Bacterial Overgrowth causing Chronic Pancreatitis and Rosacea – New treatment? And, for elderly, a quick way to get rid of lactose intolerance

Chronic pancreatitis is a disease associated with recurrent abdominal pains, and malabsorption with possible steatorhea (fatty looking stools), bloating, intermittent diarrhea. A recent study found Small Intestine bacterial overgrowth (SIBO) in 14/15 cases and suggested treatment would help those symptoms. In another study, SIBO is common in Rosacea and eradication led to “almost complete regression of their cutaneous lesions and maintained this excellent result for at least 9 months.” Half of elderly have lactose intolerance and treating them for bacterial overgrowth can cure it.

Rev Med Chil. 2008 Aug;136(8):976-80.
Small intestine bacterial overgrowth in patients with chronic pancreatitis.
Mancilla A C, Madrid S AM, Hurtado H C, Orellana B C, Peña Z M, Tobar A E, Berger F Z.
abstract

Chronic pancreatitis symptoms were:

• bloating in 9 (64%),
• recurrent abdominal pain in 8 (57%),
• intermittent diarrhea in 5 (36%)
• steatorrhea in 5 (36%)

13/14 (92%) had bacterial overgrowth though they do say other studies found it 30-40%.

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Clin Gastroenterol Hepatol. 2008 Jul;6(7):759-64.
Small intestinal bacterial overgrowth in rosacea: clinical effectiveness of its eradication.
Parodi A, Paolino S, Greco A, Drago F, Mansi C, Rebora A, Parodi A, Savarino V.
abstract

53/113 (47%) Rosacea cases had SIBO
3/60 (5%)controls

That’s 9 times the pravalence

Rosacea rifaximin therapy (1200 mg/day for 10 days) – cleared or greatly improved in 43/48 SIBO positive cases but not in placebo.

Only 3/16 SIBO negatives responded to treatment

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Bacterial overgorwth is becoming more commonly documented now that there is a treatment for it – nonabsorbable rifaximin available only in the US. I use Neomycin 500 mg twice daily though they have to take it in powder form.

I previously wrote how it could alleviate restless legs and Interstitial Cystitis link here

Bacterial overgrowth is seen in:

Irritable bowel abstract

scleroderma: abstract – they felt their delayed gastric emptying a possible cause.

Chronic renal failure abstract

Elderly with lactose intolerance

Scand J Gastroenterol. 2008;43(2):146-54. Lactose malabsorption in the elderly: role of small intestinal bacterial overgrowth. Almeida JA, Kim R, Stoita A, McIver CJ, Kurtovic J, Riordan SM.

50% elderly have lactose malabsorption symptoms – gas, bloating, maybe diarrhea after milk products (except hard cheese – has NO lactose)
SIBO found in 9/10 cases – eradication of SIBO got rid of lactose intolerance symptoms in all cases. Apparently the lactulose breath test is not reliable in the elderly though abstract

Comments – Rosacea, lactose intolerance in elderly, restless legs, and interstitial cystitis may all be markers for bacterial overgrowth. Neomycin Powder 500 mg BID for 10 days or in the US rifaximin 1200 mg/day for 10 days would be in order.

Addendum – in Pancreatic cancer, bacterial overgrowth causes diarrhea:

J Pancreas (Online) 2009 Sep 4; 10(5):576-578.
Small Intestine Bacterial Overgrowth: An Underdiagnosed Cause of Diarrhea in Patients with Pancreatic Cancer
Ivan Bustillo, Heidi Larson, Muhammad Wasif Saif    free article here

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