In patients with systemic sclerosis (SSc), some evidence suggests that the use of antibiotics may be effective in eradicating small intestinal bacterial overgrowth (SIBO), but there is a paucity of data available on the benefits of prokinetics or probiotics in these individuals, according to results published in Rheumatology.

Researchers conducted a systematic review and literature search of relevant studies on treatments for SIBO in the SSc population. Evidence on all possible SIBO treatments, including antibiotics, prokinetics, probiotics, and alternative therapies, was included in the analysis. Treatment outcomes comprised symptomatic relief or demonstrated eradication of SIBO.

Among 5295 articles identified, 5 nonrandomized studies were ultimately reviewed, comprising 78 patients with SSc and SIBO. Of the 5 studies selected, 1 trial evaluated the use of octreotide, and the remaining 4 trials investigated the efficacy of antibiotics including ciprofloxacin, rifaximin, norfloxacin, and metronidazole, as well as the combination of amoxicillin, ciprofloxacin, and metronidazole. The studies were generally of a low quality and no randomized controlled trials were included in the analysis. Although the systematic review was robust, because of the low-quality data involved, there was a relatively high risk for bias. It should be noted that because SSc is a rare disease, trials are difficult to complete.

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In the articles selected for the systematic review, the participants were all adults ≥18 years. The articles reported primary data from an original study, included a treatment group for SIBO, reported on SIBO eradication, and were available in English. The review was designed to extract all evidence on the treatment of SIBO in patients with SSc, regardless of the therapeutic modality used. The literature search was intentionally broad to retrieve all articles that referred to bacterial overgrowth or SIBO in which patients with SSc were enrolled.

The investigators concluded that longitudinal cohort studies are warranted to further explore SIBO eradication in patients with SSc.

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Reference

Pittman N, Rawn SM, Wang M, Masetto A, Beattie KA, Larché M. Treatment of small intestinal bacterial overgrowth in systemic sclerosis: a systematic review [published online July 2, 2018]. Rheumatology (Oxford). doi: 10.1093/rheumatology/key175