Erosive esophagitis may be related to small intestinal bacterial overgrowth

Scand J Gastroenterol. 2012 May;47(5):493-8. doi: 10.3109/00365521.2012.668932. Epub 2012 Mar 15.


Objectives: Erosive esophagitis (EE) may be related to small intestinal bacterial overgrowth (SIBO) because gastro-esophageal reflux disease has been a comorbid condition of irritable bowel syndrome (IBS), which has been associated with SIBO. We conducted a pilot study to investigate whether EE was associated with SIBO.

Material and methods: Twenty-eight patients with EE according to the Los Angeles classification criteria and 29 sex- and age-matched subjects without EE were enrolled. All subjects underwent esophagogastroduodenoscopy and a lactulose hydrogen breath test. A peak of H₂ values >20 ppm above the basal value after 10 g of lactulose ingestion was considered abnormal and suggestive of SIBO.

Results: Abnormal lactulose hydrogen breath test results were found in 67% of EE patients, as compared with 37% in the control group; the difference was statistically significant (p = 0.024). Among the subjects without IBS, subjects with EE and controls had 65% and 31% abnormal lactulose hydrogen breath test results, respectively; the difference was also statistically significant (p = 0.032).

Conclusions: Subjects with EE had a higher prevalence of SIBO, as assessed by the lactulose hydrogen breath test, with respect to a control group. These findings may suggest that EE is associated with SIBO.

MeSH terms

  • Adult
  • Breath Tests
  • Chi-Square Distribution
  • Endoscopy, Digestive System
  • Esophagitis / complications*
  • Esophagitis / microbiology
  • Esophagitis / pathology
  • Female
  • Humans
  • Hydrogen / analysis
  • Intestine, Small / microbiology*
  • Irritable Bowel Syndrome / complications
  • Lactulose / administration & dosage
  • Male
  • Middle Aged
  • Pilot Projects


  • Lactulose
  • Hydrogen