S2100 Diarrhea and Dysbiosis: Antidiarrheal Medication Effects on SIBO Diagnosis

Introduction: Small intestinal bacterial overgrowth (SIBO) results from gut dysbiosis. Patients can experience significant discomfort from bloating and diarrhea associated with microbiome disruption. Antidiarrheal medications are commonly used to help treat symptoms of SIBO, but little research has been conducted to determine the relationship between SIBO and antidiarrheal medications. This study aims to identify an association between the use of antidiarrheals and incidence of SIBO. Methods: This is a retrospective case-control study among patients who underwent SIBO glucose breath testing at a single academic center between 2017 and 2023. We calculated the odds ratio (OR) by use of antidiarrheals for intestinal methanogen overgrowth (IMO) and hydrogen producing SIBO (H-SIBO). We further evaluated the OR by gastric emptying results. We used the chi-square test to determine statistical significance of these associations. Results: We identified 1,447 individuals who had received SIBO glucose breath testing at our center. Of these, 990 were IMO positive and 249 were H-SIBO positive. 172 were taking antidiarrheals and 1,275 were not taking antidiarrheals. Antidiarrheal usage was associated with H-SIBO (OR 2.29, P < 0.00001. No such association was found between antidiarrheal use and IMO (OR 1.3., P = 0.36). Of the 1,447 individuals who underwent breath testing, 123 had a history of a slow gastric emptying test result. Among patients with confirmed delayed gastric emptying, we found that patients using antidiarrheals had a higher incidence of H-SIBO than those not taking antidiarrheals (OR 3.34, P = 0.034). Conclusion: It is essential to recognize which medications may influence the course of SIBO and IMO to improve diagnosis and management for affected individuals. Our research identified an association between H-SIBO and the use of antidiarrheal medications. Given the widespread use of antidiarrheal medications for the treatment of symptoms related to H-SIBO symptoms, further investigation is necessary to more thoroughly understand the link between common treatment and the condition itself. Additionally, there is an independent association of H-SIBO diagnosis among patients with delayed gastric emptying taking antidiarrheals. Potential drug effects exacerbating impaired motility may be worth careful consideration in management of patients suspected to have H-SIBO.