scholarly journals Ocular Rosacea: Treatment with Rifaximin, a Non-Systemic Antibiotic

2016 ◽  
Vol 1 (1) ◽  
Keyword(s):  
Gastrointestinal Symptoms ◽  
Bacterial Overgrowth ◽  
Small Intestinal Bacterial Overgrowth ◽  
Open Label ◽  
Dry Eyes ◽  
Corneal Ulcers ◽  
Ocular Manifestations ◽  
Mild Improvement ◽  
Ocular Rosacea ◽  
Eye Symptoms

Background: Rosacea is associated with Crohn’s disease, liver disease, chronic pancreatitis, achlorhydria, Helicobacter pylori and recently with idiopathic small intestinal bacterial overgrowth (SIBO). Two publications demonstrated that rifaximin, a non-absorbed, gut-directed antibiotic for SIBO led to improvement in facial rosacea. Ocular manifestations occur in up to 58% of rosacea patients and include dry eyes, foreign body sensation, photosensitivity, eyelid inflammation, neovascularization and corneal ulcers. Methods: Patients who had been diagnosed with ocular rosacea by four ophthalmologists were referred for SIBO testing using the lactulose breath test (LBT). All were refractory to rosacea therapy. An open-label, IRBapproved trial of rifaximin 550 mg/3x/day for 10-14 days was performed in LBT-positive subjects. Ten and twenty days after ending rifaximin, subjects were queried if their eye symptoms had marked, moderate or mild improvement or if they were unchanged. Results: Twenty four patients (21F/3M), mean age 59 with facial involvement in 4 were tested. The LBT was positive in 9/24 (38%). LBT-positive subjects had chronic gastrointestinal symptoms in 63% vs., 33% in LBTnegative subjects. Rifaximin was prescribed to 9 LBT-positive subjects. Insurance denied the prescription in one subject. One subject was lost was to follow up. Improvement in ocular rosacea symptoms was marked (4), moderate (1) and mild (2). Conclusions: Rifaximin therapy led to improvement in ocular rosacea in the setting of SIBO. Dysregulation of the innate immune system as a result of gastrointestinal inflammation could lead to an increase in systemic cytokines and microbial antigens/antibodies in the skin and eyelids leading to activation of rosacea.

Small Intestinal Bacterial Overgrowth: Histopathologic Features and Clinical Correlates in an Underrecognized Entity

2010 ◽  
Vol 134 (2) ◽  
pp. 264-270 ◽  
Author(s):  
Paul J. Lappinga ◽  
Susan C. Abraham ◽  
Joseph A. Murray ◽  
Emily A. Vetter ◽  
Robin Patel ◽  
...  
Keyword(s):  
Clinical Features ◽  
Reference Range ◽  
Gastrointestinal Symptoms ◽  
Bacterial Overgrowth ◽  
Small Intestinal Bacterial Overgrowth ◽  
Presenting Symptoms ◽  
Intestinal Bacterial Overgrowth ◽  
Colony Forming Units ◽  
Small Intestinal ◽  
Duodenal Biopsies

Abstract Context Small intestinal bacterial overgrowth (SIBO) is a common cause of chronic diarrhea and malabsorption. Morphologic changes associated with this condition have not, to our knowledge, been studied in detail. Objective To better characterize the histopathologic changes associated with SIBO by comparing the clinicopathologic features of patients with SIBO (duodenal aspirate cultures with ≥105 colony-forming units [CFUs]/mL) to controls with cultures found to be negative (<105 CFUs/mL). Design We included 67 consecutive patients with SIBO and 55 controls in the series. Each duodenal biopsy was assessed for the following features: villous to crypt ratio, intraepithelial lymphocytosis, crypt apoptoses, basal plasmacytosis, cryptitis/villitis, peptic duodenitis, erosions/ulcers, eosinophilia, and absence of goblet and Paneth cells; and correlated with clinical features and culture results. Results Decreased villous to crypt ratio (<3∶1) was more frequent in SIBO than controls (24% versus 7%; P  =  .01). Duodenal biopsies from patients with SIBO were slightly less likely to be judged within reference range than were controls (52% versus 64%; P  =  .27). There were no significant differences in any of the other histologic features. Clinically, patients in the SIBO group were older than the age of controls (mean, 60 years versus 52 years; P  =  .02), and they were more likely to have one of the known predisposing factors for bacterial overgrowth (66% versus 36%; P  =  .002). Other clinical features, including presenting symptoms, were similar. Conclusions Villous blunting is the only feature more common to SIBO than to controls. More than half of biopsies from SIBO patients are histologically unremarkable. Therefore, SIBO needs to be considered as a potential etiology for gastrointestinal symptoms even when duodenal biopsies are found to be normal.

