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A study of the methodological and clinical validity of the combined lactulose hydrogen breath test with scintigraphic oro-cecal transit test for diagnosing small intestinal bacterial overgrowth in IBS patients.
Neurogastroenterol Motil 2014; 26(6):794-802NM

Abstract

BACKGROUND

Small intestinal bacterial overgrowth (SIBO) may be a cause of irritable bowel syndrome (IBS); however, current investigations have important limitations. We aimed to identify clinically relevant diagnostic criteria for SIBO based on lactulose hydrogen breath test (LHBT) alone and combined with scintigraphic measurement of oro-cecal transit (SOCT).

METHODS

Results of LHBT/SOCT investigation from 89 IBS patients and 13 healthy volunteers were included in a systematic analysis of six published criteria for SIBO diagnosis. Clinical relevance of competing criteria was determined by assessing (i) prevalence of SIBO in IBS patients and healthy volunteers (ii) if SIBO diagnosis predicted improvement in IBS symptoms in a prospective, pilot therapeutic trial of a non-absorbable antibiotic (rifaximin 600 mg b.d.) in IBS patients.

KEY RESULTS

Reproducibility of SIBO diagnosis by combined LHBT/SOCT was near perfect. A ≥5 ppm H2 increase prior to appearance of cecal contrast was detected in more IBS patients than healthy volunteers (35/89 vs 1/13; p = 0.026), but not for other diagnostic criteria. IBS patients with SIBO, compared to those without SIBO, reported significantly greater improvement in abdominal symptoms following rifaximin therapy (p < 0.002 overall IBS symptom severity). This improvement was most marked in D-IBS patients in whom all symptoms improved, including stool frequency and consistency (all p < 0.004).

CONCLUSIONS & INFERENCES

Combined LHBT/SOCT testing using a H2 5 ppm cutoff may identify a subgroup of IBS patients with SIBO. Pilot data examining the clinical response to rifaximin suggest that this subset of IBS patients may benefit more than those with a normal test.

Authors+Show Affiliations

Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Division of Gastroenterology & Hepatology, Tongde Hospital of Zhejiang Province, Hangzhou, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24641100

Citation

Zhao, J, et al. "A Study of the Methodological and Clinical Validity of the Combined Lactulose Hydrogen Breath Test With Scintigraphic Oro-cecal Transit Test for Diagnosing Small Intestinal Bacterial Overgrowth in IBS Patients." Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society, vol. 26, no. 6, 2014, pp. 794-802.
Zhao J, Zheng X, Chu H, et al. A study of the methodological and clinical validity of the combined lactulose hydrogen breath test with scintigraphic oro-cecal transit test for diagnosing small intestinal bacterial overgrowth in IBS patients. Neurogastroenterol Motil. 2014;26(6):794-802.
Zhao, J., Zheng, X., Chu, H., Zhao, J., Cong, Y., Fried, M., ... Dai, N. (2014). A study of the methodological and clinical validity of the combined lactulose hydrogen breath test with scintigraphic oro-cecal transit test for diagnosing small intestinal bacterial overgrowth in IBS patients. Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society, 26(6), pp. 794-802. doi:10.1111/nmo.12331.
Zhao J, et al. A Study of the Methodological and Clinical Validity of the Combined Lactulose Hydrogen Breath Test With Scintigraphic Oro-cecal Transit Test for Diagnosing Small Intestinal Bacterial Overgrowth in IBS Patients. Neurogastroenterol Motil. 2014;26(6):794-802. PubMed PMID: 24641100.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A study of the methodological and clinical validity of the combined lactulose hydrogen breath test with scintigraphic oro-cecal transit test for diagnosing small intestinal bacterial overgrowth in IBS patients. AU - Zhao,J, AU - Zheng,X, AU - Chu,H, AU - Zhao,J, AU - Cong,Y, AU - Fried,M, AU - Fox,M, AU - Dai,N, Y1 - 2014/03/18/ PY - 2013/11/23/received PY - 2014/02/21/accepted PY - 2014/3/20/entrez PY - 2014/3/20/pubmed PY - 2015/2/11/medline KW - antibiotic therapy KW - irritable bowel syndrome (IBS) KW - lactulose hydrogen breath test (LHBT) KW - rifaximin KW - scintigraphic oro-cecal transit (SOCT) test KW - small intestinal bacterial overgrowth (SIBO) SP - 794 EP - 802 JF - Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society JO - Neurogastroenterol. Motil. VL - 26 IS - 6 N2 - BACKGROUND: Small intestinal bacterial overgrowth (SIBO) may be a cause of irritable bowel syndrome (IBS); however, current investigations have important limitations. We aimed to identify clinically relevant diagnostic criteria for SIBO based on lactulose hydrogen breath test (LHBT) alone and combined with scintigraphic measurement of oro-cecal transit (SOCT). METHODS: Results of LHBT/SOCT investigation from 89 IBS patients and 13 healthy volunteers were included in a systematic analysis of six published criteria for SIBO diagnosis. Clinical relevance of competing criteria was determined by assessing (i) prevalence of SIBO in IBS patients and healthy volunteers (ii) if SIBO diagnosis predicted improvement in IBS symptoms in a prospective, pilot therapeutic trial of a non-absorbable antibiotic (rifaximin 600 mg b.d.) in IBS patients. KEY RESULTS: Reproducibility of SIBO diagnosis by combined LHBT/SOCT was near perfect. A ≥5 ppm H2 increase prior to appearance of cecal contrast was detected in more IBS patients than healthy volunteers (35/89 vs 1/13; p = 0.026), but not for other diagnostic criteria. IBS patients with SIBO, compared to those without SIBO, reported significantly greater improvement in abdominal symptoms following rifaximin therapy (p < 0.002 overall IBS symptom severity). This improvement was most marked in D-IBS patients in whom all symptoms improved, including stool frequency and consistency (all p < 0.004). CONCLUSIONS & INFERENCES: Combined LHBT/SOCT testing using a H2 5 ppm cutoff may identify a subgroup of IBS patients with SIBO. Pilot data examining the clinical response to rifaximin suggest that this subset of IBS patients may benefit more than those with a normal test. SN - 1365-2982 UR - https://www.unboundmedicine.com/medline/citation/24641100/A_study_of_the_methodological_and_clinical_validity_of_the_combined_lactulose_hydrogen_breath_test_with_scintigraphic_oro_cecal_transit_test_for_diagnosing_small_intestinal_bacterial_overgrowth_in_IBS_patients_ L2 - https://doi.org/10.1111/nmo.12331 DB - PRIME DP - Unbound Medicine ER -