Introduction

Small intestinal bacterial overgrowth (SIBO) is a frequent condition characterized by an abnormal increase in the bacterial population in the small intestine. It is associated with digestive disorders, metabolic disturbances, and an elevated cardiovascular risk in patients with dyslipidemia. Emerging evidence suggests that SIBO may aggravate lipid metabolism abnormalities by disrupting the gut microbiota.

Aims & Methods

The aim of the study was to determine the prevalence of SIBO among patients with dyslipidemia and evaluate the impact of SIBO-targeted therapy on lipid metabolism correction. The study included 342 patients with dyslipidemia. SIBO was diagnosed via hydrogen breath testing. Patients received a combined therapy with rifaximin (400 mg TID for 14 days) followed by Saccharomyces boulardii CNCM I-745 (250 mg BID for 14 days). Clinical symptoms, lipid profiles (total cholesterol, triglycerides, LDL-C, HDL-C), apolipoprotein levels (ApoA1, ApoB), and homocysteine were assessed before and after treatment.

Results

SIBO was detected in 45.3% of patients with dyslipidemia. Combined therapy significantly reduced the prevalence of SIBO to 18% and alleviated clinical symptoms such as abdominal pain, bloating, meteorism, and stool disturbances. Notably, therapy led to significant improvements in lipid profiles: reductions in total cholesterol, LDL-C, triglycerides, ApoB, and homocysteine levels, alongside increases in HDL-C and ApoA1. These improvements were comparable between patients receiving statin therapy and those not receiving it.

Conclusion

SIBO is highly prevalent in patients with dyslipidemia and may contribute to lipid metabolism disorders and cardiovascular risk. Targeted therapy with rifaximin and S. boulardii effectively reduces SIBO prevalence, improves gut symptoms, and enhances lipid parameters. Integrating SIBO treatment into dyslipidemia management strategies offers promising new therapeutic opportunities for cardiovascular risk reduction.

Introduction

STW 5, a herbal medicinal product with well characterized pharmacological action, has been shown in several RTCs to be an effective treatment in disorders of the gut-brain interaction (DGBI) as functional dyspepsia (FD) [1, 2]. The aim of the present study was to examine whether changes in gut microbiota induced in an experimental model of FD could be prevented by STW 5.

Aims & Methods

FD was induced in rats by subjecting them to neonatal maternal separation followed by subjecting them to restraint stress for 90 minutes/day for one week. During that week, one group (8 animals) was treated with the liquid form of STW 5 (5 ml/Kg) and one with its vehicle at the same dose level. Animals were sacrificed 24 h after the last drug administration. Fecal samples were taken from the cecum. Genomic DNA was isolated and changes in selected bacterial phyla and genera were assessed using quantitative Real Time-PCR (qPCR). The main phyla studied under the influence of stress in the model were the Bacteroidetes, Firmicutes, Fusibacterium and Actinobacteria.

Results

FD led to a 50% drop in the Lactobacilli population but to a two-fold rise in Proteobacteria abundance but did not affect significantly the changes in Bacteroidetes. Furthermore, the Methanobrevibacter population was raised more than two-fold while the genomic DNA concentration in Bifidobacterium dropped from ca. 3 ng/g feces to nearly nil.

Conclusion

In general, STW 5 tended to ameliorate and protect against the changes induced by the stress model. The results lend further support to the use of STW 5 in FD and IBS by providing evidence that it acts at least in part through influencing beneficially the changes in intestinal microbiota induced by stress. Taken together, the findings shed more light on mechanisms involved in the therapeutic action of STW 5 in gastro-intestinal disorders.

References

1. Malfertheiner P. STW 5 (Iberogast) Therapy in Gastrointestinal Functional Disorders. Dig Dis. 2017, 35 Suppl 1: 25-29
2. Allescher H-D, Burgell R, Malfertheiner P, Mearin F. Multi-target Treatment for Irritable Bowel Syndrome with STW 5: Pharmacological Modes of Action. Gastrointest Liver Dis. 2020;29: 227-233

Disclosure

OK and HA-K are empolyees of Steigerwald Arzneimittelwerk GmbH, Darmstadt, Germany. MTK has been obtaining travel support and speakers fees from Steigerwald Arzneimittelwerk GmbH, Darmstadt, Germany.

Introduction

Ehlers–Danlos syndrome (EDS) is a connective tissue disorder characterized by a non-inflammatory nature. Hypermobility EDS (hEDS) accounts for 80–90% of all EDS cases‎^‎1.
Over the past two decades, studies have reported a high prevalence of gastrointestinal (GI) symptoms among hEDS patients, including abdominal pain, bloating, constipation, diarrhea, nausea, vomiting, and reflux disease.

