2022+亚太共识:胃肠道疾病中的小肠细菌过度生长.pdf
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1、ASIAN-PACIFIC CONSENSUSAsian-Pacific consensus on small intestinal bacterial overgrowthin gastrointestinal disorders:An initiative of the IndianNeurogastroenterology and Motility AssociationUday C.Ghoshal1&Sanjeev Sachdeva2&Ujjala Ghoshal3&Asha Misra1&Amarender Singh Puri2&Nitesh Pratap4&AyeshaShah5
2、&M.MasudurRahman6&KokAnnGwee7,8&VictoriaPYTan9&TahmeedAhmed10&YeongYehLee11,12&B S Ramakrishna13&Rupjyoti Talukdar14&S V Rana15&Saroj K Sinha16&Minhu Chen17&Nayoung Kim18&Gerald Holtmann5Received:20 June 2022/Accepted:2 August 2022#The Author(s)2022AbstractIn the clinical setting,small intestinal ba
3、cterial overgrowth(SIBO)is a frequent,but under-diagnosed entity.SIBO is linked tovarious gastrointestinal(GI)and non-GI disorders with potentially significant morbidity.The optimal management of SIBO isundefined while there is a lack of published consensus guidelines.Against this background,under t
4、he auspices of the IndianNeurogastroenterology and Motility Association(INMA),formerly known as the Indian Motility and Functional DiseasesAssociation(IMFDA),experts from the Asian-Pacific region with extensive research and clinical experience in the field ofgutdysbiosisincludingSIBOdevelopedthisevi
5、dence-basedpracticeguideline forthe managementofSIBOutilizingamodifiedDelphi process based upon 37 consensus statements,involving an electronic voting process as well as face-to-face meetings andreview of relevant supporting literature.These statements include 6 statements on definition and epidemio
6、logy;11 onetiopathogenesis and pathophysiology;5 on clinical manifestations,differential diagnosis,and predictors;and 15 on investiga-tions and treatment.When the proportion of those who voted either to accept completely or with minor reservations was 80%orhigher,the statement was regarded as accept
7、ed.The members of the consensus team consider that this guideline would bevaluable to inform clinical practice,teaching,and research on SIBO in the Asian-Pacific region as well as in other countries.Keywords Breathmethane.Disordersofgut-braininteraction.Dysbiosis.FODMAP.Gutmicrobiota.Hydrogenbreatht
8、est.Irritablebowelsyndrome.RifaximinIntroductionThe human gut is inhabited by an intricate population of mi-crobes,collectively known as microbiota.The composition ofmicrobiota in the proximal gut differs qualitatively as well asquantitatively from that in the colon 1.Usually,the smallintestine isde
9、voidofcoliformbacteria,and evenifpresent thenumber is little.Small intestinal bacterial overgrowth(SIBO)is characterized by the presence of an excessive amount ofbacteria within the small intestine,which may result in a con-stellation of gastrointestinal(GI)symptoms 2,3.Studies utilizing molecular t
10、echniques suggest that com-pared to the true prevalence,SIBO remains in the clinicalsetting frequently undiagnosed 4.Etiopathogenesis ofSIBO is multifactorial 1 and it is linked to several GIand non-GI disorders with significant morbidity includingirritable bowel syndrome(IBS),non-alcoholic fatty li
11、verdisease(NAFLD),chronic pancreatitis,celiac disease,obe-sity,and inflammatory bowel disease(IBD)5.Contrasting the prevalence,research into SIBO has juststarted and this condition remains worldwide largely un-der-researched.While diagnostic modalities for SIBO are still evolving,itsmanagement also
12、remains a challenge with the limited dataand the absence of consensus-based clinical guidelines.Uday C Ghoshal and Sanjeev Sachdeva contributed equally to the workand are joint first authors of the paper.*Uday C.GExtended author information available on the last page of the articleIndian Journal of
13、Gastroenterologyhttps:/doi.org/10.1007/s12664-022-01292-xAgainst this background and under the auspices of the IndianNeurogastroenterology and Motility Association(INMA),formerly known as the Indian Motility and FunctionalDiseases Association(IMFDA),experts from the Asian-Pacific Region with clinica
14、l and research experience in thefield of SIBO and gut dysbiosis collaborated with the aim todevelop evidence-based practice guideline for the manage-ment of patients with SIBO.The consensus team aimed toprovide valid guidance for clinical practice,teaching,and fu-ture research on SIBO across the glo
15、be with the firstconsensus-based guideline that utilized a rigorous Delphiprocess.MethodsThe members of the consensus team were selected from Asian-Pacific countries based on their interest and experience in thefield of gut dysbiosis including SIBO as evidenced by an elec-tronic literature search on
16、 PubMed.The members included ex-perts from India,Bangladesh,China,South Korea,Singapore,Hong Kong,Malaysia,and Australia.A core group of fourmembers was selected from among the consensus team mem-bers who made the first set of 37 statements on definition,epidemiology,etiopathogenesis,pathophysiology
17、,clinicalmanifestations,differentialdiagnosis,predictors,investigations,andtreatment.The membersofthecoreteam hada preliminaryface-to-face meeting in Lucknow(India)on 10th November2017 to develop preliminary statements for further refinementand discussion by the full consensus group.The consensus pr
18、ocess involved a modified Delphi method6.Before the first round of voting on the statements,an elec-tronic library was created in the Digital Medical Education sec-tion of the Shanti Public Educational and Development Societywebsite(www.spreadhealth.in).The first round of online votingwasheldinJuly2
19、019.Thevotingwasconductedinanelectroniconline anonymous voting system developed in the Research andInnovation initiative menu in the www.spreadhealth.in and theresults were analyzed electronically.The result of the first roundofvotingwaspresentedtotheentireconsensusteaminaface-to-facemeetingheldinKo
20、lkata(India)on13thDecember2019,onthesidelinesoftheAsian-PacificDigestiveWeek-2019(APDW-2019)Conference.Duringthisface-to-facemeetingatKolkata,adiscussion was held on the modification of five statements,which could not reach 80%acceptance during the first roundof voting.Also,the formulation of an alg
21、orithm for the manage-mentofSIBOwasdiscussed.Thesecondroundofonlinevotingwas subsequently held in January 2020 in which the five modi-fied statements were put to voting.Method of Grading ofRecommendations,Assessment,Development and Evaluation(GRADE)Working group was used for deriving at the level of
22、agreement,level of evidence,and grade of recommendation(Table 1)7.When the proportion of those who voted eitherto accept completely or with some reservation was 80%orhigher,the statement was regarded as accepted.Finally,a con-sensus was achieved on all 37 statements,which included thefive modifiedst
23、atements.Analgorithm ofmanagementof SIBOwas finalized as per suggestions of the consensus team.However,due to the pandemic of Corona Virus Disease-19(COVID-19)that devastated the whole world,further works onthisconsensusgotstalledforthenext2years.On7thMay2022,the core group members of the consensus
24、team physically metduring the 5th Annual Congress of the Indian Motility andFunctional Diseases Association(now named as INMA)inLucknow,India,to finalize the manuscript for publication.Theconsensus was presented on the same day to all the delegates ofthe 5th INMA Congress.Consensus statementsDefinit
25、ion and epidemiologyStatement 1:Small intestinal bacterial overgrowth(SIBO)isdefined as the growth of bacteria 105colony-forming unit(CFU)/mL or 103CFU/mL(particularly if coliforms arepresent)on a quantitative culture of upper gut aspirate.Voting summary:Accepted completely 57.9%,acceptedwithsomeres
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- 亚太 共识 共鸣 胃肠道 疾病 中的 小肠 细菌 过度 生长
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