Abstract
Background and Aims: Validity of the lactulose breath test (LBT) to diagnose small intestinal bacterial overgrowth (SIBO) has been questioned. Therefore, a study was planned to compare LBT with glucose breath test (GBT) to diagnose SIBO in irritable bowel syndrome (IBS) patients and controls. Methods: 175 diarrhea-predominant IBS patients and 150 apparently healthy controls were enrolled. IBS was diagnosed according to Rome II criteria. Breath samples were collected every 10 min up to 180 min. Breath H2 and CH4 were measured using an SC MicroLyzer. SIBO was positive with a sustained increase in breath H2 or CH4 or both ≥10 ppm over a baseline value within <90 min in case of LBT and within <120 min in GBT. Results: SIBO was positive in 60/175 (34.3%) patients by lactulose and in 11/175 (6.2%) patients by GBT. In controls, LBT was positive for SIBO in 45/150 (30%) patients and in 1/150 (0.66%) patients by GBT. Positive LBT for SIBO was not significantly different in patients and controls; while using GBT, SIBO was significantly higher (p < 0.01) in patients as compared to controls. By using GBT as gold standard for SIBO, sensitivity, specificity, positive predictive value and negative predictive value of LBT in IBS patients was 63.6, 67.7, 11.7 and 96.6% respectively. Conclusion: LBT is not a good test to discriminate SIBO in IBS patients from controls.
Journal Section:
Original Paper
References
1.
Cremonini F, Talley NJ: Irritable bowel syndrome: epidemiology, natural history, healthcare seeking and emerging risk factors. Gastroenterol Clin North Am 2005;34:189–204.
[PubMed]
2.
Malagelada JR: A symptom-based approach to making a positive diagnosis of irritable bowel syndrome with constipation. Int J Clin Pract 2006;60:57–63.
3.
Hungin APS, Chang L, Locke GR, et al: Irritable bowel syndrome in the United States: prevalence, symptom patterns and impact. Aliment Pharmacol Ther 2005;21:1365–1375.
4.
Ford AC, Talley NJ: IBS in 2010: advances in pathophysiology, diagnosis and treatment. Nat Rev Gastroenterol Hepatol 2011;8:76–78.
5.
Lin HC: Small intestinal bacterial overgrowth: a framework for understanding irritable bowel syndrome. JAMA 2004;292:852–858.
[PubMed]
6.
Husebye E: The pathogenesis of gastrointestinal bacterial overgrowth. Chemotherapy 2005;51:1–22.
[PubMed]
7.
Simren M, Stotzer P-O: Use and abuse of hydrogen breath tests. Gut2006;55:297–303.
[PubMed]
8.
Di Stefano M, Corazza GR: Treatment of small intestine bacterial overgrowth and related symptoms by rifaximin. Chemotherapy2005;51:103–109.
[PubMed]
9.
Singh VV, Toskes PP: Small bowel bacterial overgrowth: presentation, diagnosis, and treatment. Curr Treat Options Gastroenterol 2004;7:19–28.
[PubMed]
10.
Lupascu A, Gabrielli M, Lauritano EC, et al: Hydrogen glucose breath test to detect small intestinal bacterial overgrowth: a prevalence case-control study in irritable bowel syndrome. Aliment Pharmacol Ther 2005;22:1157–1160.
[PubMed]
11.
Nucera G, Gabrielli M, Lupascu A, et al: Abnormal breath tests to lactose, fructose and sorbitol in irritable bowel syndrome may be explained by small intestinal bacterial overgrowth. Aliment Pharmacol Ther 2005;21:1391–1395.
[PubMed]
12.
Pimentel M, Chow EJ, Lin HC: Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome. A double-blind, randomized, placebo-controlled study. Am J Gastroenterol 2003;98:412–419.
[PubMed]
13.
Walters B, Vanner SJ: Detection of bacterial overgrowth in IBS using the lactulose H2 breath test: comparison with 14C-D-xylose and healthy controls. Am J Gastroenterol 2005;100:1566–1570.
14.
Pimentel M, Chow EJ, Lin HC: Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol 2000;95:3503–3506.
[PubMed]
15.
Rana SV, Bhardwaj SB: Small intestinal bacterial overgrowth. Scand J Gastroenterol 2008;43:1030–1037.
16.
Rana SV, Sinha SK, Sikander A, et al: Study of small intestinal bacterial overgrowth in North Indian patients with irritable bowel syndrome: a case-control study. Trop Gastroenterol 2008;29:23–25.
17.
Rana SV, Sharma S, Sinha SK, et al: Incidence of predominant methanogenic flora in irritable bowel syndrome patients and apparently healthy controls from North India. Dig Dis Sci 2009;54:132–135.
18.
Kunkel D, Basseri RJ, Makhani MD, et al: Methane on breath testing is associated with constipation: a systematic review and meta-analysis. Dig Dis Sci 2011;56:1612–1618.
19.
Hwang L, Low K, Khoshini R, et al: Evaluating breath methane as a diagnostic test for constipation-predominant IBS. Dig Dis Sci 2010;55:398–403.
20.
Corazza GR, Menozzi MG, Strocchi A, et al: The diagnosis of small bowel bacterial overgrowth. Reliability of jejunal culture and inadequacy of breath hydrogen testing. Gastroenterology 1990;98:302–309.
[PubMed]
21.
Bratten JR, Spanier J, Jones MP: Lactulose breath testing does not discriminate patients with irritable bowel syndrome from healthy controls. Am J Gastroenterol 2008;103:1–6.
22.
Posserud I, Stotzer PO, Bjornsson ES, et al: Small intestinal bacterial overgrowth in patients with irritable bowel syndrome. Gut 2007;56:802–808.
23.
Yu D, Chesseman E, Vanner S, et al: Combined oro-caecal scintigraphy and lactulose hydrogen breath testing demonstrate that breath testing detects oro-caecal transit, not small intestinal bacterial overgrowth in patients with IBS. Gut 2011;60:334–340.
24.
Rana SV, Sinha SK, Lal S, et al: Small intestinal bacterial overgrowth in North Indian patients with celiac disease. Trop Gastroenterol 2007;28:159–161.
25.
Ford AC, Spiegel BM, Talley NJ, et al: Small intestinal bacterial overgrowth in irritable bowel syndrome: systematic review and meta-analysis. Clin Gastroenterol Hepatol 2009;7:1279–1286.
26.
Reddymasu SC, Sostarich S, McCallum RW: Small intestinal bacterial overgrowth in irritable bowel syndrome: are there any predictors? BMC Gastroenterol 2010;10:23–28.
27.
Sachdeva S, Rawat AK, Reddy RS, et al: Small intestinal bacterial overgrowth (SIBO) in irritable bowel syndrome: frequency and predictors. J Gastroenterol Hepatol 2011;26(suppl 3):135–138.
28.
Parodi A, Dulbecco P, Sayarino E, et al: Positive glucose breath testing is more prevalent in patients with IBS-like symptoms compared with controls of similar age and gender distribution. J Clin Gastroenterol 2009;43:962–966.
© 2012 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2012
You do not currently have access to this content.
