Small intestinal bacterial overgrowth in adult patients with type 1 diabetes.

623 SIBO is defined as an overgrowth of bacterial flora inhabiting the small intestine and is usually described in association with irritable bowel syn‐ drome.5 A number of studies reported the devel‐ opment of SIBO in patients who had undergone surgical treatment of gastrointestinal tumors[6] or other abnormalities in the gastrointestinal tract.7,8 In their paper, Adamska et al4 claimed that there had been no studies on the occurrence of SIBO in the course of diabetes, including type 1 diabetes. Indeed, there are few such studies, but isolated reports concerning type 1 and 2 di‐ abetes are available. For example, Rana et al9 ex‐ amined patients with type 2 diabetes and dem‐ onstrated a significant increase in the incidence of SIBO compared with the healthy population. Ojetti et al10 demonstrated that SIBO is present much more often in patients with type 1 diabe‐ tes who also have autonomic neuropathy, which is associated with a higher daily supply of insu‐ lin. Faria et al11 proved that intestinal transit can be inhibited in the course of type 1 diabetes, but the incidence of SIBO in this patient group is not significantly higher. This study was also cited by Adamska et al.4 It is therefore clear that the prob‐ lem is not completely new, but it has not been well documented. In their study, Adamska et al4 employed hydro‐ gen breath testing to diagnose SIBO. The authors were right to point out that the gold standard for the diagnosis of SIBO is microbiological testing of a duodenal or jejunal aspirate; however, it is an in‐ vasive method.4 Breath testing enables a quick and noninvasive diagnosis of SIBO, but false results are possible (sensitivity of the test when lactu‐ lose is applied is 52%, and specificity—86%).12 Increased intestinal transit can reduce the sen‐ sitivity of the breath test, which causes a rapid removal of lactulose from the proximal small in‐ testine. On the other hand, advanced lung dis‐ eases, such as tumors or inflammations, can re‐ sult in false positive results due to the presence of abundant bacterial flora in the lungs.12 It seems In recent years, our understanding of the func‐ tion of the human gastrointestinal tract has vast‐ ly improved, especially as regards the role of gas‐ trointestinal microbiota (commensal intestinal flora). There is growing evidence for the signifi‐ cant effect of these microbes on the function and health of the human body. Commensal flora of the gastrointestinal tract plays a vital role in di‐ gestion and absorption of nutrients and protects against the invasion of pathogenic microorgan‐ isms by creating resistance to colonization and af‐ fecting the immune system of the host organism. The gastrointestinal tract, especially in its final section, contains an enormous number of bacte‐ ria, which form a peculiar ecosystem. Gastroin‐ testinal flora is an important part of the body. Its role and significance are increasingly recognized, which helps explain the course and causes of nu‐ merous diseases. An increasing number of stud‐ ies have reported changes in microbiota compo‐ sition in the course of various diseases, such as inflammatory bowel disease,1 celiac disease,2 di‐ abetes, obesity,3 and many others. Following this trend, Adamska et al,4 in the cur‐ rent issue of the Polish Archives of Internal Medicine (Pol Arch Med Wewn), presented the results of their studies on small intestinal bacterial overgrowth (SIBO) in patients with type 1 diabetes mellitus. The study included 148 adults with type 1 diabetes mellitus and 41 controls. SIBO was confirmed us‐ ing a noninvasive hydrogen breath test performed with Gastro+Gastrolyzer (Bedfont Scientific Ltd., Maidstone, United Kingdom). The test consisted in assessing the concentration of exhaled hydro‐ gen derived from 20 grams of lactulose admin‐ istered orally and later decomposed by bacteria. The incidence of SIBO was shown to be significant‐ ly higher in the control group in comparison with the study group (73% and 37.8%, respectively, P = 0.006), which probably came as surprise to the au‐ thors.4 Similarly, no significant correlations were demonstrated between the symptoms of SIBO and a positive result of the hydrogen breath test. EDITORIAL