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Objective To compare different therapeutic regimens for treatment of Helicobacter pylori（Hp） infection combined with small intestinal bacterial overgrowth （SIBO）. Methods This study was a single⁃center, single⁃blind, 16⁃week randomized controlled trial to evaluate the efficacy of different therapeutic regimens for patients with Hp infection combined with SIBO. Patients who were co⁃positive for Hp and SIBO attending the outpatient and inpatient departments of the Department of Gastroenterology of the Sixth Medical Center of the PLA General Hospital from April 2022 to July 2023 were enrolled. The enrolled patients were randomly divided into 3 groups， A， B， and C. Different treatment regimens were applied to the three groups. The 13C⁃urea breath test and methane hydrogen breath test were reviewed respectively after 4 ~ 6 weeks of drug discontinuation， to compare the rate of co⁃conversion of Hp and SIBO, the degree of improvement of abdominal symptom scores， and the incidence of adverse reactions, such as diarrhea, constipation, and nausea in the three groups. Results There was no statistically significant difference in the Hp conversion rate among the three groups（P > 0.05）， and the SIBO conversion rate and co⁃conversion rate of group B were higher than that of group A（P < 0.05）， and the difference was not statistically significant compared with that of group C（P > 0.05）. The degree of improvement in GSRS score after treatment was higher in group B than in groups A and C （P = 0.015，P = 0.014）， and the overall adverse reactions in group B were lower than those in group A （P < 0.001）. The difference in overall adverse reactions between groups B and C was not statistically significant（P > 0.05）. The rate of SIBO conversion， the rate of co⁃conversion, and the degree of improvement in GSRS score after treatment were not statistically significant between group A and C（P > 0.05), and the adverse reaction incidence was higher than that of group C （P = 0.004）. Conclusion Most patients with Hp infection combined with SIBO are accompanied by gastrointestinal discomforts such as acid reflux, heartburn, abdominal distension, constipation, and diarrhea， etc. HP treatment after removal of small intestinal bacteria can improve the rate of Hp and SIBO co⁃conversion, and effectively alleviate the abdominal symptoms and reduce the incidence of adverse reactions. [ABSTRACT FROM AUTHOR]

Objective To observe small intestinal bacterial overgrowth（SIBO）and oral cecal transit time （OCTT）in patients with ulcerative colitis, the therapeutic effect of rifaximin combined with Bacillus subtilis were investigated. Methods All of the people enrolled in the study（UC group = 100 cases, healthy group = 50 cases） were tested for SIBO and OCTT. UC patients with SIBO were randomly divided into two groups：control group： Bacillus subtilis（500 mg, 3/d, 14 d）;Treatment group：Bacillus subtilis（500 mg, 3/d, 14 d）and Rifaximin（0.2 g, 4/d, 14 d）. After treatment, interleukin-6（IL-6）and C-reactive protein（CRP）were observed. Results （1）SIBO in patients with ulcerative colitis was 41.0%, and that in healthy control group was 18.0%（P < 0.05）. The incidence of SIBO was not related to gender and age（P > 0.05）.（2）OCTT in patients with ulcerative colitis was （128.8 ± 20.3）min, and in that control group was（90.7 ± 13.6）min（P < 0.05）.（3）The OCTT of ulcerative colitis patients with SIBO was（150.5 ± 22.6）min, and in that of patients without SIBO was（108.3 ± 19.7）min（P < 0.05）. （4）65% of the patients in the treatment group turned negative and 23.8% of the patients in the control group turned negative（P < 0.05）.（5）In the treatment group：IL-6 and CRP were significantly lower：IL-6（50.16 ± 8.5）vs. （20.31 ± 7.1）and CRP（33.36 ± 3.4）vs.（10.22 ± 4.1）（P < 0.05）. Conclusions Patients with ulcerative colitis had a high probability of SIBO. Rrifaximin combined with Bacillus subtilis can effectively alleviate inflammation. [ABSTRACT FROM AUTHOR]

Small intestinal bacterial overgrowth（SIBO） refers to the phenomenon of overgrowth of bacteria in the small intestine and changes of bacterial species caused by various reasons. This concept was first proposed in the 1970s to describe the pathophysiology of abdominal pain, diarrhea and malnutrition in patients after gastrointestinal surgery. With greater understanding, there is growing evidence that SIBO is closely related to digestive diseases such as inflammatory bowel disease, irritable bowel syndrome, celiac disease, fatty liver disease, and even metabolic diseases such as diabetes and obesity. Even more, some metabolic diseases such as diabetes and obesity are associated with SIBO. However, there is some debate about the "gold standard" and method for diagnosing SIBO. This article reviews the conceptual changes and diagnosis of SIBO. [ABSTRACT FROM AUTHOR]

