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Answer D
Objective: Identify the clinical presentation and risk factors for small intestinal bacterial overgrowth.
Rationale: This patient likely has small intestinal bacterial overgrowth (SIBO) based on her symptoms, the steatorrhea with the positive Sudan stain for fat, and a slight anemia with an elevated MCV suggestive of vitamin B12 deficiency secondary to the bacterial overgrowth. She also has scleroderma, a condition commonly associated with SIBO, because it impairs gastrointestinal motility.
While hydrogen breath testing may help establish the diagnosis of SIBO, there is variable sensitivity and specificity of the testing with false-positive and false-negative test results frequently occurring. An alternative strategy is to treat empirically with an accepted antibiotic regimen and assess response after the course is completed.
References
1. Bures J., Cyrany J., Kohoutova D., et al. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010 Jun 28;16(24):2978-90.
2. Abu-Shanab A., Quigley E.M.. Diagnosis of small intestinal bacterial overgrowth: The challenges persist! Expert Rev Gastroenterol Hepatol. 2009 Feb;3(1):77-87.
3. Khoshini R., Dai S.C., Lezcano S., Pimentel M. A systematic review of diagnostic tests for small intestinal bacterial overgrowth. Dig Dis Sci. 2008 Jun;53(6):1443-54.
Answer D
Objective: Identify the clinical presentation and risk factors for small intestinal bacterial overgrowth.
Rationale: This patient likely has small intestinal bacterial overgrowth (SIBO) based on her symptoms, the steatorrhea with the positive Sudan stain for fat, and a slight anemia with an elevated MCV suggestive of vitamin B12 deficiency secondary to the bacterial overgrowth. She also has scleroderma, a condition commonly associated with SIBO, because it impairs gastrointestinal motility.
While hydrogen breath testing may help establish the diagnosis of SIBO, there is variable sensitivity and specificity of the testing with false-positive and false-negative test results frequently occurring. An alternative strategy is to treat empirically with an accepted antibiotic regimen and assess response after the course is completed.
References
1. Bures J., Cyrany J., Kohoutova D., et al. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010 Jun 28;16(24):2978-90.
2. Abu-Shanab A., Quigley E.M.. Diagnosis of small intestinal bacterial overgrowth: The challenges persist! Expert Rev Gastroenterol Hepatol. 2009 Feb;3(1):77-87.
3. Khoshini R., Dai S.C., Lezcano S., Pimentel M. A systematic review of diagnostic tests for small intestinal bacterial overgrowth. Dig Dis Sci. 2008 Jun;53(6):1443-54.
Answer D
Objective: Identify the clinical presentation and risk factors for small intestinal bacterial overgrowth.
Rationale: This patient likely has small intestinal bacterial overgrowth (SIBO) based on her symptoms, the steatorrhea with the positive Sudan stain for fat, and a slight anemia with an elevated MCV suggestive of vitamin B12 deficiency secondary to the bacterial overgrowth. She also has scleroderma, a condition commonly associated with SIBO, because it impairs gastrointestinal motility.
While hydrogen breath testing may help establish the diagnosis of SIBO, there is variable sensitivity and specificity of the testing with false-positive and false-negative test results frequently occurring. An alternative strategy is to treat empirically with an accepted antibiotic regimen and assess response after the course is completed.
References
1. Bures J., Cyrany J., Kohoutova D., et al. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010 Jun 28;16(24):2978-90.
2. Abu-Shanab A., Quigley E.M.. Diagnosis of small intestinal bacterial overgrowth: The challenges persist! Expert Rev Gastroenterol Hepatol. 2009 Feb;3(1):77-87.
3. Khoshini R., Dai S.C., Lezcano S., Pimentel M. A systematic review of diagnostic tests for small intestinal bacterial overgrowth. Dig Dis Sci. 2008 Jun;53(6):1443-54.
A 56-year-old woman with a history of scleroderma presents for evaluation of recurrent episodes of bloating, excess flatulence, mild nausea, and watery diarrhea for the past 5 months without associated weight loss, gastrointestinal bleeding, or fevers.
She had a normal screening colonoscopy 2 years ago, and an upper endoscopy for evaluation of reflux and dyspepsia 5 years ago, which was only notable for a small sliding hiatal hernia. Laboratory testing reveals hemoglobin of 10.9 g/dL with an MCV 106 fL. Stool studies are negative for occult blood, fecal calprotectin is not elevated, but a Sudan stain is positive.