Abstracts
1997 Digestive Disease Week

Anti-bacterial treatment for postoperative bacterial overgrowth in Crohn's disease.

Y Funayama, I Sasaki, H Naito, K Fukushima, T Masuko, K Takahashi, H Ogawa, S Sato, T Ueno, M Noguchi, N Hiwatashi, S Matsuno. The First Department of Surgery and the Third Department of Medicine, Tohoku University School of Medicine, Sendai, Japan.

Background and Aim: Bacterial overgrowth (BOG) sometimes occurs in Crohn's disease, which complicates the disease process and occasionally leads to wrong treatment. To clarify the effect of anti-biotic therapy, we monitored the hydrogen concentration in expiratory breath.

Patients and Methods: Between December in 1995 and May in 1996, we evaluated 17 patients (14 males and 3 females, mean age 35.2±11.0) for postoperative BOG by symptoms, plain abdominal Xray, and hydrogen breath test (positive test was estimated as higher than 10 ppm). Four patients had ileitis and thirteen had ileocolitis. Various intestinal resections were performed in all, and the reconstructive procedures were ileoileostomy in seven, ileocolostomy in eight, and ileostomy in two. Strictureplasty was done at the same time in eleven patients. Postopeative period was 31.4±38.6 months. Antibiotics was administered for patients with BOG. Antibiotics were changed every week sequentially as ciprofloxacin 200mg, minocycline 100mg, and erythromycin 400mg (daily dose) until it proved effective. The figures were expressed as mean ± standard deviation, and compared by ANOVA.

Results: Nine patients had symptoms such as abdominal fullness, anorexia, and pain, who all had high value of hydrogen concentration. Eight patients had no symptoms, all of whom had normal value of hydrogen concentration. The former nine patients were estimated as having BOG (44.1±38.5 ppm), which value was significantly higher than that of other eight patients (5±2.8 ppm). After the antibiotic treatment the value of hydrogen concentration was significantly reduced to 5.3±3.4 ppm. Ciprofloxacin was effective in only one patient, but had no effect in three. Minocycline was effectve in four, but had poor effect in two. Erythromycin was effective in two patients who showed poor response to minocycline. After the BOG treatment three patients underwent reoperation for intestinal stenosis, while only one patient did without BOG.

Conclusion: In the management of Crohn's disease, anti-bacterial treatment was useful in the postoperative patients complicated by BOG. Using hydrogen breath test, BOG was effectively diagnosed and managed, which change was compatible with clinilcal symptoms. The selection of the types of antibiotics needs more considerations, because of the variable spectrums of BOG. In some cases, BOG seemed to reflect the hidden intestinal stenosis, which required the further examination.