Gastroesophageal reflux disease ( GERD ) is a common clinical disease of the upper gastrointestinal tract. According to traditional Chinese medicine (TCM) theory, its pathogenesis is not only closely related to the liver, gallbladder, spleen and stomach, but also to the heart and lung. Based on the theory of “the upper jiao is cleared, the fluid is brought down, and the stomach qi is harmonized” in Shanghan Lun, our team propose that by adjusting the functions of the heart and lung in the upper jiao, the qi flow of the spleen and stomach in the middle jiao can be restored, which is ultimately conducive to promoting harmonization and descending of the stomach qi in the middle jiao, that is, “clearing the upper jiao with the aim of harmonizing the middle jiao”. If the heart and lung of the upper jiao are malfunctioning, it will easily affect the middle jiao, which is not conducive to the harmonization and descending of the stomach qi, thus easily causing GERD to occur. Further combining clinical practice with relevant researches in western medicine, if the functions of the heart governing the blood vessels and spirit are abnormal or the function of the small intestine is abnormal, the person is prone to esophageal visceral hypersensitivity and small intestinal bacterial overgrowth. Furthermore, if the functions of the lung governing dispersion, descending and respiration are abnormal or the function of the large intestine is abnormal, this may cause esophagogastric junction barrier damage and transient lower esophageal sphincter relaxation. All of these eventually lead to GERD. Therefore, the present paper provides a new direction and theoretical basis for the prevention and treatment of GERD by clarifying the influence of heart and lung on GERD. At the same time, it further enriches the theoretical connotation of “the upper jiao is cleared, the fluid is brought down, and the stomach qi is harmonized”. [ABSTRACT FROM AUTHOR]

Small intestinal bacterial overgrowth (SIBO) is characterized by changes in the number or species of small intestinal flora. Patients with liver cirrhosis often have intestinal congestion, edema, and delayed peristalsis and develop SIBO, which can further aggravate intestinal abnormalities. In patients with liver cirrhosis, SIBO can lead to significant adverse clinical outcomes, and since the increase in intestinal permeability may cause bacterial translocation into systemic circulation, SIBO is considered an important risk factor in the pathogenesis of liver cirrhosis, spontaneous bacterial peritonitis, and hepatic encephalopathy. Antibiotics, especially rifaximin, are the most effective therapies for SIBO, and in addition, studies are being conducted to investigate the efficacy of potential therapies such as prokinetic agents, probiotics, non-selective β-receptor blocker, and liver transplantation. [ABSTRACT FROM AUTHOR]

Objective: Long-term proton pump inhibitor(PPI) therapy may increase the risk of small intestinal bacterial overgrowth(SIBO). Few studies on the effect of on-demand and continuous PPI therapy are available in elderly. To investigate the prevalence of SIBO and the effect of on-demand and continuous PPI therapy on SIBO in elderly. Methods: A total of 200 elderly outpatients admitted to Department of Gastroenterology at the Second Medical Center of PLA General Hospital were enrolled and divided into 3 groups: continuous PPI group, on-demand PPI group and control group. SIBO was diagnosed according to methane and hydrogen lactulose breath test (LBT).The prevalence of SIBO in the 3 groups was analyzed. Results: The prevalence of SIBO was 71.5% in 200 elderly. PPI therapy and diabetes mellitus (DM) were independent risk factors for SIBO. The prevalence of SIBO was 77.1% (108/140) in elderly who underwent long-term PPI therapy and 58.3% (35/60) in those without PPI therapy ( P< 0.01).The prevalence of SIBO was significantly higher in continuous PPI therapy group than that in on-demand PPI group and control group(88.6% vs. 65.7% and 58.3%, all P< 0.01).However, no significant difference was found in the prevalence of SIBO between on-demand PPI group and control group ( P> 0.05). In elderly who underwent long-term PPI therapy, the prevalence of SIBO increased significantly if administration time was longer than 61 months. Conclusions: SIBO usually occurs in elderly patients who receive continuous PPI rather than on-demand use. If elderly require long-term PPI therapy, on demand administration is suggested as long as primary diseases are properly treated.