A total of 61 patients had a positive reflux-symptom association, and this was statistically significant between dysbiosis and non-dysbiosis groups ( P 0.05). The mean DeMeester score was not different between dysbiosis and non-dysbiosis groups ( P > 0.05). The mean number of reflux events was slightly higher (61.5 ± 37.0) in patients with dysbiosis than in those without (50.4 ± 35.2), but this was not statistically significant ( P > 0.05). All statistical analyses were performed using IBM SPSS Statistics 24.Ī total of 33 patients had an abnormal acid exposure time on oesophageal pH-metry (Table 1), and this was not statistically significant between the dysbiosis and non-dysbiosis groups ( P > 0.05). A P value of < 0.05 was considered statistically significant. The association between characteristics was determined by the Pearson chi-squared tests. The means were compared by student’s t-tests. Discrete variables were expressed as numbers and percentages. Continuous variables were expressed as means ± standard deviation, unless otherwise stated. Statistical analysisĭata were collected retrospectively from the patient’s referral letter, history, HMBT report and 24-h pH-impedance data. A positive reflux-symptom association was determined by a symptom index of ≥ 50% together with a symptom association probability of ≥ 95%. The patient’s most troublesome symptoms (up to a maximum of 3) were recorded using buttons on the pH recorder for reflux-symptom association, but lower gastrointestinal symptoms (nausea, bloating and abdominal pain) were not assessed for reflux-symptom association. Exclusion criteria included patients younger than 18 years old, use of antibiotics ( 4.0%, which is a borderline abnormal result according to the Lyon Consensus. All patients who also completed a lactulose hydrogen and methane breath test were selected and the data reviewed. All patients were evaluated by a surgeon and underwent 24-h oesophageal pH-impedance monitoring with a view to potentially undergoing antireflux surgery. This retrospective database study included patients referred from secondary care to a speciality reflux centre from March 2017 to September 2019. Independently, SIBO may be a contributory factor to refractory reflux symptoms and gas bloating in antireflux surgery candidates. The prevalence of intestinal dysbiosis is high in patients with GERD, and these patients are more likely to report gas-related symptoms prior to antireflux surgery. Hydrogen gas production was significantly greater in patients with a positive reflux-symptom association for regurgitation (228.8 ppm vs 129.1 ppm, P = 0.004) and belching (mean AUC 214.8 ppm vs 135.9 ppm, P = 0.02). The oesophageal acid exposure time and number of reflux episodes were similar between dysbiosis and non-dysbiosis groups, but patients with dysbiosis were more likely to have a positive reflux-symptom association (76.2% vs 31.7% P < 0.001), especially for regurgitation in those with SIBO ( P = 0.01). ![]() ResultsĦ0.6% of patients had intestinal dysbiosis (39.4% had SIBO and 35.6% had IMO). Intestinal dysbiosis was determined by hydrogen and methane breath testing with a hydrogen-positive result indicative of SIBO and a methane-positive result indicative of intestinal methanogen overgrowth (IMO). Patients underwent a routine diagnostic workup for GERD including history, endoscopy, oesophageal manometry and 24-h pH-impedance monitoring off PPIs. Methodsĭata from consecutive patients ( n = 104) referred to a speciality reflux centre were retrospectively assessed. Patients undergoing antireflux surgery are not routinely screened for SIBO, yet many patients experience gas-related symptoms postoperatively. PPIs have been shown to cause changes to the intestinal microbiota, such as small intestinal bacterial overgrowth (SIBO), which is characterised by symptoms of gas bloating. Prior to antireflux surgery, most patients with symptoms of gastroesophageal reflux disease (GERD) have been taking long-term proton pump inhibitors (PPIs).
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