Tracking Clinical Improvement in SIBO Patients Using the Mayo Bloating Questionnaire

Introduction: Small intestinal bacterial overgrowth (SIBO) is a poorly understood disorder with a range of presenting symptoms. Although symptoms of SIBO can be nonspecific, abdominal bloating and distension are 2 frequently reported symptoms in this population. One of the challenges with treating these symptoms is the inability to reliably track treatment outcomes. The validated Mayo Bloating Questionnaire (MBQ) is a novel tool for measuring symptoms of bloating and determining the impact on patients. Our goal with this study was to determine whether this instrument could measure improvement in symptoms of bloating and distension among patients with SIBO following treatment. Methods: This was a prospective cohort study of patients referred to the motility lab at Mayo Clinic Florida for breath testing due to symptoms of bloating and/or abdominal distension between July 2022 and April 2023. Patients completed the MBQ prior to breath testing. The collected data included demographics and scores on the MBQ. Possible score ranged from 0-1400. Questions on the MBQ focus on how symptoms affect quality-of-life, including severity and impact on wellness and interference with daily activities. Questions are individually scored on a Likert scale. Patients who tested positive for SIBO on breath testing completed the survey again within 3 weeks of completion of SIBO treatment. Comparisons between groups were made using paired samples t-test. Results: Two hundred and four consecutive adult patients were evaluated; demographic data are listed in Table 1. Seventeen patients were positive for SIBO on breath testing and completed both pre- and post-treatment surveys. Patients who were positive for SIBO were not different in their average pre-treatment questionnaire scores compared to their SIBO-negative counterparts (P=0.054). There was a statistically significant decrease in average bloating questionnaire scores among the SIBO-positive cohort after treatment (P=0.0012). Conclusion: Among patients referred for breath testing due to symptoms of bloating and/or abdominal distension, those who tested positive for SIBO had a statistically significant decrease in average bloating questionnaire score following SIBO treatment. On average, overall symptom severity scores decreased by over 40%. This study confirms that the MBQ is a valid, reliable, and clinically useful tool for the quantification of abdominal bloating and distension and can be used to inform clinicians about the results of therapeutic interventions for the management of SIBO. Table 1 - Survey Timing Mean Total Score Standard Deviation Mean of the Differences t-score P-value Pre-treatment 578.13 160.18 248.44 3.94 0.0012** Post-treatment 329.69 234.82 **P < 0.05 used to determine significance.