Health and safety: small intestinal bacterial overgrowth is the fundamental mechanism for development of abdominal discomforts from poor water, sanitaion and hygiene (wash) practices after flood disaster

• Main Author: Yeh, Lee Yeong (Author)
• Format: Article
• Language: English
• Published: Pusat Pengajian Sains Kesihatan, Universiti Sains Malaysia, 2017.
• Subjects: RA Public aspects of medicine
• Online Access: Get fulltext

 'Background & aims After a major environmental disaster, the affected community is at I increased risk for persistent abdominal pain but exact mechanisms are unclear. We , aimed, firstly, to determine the association between. abdominal pain and poor water, , '.sanitation and hygiene (waSH) practices, and secondly, to determine if small intestinal ' 'bacterial overgrowth (SIBO) and or gut dysbiosis explain the persistent pain. Methods Flood victims from two severely affected villages in the northeastern region of Peninsular Malaysia were consented. Their abdominal symptoms after flood that persisted for six months or more, quality of life, psychological disturbances and WaSH practices during flood were assessed. For consented participants, glucose breath test to assess for SIBO and stools for high-throughput sequencing of 165 rRNA gene were · performed. A P value < 0.05 was considered significant Results Of 211 participants (mean age 54.5 ± 1.0 years, females 71 %), 37.9% had persistent abdominal pain. Poor WaSH practices during flood (adjusted OR 1.11, 95% 'Cl 1.00; 1.24, P = 0.04) and irritable bowel syndrome (adjusted OR 9.53, 95% Cl: 3.51; 25.86, P < 0.001) were significantly associated with abdominal pain. Those with abdominal pain also experienced worse quality of life and more anxiety, both P < 0.05. 'Of 135 participants who consented for breath-testing, abdominal pain (OR 4.94, 95% Cl 1.47; 16.55, P = 0.01), poor water practices during flood (OR 1.14, 95% Cl 1.01; 1.30, P = 0.04) and limited physical functioning (OR 0.98, 95% Cl 0.96; 1.00, P = 0.02) . were significantly associated with SIBO. Based on linear discriminant analysis effect size (LEfSe) method, there was significant gut dysbiosis observed in those with anxiety (Bacteroidetes and Proteobacteria, effect size 4.8) and abdominal pain (Fusobacteria, Staphylococcus, Megamonas and Plesiomonas, effect size 4.0). Conclusions Gut dysbiosis and SIBO may explain persistent abdominal pain after a major environmental disaster in the presence of poor WaSH practices. There is also significant impairment in quality of life and anxiety in flood victims with persistent pain.