Aims & Methods

To characterize the GI symptoms in patients with hEDS and to explore the potential contribution of functional and anatomical abnormalities to the GI manifestations observed in this population.
We conducted a retrospective cohort study of patients diagnosed with hEDS who were evaluated at both the EDS and Gastroenterology clinics. Eligible patients had a clinical diagnosis of hEDS based on the Brighton criteria. Patients with a documented diagnosis of inflammatory bowel disease (IBD) were excluded. Demographic data, GI symptoms, and results from diagnostic evaluations—including anorectal manometry, balloon expulsion test, defecography, gastric emptying scans, transit studies, and endoscopic procedures—were collected and analyzed.

Results

A total of 76 patients with hEDS were included with a median age of 33.7 years. Common comorbidities included endometriosis (43.5%), fibromyalgia (36.8%). Macrophage activation syndrome was diagnosed in 2.6%.
Upper GI symptoms were frequently reported, with heartburn (31.6%), postprandial pain (30.3%), early satiety (25%), epigastric pain unrelated to meals (22.4%), and dysphagia (13.2%) being the most prevalent.
Lower GI complaints were even more common: constipation affected 64.5% of patients, bloating 57.9% and chronic diarrhea 40.8%. Notably, 19.7% experienced both constipation and diarrhea.
Among 32 patients who underwent colonoscopy, 30 had normal findings.
Anorectal manometry revealed hyposensitivity in 54% of constipated patients and hypersensitivity in 54% of diarrhea patients. Squeeze pressure was low in 38% of diarrhea patients. Balloon expulsion failure occurred in ~50% of patients across groups.
Defecography demonstrated a high prevalence of anatomical abnormalities: rectocele (67–78%), enterocele (47–78%), and rectal prolapse (53–78%). Gastroparesis was identified in 45–60% of patients undergoing gastric emptying scans due to lower GI complaints. Prolonged colonic transit was found in 25–50% of those evaluated.

Conclusion

Patients with hEDS commonly experience a broad range of upper and lower GI symptoms, often presenting with multiple overlapping complaints. Functional and structural abnormalities—such as rectal hyposensitivity, pelvic floor dysfunction, rectocele, and enterocele—were frequently identified and may underlie these symptoms. Notably, gastroparesis was prevalent, highlighting the widespread impact of EDS on GI motility. These findings underscore the importance of comprehensive GI assessment in EDS patients, integrating both functional testing and imaging to guide appropriate management.

References

1. Tinkle B, Castori M, Berglund B, Cohen H, Grahame R, Kazkaz H, Levy H. Hypermobile Ehlers-Danlos syndrome (a.k.a. Ehlers-Danlos syndrome Type III and Ehlers-Danlos syndrome hypermobility type): Clinical description and natural history. Am J Med Genet C Semin Med Genet. 2017 Mar;175(1):48-69. doi: 10.1002/ajmg.c.31538. Epub 2017 Feb 1. PMID: 28145611

Introduction

Nonalcoholic fatty liver disease (NAFLD) is a widespread metabolic disorder associated with intestinal dysbiosis, low-grade systemic inflammation, and small intestinal bacterial overgrowth (SIBO). Targeting the gut-liver axis through microbiome-modulating therapies may represent a promising approach to disease management.

Aims & Methods

The aim was to investigate gut microbiota alterations in NAFLD patients and assess the efficacy of microbiota-based therapy on metabolic, inflammatory, and structural liver parameters. The study included 152 NAFLD patients and 47 controls. Gut microbiota composition was evaluated using qRT-PCR, and SIBO was diagnosed via hydrogen breath testing. The therapeutic protocol included rifaximin (200 mg TID for 14 days), Saccharomyces boulardii CNCM I-745 (1 capsule BID for 30 days), and essential phospholipids (600 mg TID for 30 days). Liver function tests, inflammatory markers, and steatometry were assessed before and after treatment.

Results

Alterations in gut microbiota composition indicative of dysbiosis—including increased Firmicutes/Bacteroides ratio and Actinobacteria abundance—were identified in NAFLD. Strong correlations emerged between the F/B index and triglycerides (r = 0.78), TNF-α (r = 0.77), and between Actinobacteria and hsCRP (r = 0.66). SIBO rates declined significantly post-treatment (51% → 17%). Liver enzymes, inflammatory markers, and steatometric parameters improved substantially (p<0.05).

Conclusion

Microbiota-targeted therapy combining rifaximin, S. boulardii, and phospholipids effectively corrected dysbiosis, reduced inflammation, improved metabolic parameters, and promoted liver structural recovery in NAFLD patients. These findings support incorporating microbiome-focused interventions into routine clinical practice for NAFLD. ​