An unusual presentation of thymoma: dysgeusia, ulcerative colitis, keratoconjunctivitis sicca, autoimmune retinopathy and myasthenia gravis

2022 ◽  
Vol 15 (1) ◽  
pp. e246861
Author(s):  
Priyanka Sanghi ◽  
Fion Bremner
Keyword(s):  
Ulcerative Colitis ◽  
Myasthenia Gravis ◽  
Keratoconjunctivitis Sicca ◽  
Case Reports ◽  
Gastrointestinal Symptoms ◽  
Myasthenic Crisis ◽  
Autoimmune Retinopathy ◽  
Dry Eyes ◽  
Eye Symptoms ◽  
Visual Field Constriction

A 41-year-old female presented with dysgeusia, dry eyes, nyctalopia with progressive visual field constriction (due to autoimmune retinopathy) and gastrointestinal symptoms (due to ulcerative colitis). She was subsequently admitted to intensive care with a myasthenic crisis, and CT of the thorax demonstrated a thymoma.Following thymectomy and adjuvant radiotherapy, she has remained in complete remission from her ulcerative colitis and myasthenia gravis, her retinopathy has stabilised and there has been no thymoma recurrence over a 10-year postoperative period. There was a brief relapse of her dysgeusia (causing weight loss) and dry eye symptoms 3 years after her surgery, which resolved 8 months later. While the association of thymomas with paraneoplastic syndromes (PNS) is well established, it is unusual to present with multiple PNS, and some of these have only been documented in sparse case reports to date. Thymectomy played a crucial role in improvement and stabilisation of her PNS.

Bacterial overgrowth of the small intestine

2020 ◽  
pp. 2879-2883
Author(s):  
Stephen J. Middleton ◽  
Raymond J. Playford
Keyword(s):  
Small Intestine ◽  
Total Concentration ◽  
Gastrointestinal Symptoms ◽  
Specific Treatment ◽  
Bacterial Overgrowth ◽  
Small Intestinal Bacterial Overgrowth ◽  
Nutritional Deficiencies ◽  
Small Intestinal ◽  
Motor Abnormalities ◽  
Immunological Deficiency

Small intestinal bacterial overgrowth can be defined as the presence of excessive bacteria in the small intestine which can interfere with digestion and absorption. Predisposing causes include sustained hypochlorhydria induced by proton pump inhibitors, small intestinal dysmotility and stasis due to anatomical or motor abnormalities, and reduced antibacterial activity as seen in immunological deficiency and chronic pancreatitis. Presentation is predominantly from consequences of malabsorption, including gastrointestinal symptoms (e.g. diarrhoea or steatorrhoea) and features of specific nutrient malabsorption (e.g. osteoporosis, anaemia, neuropathy, and night blindness). Definitive diagnosis is difficult, requiring a properly collected and appropriately cultured aspirate from the proximal small intestine revealing a total concentration of a mixed growth of bacteria generally greater than 105 organisms/ml. Alternative investigations frequently used include glucose/lactulose breath tests or either the 13C- or 14C-xylose breath test, with elevated levels of 13CO2 or 14CO2 found in the breath. There may be low levels of cobalamin (metabolized by Gram-negative anaerobes), increased serum folate (synthesized by overgrowth flora), and increased urinary indicans (intraluminal product of bacterial tryptophan metabolism). Aside from treatment of any nutritional deficiencies, specific treatment is with an antimicrobial that is effective against both aerobic and anaerobic enteric bacteria (e.g. doxycycline, amoxicillin–clavulanic acid, rifaximin, or ciprofloxacin), which can be administered in rotation to reduce antibiotic resistance. Where possible and appropriate, correction of any underlying cause should also be performed.

scholarly journals Clinical efficacy of fecal microbiota transplantation for patients with small intestinal bacterial overgrowth: a randomized, placebo-controlled clinic study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fenghua Xu ◽  
Ning Li ◽  
Chun Wang ◽  
Hanyang Xing ◽  
Dongfeng Chen ◽  
...  
Keyword(s):  
Placebo Group ◽  
Fecal Microbiota Transplantation ◽  
Gastrointestinal Symptoms ◽  
Bacterial Overgrowth ◽  
Small Intestinal Bacterial Overgrowth ◽  
Fecal Microbiota ◽  
Trial Registry ◽  
Intestinal Bacterial Overgrowth ◽  
Small Intestinal ◽  
Microbiota Diversity

Abstract Background Small intestinal bacterial overgrowth (SIBO) is characterized by the condition that bacteria overgrowth in the small intestine. Fecal microbiota transplantation (FMT) has been applied as an effective tool for reestablishing the structure of gut microbiota. However, whether FMT could be applied as a routine SIBO treatment has not been investigated. Methods In this trial, 55 SIBO patients were enrolled. All participants were randomized in two groups, and were given FMT capsule or placebo capsules once a week for 4 consecutive weeks. Measurements including the lactulose hydrogen breath test gastrointestinal symptoms, as well as fecal microbiota diversity were assessed before and after FMT therapy. Results Gastrointestinal symptoms significantly improved in SIBO patients after treatment with FMT compared to participants in placebo group. The gut microbiota diversity of FMT group had a significant increase, while placebo group showed none. Conclusions This study suggests that applying FMT for patients with SIBO can alleviate gastrointestinal symptoms, indicating that FMT may be a promising and novel therapeutic regimen for SIBO. Trial registry This study was retrospectively registered with the Chinese Clinical Trial registry on 2019.7.10 (ID: ChiCTR1900024409, http://www.chictr.org.cn).

Sign in / Sign up

Export Citation Format

Share Document