[Influence of Helicobacter pylori infection and its eradication treatment on small intestinal bacterial overgrowth]

Zhonghua Yi Xue Za Zhi. 2022 Nov 15;102(42):3382-3387. doi: 10.3760/cma.j.cn112137-20220316-00551.
[Article in Chinese]


Objectives: To analyze the effects of Helicobacter pylori (H. pylori) infection and eradication therapy on small intestinal bacterial overgrowth (SIBO). Methods: From September to December 2021, patients with abdominal symptoms who received 13C urea breath test at the Department of Gastroenterology in Peking University First Hospital were enrolled.13C urea breath test was used to detect H. pylori infection and patients were divided into H. pylori positive and negative groups accordingly. Lactulose hydrogen methane breath test was performed to determine SIBO. H. pylori positive patients were treated with quadruple therapy including amoxicillin, metronidazole, rabeprazole and bismuth potassium citrate. 13C urea breath test and lactulose hydrogen methane breath test were reexamined 6 weeks after the treatment. Results: A total of 102 patients (49 males and 53 females) were enrolled, with a mean age of (42.1±9.9) years. Among them, 49 patients were H. pylori negative and 53 were H. pylori positive. Moreover, 47 patients were SIBO positive and 55 were SIBO negative. There was no significant difference in age, sex, body mass index, abdominal symptoms and the diagnosis of chronic atrophic gastritis between H. pylori positive and negative patients at the enrollment (all P>0.05). The detection rate of SIBO in H. pylori infected patients was higher than that in uninfected patients, and the difference was statistically significant (60.4% vs 30.6%, P=0.003). Patients with SIBO had significantly more frequent abdominal distension (36.2% vs 10.9%, P=0.002) and constipation (27.7% vs 1.8%, P<0.001) than patients without SIBO. The rate of SIBO after H. pylori eradication treatment was significantly lower than that before treatment (20.8% vs 60.4%, P<0.001). The remission rate of SIBO after eradication therapy was 66.7% (20/30). Besides, patients had obvious improvement of constipation (6.0% vs 18.9%, P=0.008), and the incidence of other abdominal symptoms decreased to various degrees including diarrhea, abdominal pain, abdominal distention and poor appetite. Conclusion: H. pylori infection increases the risk of SIBO, and the quadruple regimen containing amoxicillin and metronidazole has a therapeutic effect for patients with H.pylori infection and concomitant SIBO.

目的: 分析幽门螺杆菌(H. pylori)感染和根除治疗对小肠细菌过度生长(SIBO)的影响。 方法: 连续纳入因消化道症状于2021年9至12月在北京大学第一医院消化内科门诊接受13C尿素呼气试验检查且既往未接受根除治疗的患者,根据13C尿素呼气试验诊断是否感染H. pylori,分为H. pylori阳性组和阴性组,乳果糖氢甲烷呼气试验诊断SIBO。H. pylori阳性患者使用阿莫西林+甲硝唑+雷贝拉唑+枸橼酸铋钾方案治疗。停药6周复查13C尿素呼气试验和乳果糖氢甲烷呼气试验。 结果: 共纳入102例患者,男49例,女53例,年龄(42.1±9.9)岁。其中H. pylori阴性49例,H. pylori阳性53例;SIBO阳性47例,阴性55例。H. pylori阳性组和阴性组患者年龄、性别、体质指数、腹部症状及萎缩性胃炎比例差异均无统计学意义(均P>0.05)。H. pylori感染者SIBO阳性率高于非感染者(60.4%比30.6%,P=0.003);SIBO阳性者腹胀(36.2%比10.9%,P=0.002)和便秘(27.7%比1.8%,P<0.001)症状发生率高于SIBO阴性者。H. pylori根除后SIBO检出率较治疗前下降(20.8%比60.4%,P<0.001),根除后SIBO缓解率为66.7%(20/30),患者便秘症状较前改善(6.0%比18.9%,P=0.008),其余胃肠道症状包括腹泻、腹痛、腹胀、纳差发生率均有不同程度的降低,但差异无统计学意义(均P>0.05)。 结论: H. pylori感染增加SIBO风险,含阿莫西林和甲硝唑的四联方案对H. pylori感染合并SIBO有治疗作用。.

Publication types

  • English Abstract

MeSH terms

  • Adult
  • Amoxicillin / therapeutic use
  • Anti-Bacterial Agents / therapeutic use
  • Bismuth / therapeutic use
  • Breath Tests
  • Constipation / chemically induced
  • Constipation / drug therapy
  • Drug Therapy, Combination
  • Female
  • Helicobacter Infections* / drug therapy
  • Helicobacter pylori*
  • Humans
  • Hydrogen / pharmacology
  • Hydrogen / therapeutic use
  • Lactulose
  • Male
  • Methane / pharmacology
  • Methane / therapeutic use
  • Metronidazole / therapeutic use
  • Middle Aged
  • Urea / pharmacology
  • Urea / therapeutic use


  • Metronidazole
  • Lactulose
  • Anti-Bacterial Agents
  • Amoxicillin
  • Bismuth
  • Urea
  • bismuth tripotassium dicitrate
  • Methane
  • Hydrogen