{
  "abstract": "Introduction Small intestinal bacterial overgrowth (SIBO) is a frequent complication in systemic sclerosis (SSc), affecting approximately one-third of patients and contributing to malabsorption and mortality. Currently, no standardized approach exists for the diagnosis or treatment of SIBO in SSc. This study aimed to describe diagnostic modalities and treatment strategies used for SSc-associated SIBO in real-world clinical practice.Material and Methods We conducted a multicenter retrospective study of SSc patients aged >=18 years with clinically diagnosed SIBO across three university-affiliated hospitals: the Jewish General Hospital (2004–2020), the Centre hospitalier de l’Université de Montréal (2010–2024), and the Centre hospitalier de l’Université de Sherbrooke (2014-2024). Data were extracted from electronic medical records using a standardized case report form.Results Seventy-nine patients were included (81% female, 91% White, 54% limited SSc, 45% anti-centromere positive). Mean age at SIBO diagnosis was 61 years, with a mean disease duration of 6 years from first non-Raynaud manifestation. The most common symptoms were diarrhea (89%), bloating (82%), abdominal pain (53%), weight loss (49%), constipation (47%), and flatulence (26%). Parenteral nutrition was required in 21%.The median delay from gastrointestinal symptom onset to SIBO diagnosis was 2 years (range 0–10). Breath tests (cholate or lactulose) were performed in 43% of patients, with 14/32 (44%) positivity. Seven patients also underwent fecal calprotectin testing, and only one underwent jejunal aspiration.On average, patients received three different antibiotic regimens. The most frequently prescribed monotherapies were fluoroquinolone (44%), amoxicillin/clavulanate (33%), metronidazole (31%), tetracycline (21%), and rifaximin (10%), with response rates ranging from 47% to 65%. Vancomycin and cephalosporin monotherapies were rarely used (<=6%). Rotating antibiotic therapies most commonly consisted of metronidazole (26%), amoxicillin/clavulanate (19%), tetracycline (17%), and fluoroquinolone (17%), with response rates of 89–100%. Rotating regimens based on rifaximin, sulfonamide, cephalosporin, or vancomycin were used infrequently (<=6%).Notably, all 18 patients with a negative breath test still received antibiotics, of whom 13/15 (87%) responded positively.Conclusions This study highlights significant heterogeneity in diagnostic modalities and treatment patterns used in the management of SSc-associated SIBO. Diagnosis was often delayed and relied primarily on clinical features rather than objective testing, likely reflecting the limited accuracy and availability of non-invasive tools such as breath tests. While monotherapies achieved symptom improvement in roughly half of patients, rotating antibiotic therapies were associated with substantially higher response rates. Given the morbidity associated with SIBO in SSc, there is an urgent need for more accurate, non-invasive diagnostic tools and evidence-based treatment guidelines.Abstract P.172 Figure 1Abstract P.172 Table 1",
  "authors": [
    {
      "affiliations": [
        "Division of Rheumatology, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada"
      ],
      "name": "Marie-Laurence Laliberté"
    },
    {
      "affiliations": [
        "Division of Rheumatology, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada",
        "Division of Rheumatology, Department of Medicine, McGill University, Montreal, Quebec, Canada"
      ],
      "name": "Hao Cheng Shen"
    },
    {
      "affiliations": [
        "Division of Rheumatology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada"
      ],
      "name": "Ariel Masetto"
    },
    {
      "affiliations": [
        "Division of Rheumatology, Department of Medicine, McGill University, Montreal, Quebec, Canada"
      ],
      "name": "Genevieve Gyger"
    },
    {
      "affiliations": [
        "Division of Rheumatology, Department of Medicine, McGill University, Montreal, Quebec, Canada"
      ],
      "name": "Marie Hudson"
    },
    {
      "affiliations": [
        "Division of Rheumatology, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada"
      ],
      "name": "Sabrina Hoa"
    }
  ],
  "title": "P.172 Real world diagnosis and treatment of small intestinal bacterial overgrowth in systemic sclerosis: results from a multicenter retrospective descriptive study",
  "uid": "4d27f2ba-2586-5eeb-9d34-fe6327848b07"
}