, there is a need for standardized guidelines to improve SIBO assessment and management in this population.
Conclusion
SIBO is a common but underrecognized condition after oesophagogastric cancer resection, presenting with nonspecific symptoms that complicate clinical diagnosis. Enhanced diagnostic strategies and treatment guidelines are warranted to address this significant postoperative concern.
References
Evaluation of Small Intestinal Bacterial Overgrowth (SIBO) Prevalence in Patients Following Oesophagogastric Cancer Resection
