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, 9 (4), 146

Does Colectomy Predispose to Small Intestinal Bacterial (SIBO) and Fungal Overgrowth (SIFO)?


Does Colectomy Predispose to Small Intestinal Bacterial (SIBO) and Fungal Overgrowth (SIFO)?

Satish S C Rao et al. Clin Transl Gastroenterol.


Objectives: After subtotal colectomy, 40% of patients report chronic gastrointestinal symptoms and poor quality of life. Its etiology is unknown. We determined whether small intestinal bacterial overgrowth (SIBO) or small intestinal fungal overgrowth (SIFO) cause gastrointestinal symptoms after colectomy.

Methods: Consecutive patients with unexplained abdominal pain, gas, bloating and diarrhea (>1 year), and without colectomy (controls), and with colectomy were evaluated with symptom questionnaires, glucose breath test (GBT) and/or duodenal aspiration/culture. Baseline symptoms, prevalence of SIBO/SIFO, and response to treatment were compared between groups.

Results: Fifty patients with colectomy and 50 controls were evaluated. A significantly higher (p = 0.005) proportion of patients with colectomy, 31/50 (62%) had SIBO compared to controls 16/50 (32%). Patients with colectomy had significantly higher (p = 0.017) prevalence of mixed SIBO/SIFO 12/50 (24%) compared to controls 4/50 (8%). SIFO prevalence was higher in colectomy but not significant (p = 0.08). There was higher prevalence of aerobic organisms together with decreased anaerobic and mixed organisms in the colectomy group compared to controls (p = 0.008). Patients with colectomy reported significantly greater severity of diarrhea (p = 0.029), vomiting (p < 0.001), and abdominal pain (p = 0.05) compared to controls, at baseline. After antibiotics, 74% of patients with SIBO/SIFO in the colectomy and 69% in the control group improved (p = 0.69).

Conclusion: Patients with colectomy demonstrate significantly higher prevalence of SIBO/SIFO and greater severity of gastrointestinal symptoms. Colectomy is a risk factor for SIBO/SIFO.

Conflict of interest statement

Guarantor of the article: Satish S.C. Rao, MD., Ph.D., FRCP (LON).

Specific author contributions: Satish SC Rao—Study concept and design, performing duodenal aspiration, breath test interpretations, data acquisition, data collection, study recruitment, data analysis and interpretation, manuscript preparation, critical revision, and important intellectual content and final approval. G. Tan, MD: Data collection and analysis of controls, manuscript preparation. H. Abdulla, MD: Data collection, data analysis and interpretation, manuscript preparation. S. Yu, MD: Study recruitment, Interpretation breath tests, IRB, Data analysis and interpretation, manuscript preparation. P. Leelasinjaroen, MD: Data collection and analysis, manuscript preparation. S. Larion, MD: Data analysis and statistics, manuscript preparation. All authors are affiliated and located at Augusta University and all authors have approved the final draft submitted.

Financial support: none.

Potential competing interest: none.


Fig. 1
Fig. 1
The prevalence of aerobic and/or anaerobic organisms in patients with colectomy compared to controls
Fig. 2
Fig. 2
The prevalence of SIBO and/or SIFO in patients with colectomy and controls without colectomy

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