Researchers Hunt Causes of Non-responsive Celiac Disease

A recent study used lactulose hydrogen-breath assays to show that small intestine bacterial overgrowth (SIBO) is likely a routine cause of non-responsive celiac disease.

A team of researchers from the Mayo Clinic College of Medicine recently set out to assess the rates and significance of SIBO in celiac disease based on the results of quantitative culture of intestinal aspirate.

The team was made up of Alberto Rubio-Tapia, M.D., Susan H. Barton, M.D., Joseph A. Murray, M.D., of the Mayo’s Division of Gastroenterology and Hepatology, and Jon E. Rosenblatt, M.D., of the Mayo’s department of Laboratory Medicine and pathology. Their efforts were supported by the American College of Gastroenterology (ACG) International Training Grant 2006 (ART) and the NIH grants DK-57892 and DK-070031 (JAM).

The team set out to examine the causes of non-responsive celiac disease by looking at people with celiac disease in whom culture of intestinal aspirate was assessed for the presence of both aerobic and anaerobic bacteria. They defined bacterial overgrowth as culture >105 colony forming units/mL.

In all, they evaluated 149 people with biopsy-confirmed celiac disease. They took intestinal aspirate samples from 79 (53%) patients with non-responsive celiac disease, 47 (32%) as initial work-up for mal-absorption, and in 23 (15%) with asymptomatic treated celiac disease.

The team diagnosed 14 cases of SIBO (9.3%), nine cases of non-responsive celiac disease (11%), five cases at initial work-up for mal-absorption (11%), and 0 cases in asymptomatic treated celiac disease. Patients with a positive culture showed signs of worse mal-absorption. 67% of patients with both non-responsive CD and bacterial overgrowth showed a coexistent disorder.

The results showed that nearly 1 in 10 celiac patients had SIBO as diagnosed by quantitative culture of intestinal aspirate (9.3%). This figure included both patients with symptomatic treated or untreated CD. This shows that SIBO may exist along with other maladies associated with non-responsive celiac disease.