ResearchResearch summary
Small-intestinal fungal overgrowth in a specialist referral cohort
A 150-person study used duodenal aspirate cultures and found that symptoms did not distinguish bacterial or fungal overgrowth.
In this pathway
- Current topic
- Small-intestinal fungal overgrowth in a specialist referral cohortCurrent
Bottom line
Duodenal cultures identified fungal growth in some highly selected patients, but their symptoms did not distinguish them from patients without overgrowth.
Why this source matters
It provides direct aspirate-culture data while separating clinical SIFO from broad diagnoses made from symptoms alone.
Study and population
This observational study analyzed 150 patients referred to one US gastroenterologist for persistent unexplained gastrointestinal symptoms.
What was tested
Researchers combined duodenal bacterial and fungal cultures, 24-hour intestinal manometry, PPI-use records, and a symptom questionnaire.
Results
Of 150 patients, 94 had overgrowth: 24 of those 94 had SIFO alone, 32 had mixed SIBO/SIFO, and 38 had SIBO alone. Symptom profiles were similar with and without overgrowth.
Applicability
The findings concern a specialist referral cohort and an invasive aspirate definition. They do not estimate population prevalence or diagnose SIFO from symptoms.
Limitations
The study was single-center and observational, used combined overgrowth categories, and could not establish treatment benefit or symptom causation.
Contribution to the evidence
Contextual. It defines an aspirate-culture boundary and demonstrates that the recorded symptoms were poor discriminators in this cohort.
Practical change
No practical change. The result does not support symptom-based Candida diagnosis or self-treatment.
Funding and conflicts
The study was partially supported by NIH grant 2R01 KD57100-05A2. The authors declared no personal interests.
Source
Read the original publication (published June 2013).
Study type, population, and sample scale
- Study type
- Observational single-center specialist referral study with duodenal aspirate culture and intestinal manometry
- Population
- 150 consecutive patients aged 17 to 82 with persistent unexplained gastrointestinal symptoms after negative routine investigations, referred to one US gastroenterologist from 1995 to 2010
- Sample scale
- 150 analyzed patients (46 men; 104 women); 18 additional evaluated patients were excluded for incomplete testing, missing PPI information, or incomplete or possibly contaminated cultures
Results
- Of 150 patients, 94 had bacterial and/or fungal overgrowth; among those 94, 24 had fungal overgrowth alone, 32 had mixed bacterial and fungal overgrowth, and 38 had bacterial overgrowth alone. All fungal growth was Candida.
- Symptom profiles were similar in patients with and without bacterial or fungal overgrowth, so the measured symptoms did not discriminate the culture groups.
Limitations
- Duodenal cultures identified fungal growth alone in 24 of 94 overgrowth-positive patients and mixed growth in 32 of 94.
- The single-center referral cohort was highly selected, fungal growth had no quantitative threshold, and aspirate collection could vary by intestinal location.
- Symptoms did not distinguish patients with and without overgrowth.
- The questionnaire was subject to reporting bias in people with longstanding refractory symptoms, and combined SIBO/SIFO categories prevent a Candida-specific symptom estimate.
Applies to
- Aspirate-culture findings in a selected tertiary-care population with persistent unexplained gastrointestinal symptoms
Does not apply to
- Diagnosing SIFO from symptoms, broad systemic Candida claims, population prevalence, or benefit from antifungal treatment
Contribution to the current conclusion
Contextual
This early 150-person study supplies the direct aspirate-culture and symptom-discrimination data behind the SIFO boundary; a summary can expose its specialist referral population, single center, combined SIBO/SIFO categories, and inability to establish treatment benefit.
Related evidence mapPractical change or no change
No practical change. This study supports an aspirate-defined clinical SIFO boundary and shows that symptoms alone were poor predictors; it does not validate broad symptom-based Candida diagnoses or establish treatment benefit.
Funding and conflicts
- Funding
- The study was partially supported by NIH grant 2R01 KD57100-05A2.
- Conflicts
- The authors declared no personal interests.
- Paper date
- 2013-06-01
Sources
View all 1 source
- Dysmotility and proton pump inhibitor use are independent risk factors for small intestinal bacterial and/or fungal overgrowth
- Source type
- Observational study
- Published
- 2013-06-01