World Journal Gastro

[Guest guest]

When you scan the internet you must be aware that the search

engines will look everywhere to find a " match " . This journal

is not one which publishes well done studies or so-called

thought papers. There is no likely connection between

CLL/SLL and SIBO...both are common enough disorders to have

overlap. The gastrointestinal symptoms ascribed to SIBO are

very common and most gastroenterologists treat the symptoms

more or less empirically (often doing reasonable tests to

exclude major issues such as cancer of the gut or

inflammatory bowel disease). To prove SIBO is a bit

cumbersome and is most often not done. If the symptoms fit

the pattern and most other worrisome disorders seem to have

been excluded, then empiric therapy is reasonable,

especially if the patient derives benefit from such therapy.

Treating these types of gastrointestinal symptoms (which are

often lumped together and erroneously called " functional GI

complaints " ) can be difficult as multiple mechanisms can be

at play, but we are often able to find some regimen that

works.

There are some patients with CLL who, indeed, may have

gastrointestinal symptoms as a consequence of their

CLL...either through humoral effects on gastrointesinal

motility or mucosal permeability/absorptive capacity or

because of infiltration of the gastrointestinal mucosa with

large amounts of malignant lymphocytes, BUT empiric therapy

(after excluding cancer, IBD, etc) is reasonable because

such symptoms would presumably not be otherwise relieved

without eradicating the underlying lymphoma.

Another thing to consider is that one of the largest

segments of this population of people with so-called

functional GI symptoms are those with LYMPHOCYTIC COLITIS

which is not completely understood, but which certainly

occurs mostly in people who DO NOT have CLL. I don't know

how to sort out lymphocytic colitis from CLL infiltration in

a patient with CLL (unless the biopsies were to show

absolutely massive infiltration of lymphocytes into the GI

submucosa and accompanying collagen deposition beyond that

usually seen in lymphocytic colitis)...but there really is

no point in trying too hard to dissect this out. Unless you

are going to somehow eradicate all lymphoma cells from the

patient, the appropriate course of action is to treat as the

patient has ordinary lymphocytic colitis which is a very

common condition.

In my opinion patients with CLL/SLL should work with a

competent gastroenterologist to deal with their GI symptoms.

The doctor should certainly be aware of the underlying

lymphoma,but generally when you hear hoofbeats you should

think of horses, not zebras.

Good luck,

Rick