P1251 - Discordance Between Self-Reported Gastrointestinal Symptoms and Glucose Breath Test Results in Small Intestinal Bacterial Overgrowth: A Retrospective Analysis

Sunday, October 22, 2023

3:30 PM - 7:00 PM PT

Location: Exhibit Hall

Presenting Author(s)

Jonathan D. Dvorak, MD

Atrium Health Carolinas Medical Center
Charlotte, NC

Jonathan D. Dvorak, MD¹, Mackenzie Mcarthur, PA-C¹, Sahla Hammad, MD², Jason Baker, PhD³, Baharak Moshiree, MD, MSc⁴, Satish SC. Rao, MD, PhD⁵
¹Atrium Health Carolinas Medical Center, Charlotte, NC; ²Atrium Health Cleveland, Shelby, NC; ³Anxrobotics, Foley, AL; ⁴Atrium Health, Wake Forest Medical University, Charlotte, NC; ⁵Augusta University Medical Center, Augusta, GA

Introduction: SIBO is diagnosed using Glucose Hydrogen Breath Testing (GBT). GI symptoms (sxs) are poor predictors of GBT positivity. There is a paucity of literature on the predictive values of self-reported GI sxs in terms of their frequency, intensity, and duration for determining a positive GBT test.

Methods: We retrospectively reviewed all adult pts presenting to a single medical center from 6/2022–04/2023 for GBT. A positive GBT for SIBO was defined by the North American Consensus. Pts completed a GI questionnaire assessing 17 key sxs: regurgitation (RG), chest pain (CP), heartburn (HB), belch (BH), abdominal pain (AP), bloating (BT), gas (GS), nausea (NA), vomit (VT), abdominal cramps (AC), indigestion (ID), distension (DN), fullness (FL), early satiety (ES), diarrhea (DR), constipation (CN), and fatigue (FT). Sxs were measured by Frequency, Intensity, and Duration. Sub-groups, GERD (RG+CP+HB), Dyspeptic (AP+BT+GS+NA+FL+ES), and IBS (AP+DR+CN) were made assessing the mean summation scores for Frequency, Intensity, and Duration between negative and positive GBTs. Univariate and logistic regression analysis was performed. P-value of < 0.05 was considered statistically significant.

Results: N = 195 pts, mean age of 51.4, 79.3% female, 79.6% Caucasian, and mean BMI of 27.2. No demographic differences between negative (n = 93) and positive (n = 91) GBT groups for sex, race, and BMI; positive GBT group was significantly older than the negative GBT group, 53.7 (17.2) vs. 48.9 (16.1), p = 0.02. No significant differences between GI sx frequency, intensity, and duration categories between GBT outcome groups, although a trend for more severe RG in positive vs. negative GBT groups, 8.2% vs. 0.0%, p = 0.08. Regression analysis depicted a trend toward a positive GBT for longer duration of reported Dyspeptic sxs, p = 0.09; OR = 1.06; 95% CI: 0.99, 1.13, controlling for age. (p = 0.09; OR = 2.24; 95% CI: 0.86, 5.84). The mean Dyspeptic Duration score was significantly higher in positive vs. negative GBT groups: 11.4 (4.5) vs. 10.3 (4.7), p = 0.05. No further differences were seen between the GERD, Dyspeptic, and IBS sub-groups relative to frequency, intensity, and duration mean summations scores.

Discussion: A positive GBT cannot be predicted based on pre-test symptoms. The decision to perform GBT should consider the comprehensive patient presentation, including the association of SIBO with various systemic disease processes and risk factors as self-reported symptoms alone are poor predictors of GBT outcomes.

Mean Summation Score	Negative Glucose Hydrogen Breath Test (n = 98)	Positive Glucose Hydrogen Breath Test (n = 93)	P-Value
Frequency
--Mean GERD Category	2.3 (2.4)	2.4 (2.4)	0.38
--Mean Dyspeptic Category	11.0 (4.8)	11.1 (4.8)	0.42
--Mean IBS Category	5.1 (2.6)	4.7 (2.2)	0.15
Intensity
--Mean GERD Category	2.3 (2.2)	2.3 (1.9)	0.49
--Mean Dyspeptic Category	9.3 (4.2)	9.9 (4.2)	0.18
--Mean IBS Category	4.7 (2.2)	4.6 (2.0)	0.41
Duration
--Mean GERD Category	2.5 (2.3)	2.5 (2.2)	0.46
--Mean Dyspeptic Category	10.3 (4.7)	11.4 (4.5)	0.05
--Mean IBS Category	4.9 (2.5)	5.0 (2.0)	0.33

Table: Mean Summation Scores for Self-Reported Frequency, Intensity, and Duration Responses to GI Symptoms Relative to the Gastroesophageal Reflux Disease (GERD), Dyspeptic, and Irritable Bowel Syndrome (IBS) Groups.

Disclosures:

Jonathan Dvorak indicated no relevant financial relationships.

Mackenzie Mcarthur indicated no relevant financial relationships.

Sahla Hammad indicated no relevant financial relationships.

Jason Baker indicated no relevant financial relationships.

Baharak Moshiree indicated no relevant financial relationships.

Satish Rao indicated no relevant financial relationships.

Jonathan D. Dvorak, MD¹, Mackenzie Mcarthur, PA-C¹, Sahla Hammad, MD², Jason Baker, PhD³, Baharak Moshiree, MD, MSc⁴, Satish SC. Rao, MD, PhD⁵. P1251 - Discordance Between Self-Reported Gastrointestinal Symptoms and Glucose Breath Test Results in Small Intestinal Bacterial Overgrowth: A Retrospective Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.