Original article—alimentary tract
Small Intestinal Bacterial Overgrowth in Rosacea: Clinical Effectiveness of Its Eradication

https://doi.org/10.1016/j.cgh.2008.02.054Get rights and content

Background & Aims: To better understand the role of small intestinal bacterial overgrowth (SIBO) in rosacea, we aimed to assess the presence of SIBO in patients with rosacea and the clinical effectiveness of its eradication. Methods: We enrolled 113 consecutive rosacea ambulatory patients (31 M/82 F; mean age, 52 ± 15 years) and 60 healthy controls who were sex- and age-matched. Patients and controls underwent lactulose and glucose breath tests (BTs) to assess the presence of SIBO. Patients positive for SIBO were randomized to receive rifaximin therapy (1200 mg/day for 10 days) or placebo. A group of patients with negative BTs were also treated with rifaximin. Eradication was assessed 1 month after the end of therapy. Two dermatologists, unblinded on therapy, evaluated rosacea patients before and after treatment on the basis of an objective scale. Results: The prevalence of SIBO was higher in patients than controls (52/113 vs 3/60, P < .001). After eradication, cutaneous lesions cleared in 20 of 28 and greatly improved in 6 of 28 patients, whereas patients treated with placebo remained unchanged (18/20) or worsened (2/20) (P < .001). Placebo patients were subsequently switched to rifaximin therapy, and SIBO was eradicated in 17 of 20 cases. Fifteen had a complete resolution of rosacea. After antibiotic therapy, 13 of 16 patients with negative BTs for SIBO remained unchanged, and this result differed from SIBO-positive cases (P < .001). Conclusions: This study demonstrated that rosacea patients have a significantly higher SIBO prevalence than controls. Moreover, eradication of SIBO induced an almost complete regression of their cutaneous lesions and maintained this excellent result for at least 9 months.

Section snippets

Patients and Controls

This is a prospective study involving 113 consecutive rosacea patients (82 women, 31 men; mean age, 52 ± 15 years) recruited in an academic dermatologic department and 60 healthy, sex- and age-matched controls (40 women, 20 men; mean age, 49 ± 11 years). Two patients had flushing, 27 had erythrosis, and 84 had papulopustules. Two patients with papulopustular rosacea exhibited also phymata. Most patients associated 2 or more phases (Table 1).

Dermatologic Assessment

Two independent dermatologists (F.D., A.P.) evaluated

Results

Baseline blood and stool analyses were normal in all patients and controls.

A significantly increased prevalence of SIBO was found in patients with rosacea compared with controls (52/113 vs 3/60, respectively; P < .001). In 40 of 52, both LH-BT and G-BT were positive, whereas G-BT only was positive in the remaining 12 cases.

Seven patients presented both SIBO and Hp infection. When stratified for cutaneous lesions, 42 of 98 patients with flush and/or erythrosis were SIBO-positive versus 10 who

Discussion

This study demonstrates that rosacea patients have a significantly higher SIBO prevalence than controls, and, more importantly, that the eradication of SIBO induces an almost complete regression of the cutaneous lesions in rosacea patients and maintains this excellent result for at least 9 months. In fact, in 78% of our patients, skin lesions fully cleared and in 17.7% improved greatly 1 month after interrupting rifaximin therapy. Moreover, all rosacea patients who remained unchanged with

References (34)

  • A. Rebora et al.

    Helicobacter pylori in patients with rosacea

    Am J Gastroenterol

    (1994)
  • R. Marks et al.

    Gastrointestinal observations in rosacea

    Lancet

    (1967)
  • S. Walton et al.

    Rosacea and ulcerative colitis: a possible association

    J Clin Gastroenterol

    (1990)
  • R. Romiti et al.

    Rosacea fulminans in a patient with Crohn's disease: a case report and review of the literature

    Acta Derm Venereol

    (2000)
  • V.K. Sharma et al.

    A study of the prevalence of Helicobacter pylori infection and other markers of upper gastrointestinal tract disease in patients whith rosacea

    Am J Gastroenterol

    (1999)
  • S.N. Kendall

    Remission of rosacea induced by reduction of gut transit time

    Clin Exp Dermatol

    (2004)
  • M. Kirsch

    Bacterial overgrowth

    Am J Gastroenterol

    (1990)
  • Cited by (0)

    Prof Aurora Parodi and Prof Vincenzo Savarino are supported by the Italian Ministry of University.

    View full text