Diagnosing Small Intestinal Bacterial Overgrowth: A Comparison of Lactulose Breath Tests to Small Bowel Aspirates

Cangemi, David; Lacy, Brian E.; Wise, Journey L.

doi:10.1007/s10620-020-06484-z

Cited by 21 publications

(16 citation statements)

References 17 publications

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“…Interestingly, fewer patients had a positive duodenal aspirate in the current study (16.5%, compared with 25.9% of patients by lactulose breath test) [5]. Understanding that the true prevalence of SIBO remains unknown, it is possible that the low frequency of duodenal aspirate positivity may be the result of missed SIBO in the mid-or distal-small bowel.…”

contrasting

confidence: 54%

“…In comparison with breath testing, duodenal aspiration appeals to patients due to its similarity with direct cultures used to confirm common infectious disease diagnoses, and to clinicians due to its original status as the 'gold standard' test for a SIBO diagnosis in Billroth II patients [1]. Unfortunately, duodenal aspirate samples are frequently contaminated, representing 20% of samples in the current study, which can be explained by the lack of dedicated commercial devices designed to collect aspirates, challenges in avoiding collection of oral flora during tracheoesophageal intubation, and the lack of randomized controlled trials or international consensus protocols addressing appropriate sampling protocols [5].…”

mentioning

confidence: 95%

“…Toward developing a better understanding of the strengths and limitations of available SIBO tests, Cangemi et al in this issue of Digestive Diseases and Sciences retrospectively analyzed 9 years of pooled diagnostic test findings from a quaternary referral center (Mayo Clinic, Jacksonville, Florida) among patients who underwent the two most common diagnostic evaluations for SIBO: breath testing, and duodenal aspirates obtained during a routine upper endoscopy [5]. The primary finding of their study was a significant discrepancy between duodenal aspirate and breath testing results (with disagreement in 37.6% of cases, κ statistic = − 0.02).…”

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confidence: 99%

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Breath Test or Duodenal Aspirate for Small Intestinal Bacterial Overgrowth: Still No Breath of Fresh Air

Shah

2020

Dig Dis Sci

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confidence: 99%

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Breath Test or Duodenal Aspirate for Small Intestinal Bacterial Overgrowth: Still No Breath of Fresh Air

Shah

2020

Dig Dis Sci

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“…Since most nutrient absorption occurs in the small intestine, it is important to understand the characteristics of the mucosa in this intestinal region (El Aidy et al, 2013). The lactulose breath test (LBT) qualitatively evaluates bacterial growth in the small intestine, with the advantages of being noninvasive, convenient, sensitive, accurate, and reproducible (Cangemi et al, 2021). Therefore, in this study, we used LC-MS to explore the changes in metabolites in the serum of pregnant women during pregnancy, and the methane hydrogen breath test evaluated the bacterial growth of the small intestine.…”

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confidence: 99%

Association of Differential Metabolites With Small Intestinal Microflora and Maternal Outcomes in Subclinical Hypothyroidism During Pregnancy

Cai

et al. 2022

Front. Cell. Infect. Microbiol.

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ObjectiveTo investigate the association of differential metabolites with small intestinal microflora and maternal outcomes in subclinical hypothyroidism (SCH) during pregnancy.MethodsThe plasma of pregnant women in the SCH group and control group was analyzed by liquid chromatography-mass spectrometry (LC-MS), obtaining differential metabolites. Then, methane and hydrogen breath tests were performed in both groups, and basic clinical data and maternal outcome information were collected. Finally, differential metabolites were analyzed for small intestinal bacterial overgrowth (SIBO) and pregnancy outcomes using Spearman correlation analysis.Results(1) Multivariate statistics: There were 564 different metabolites in positive ion mode and 226 different metabolites in negative ion mode. (2) The positive rate of the methane hydrogen breath test in the SCH group was higher than that in the control group (p<0.05). (3) KEGG pathway analysis revealed that differential metabolites were mainly involved in bile secretion, cholesterol metabolism, and other pathways. (4) Serum cholesterol (TC) and triglyceride (TG) levels and hypertensive disorder complicating pregnancy (HDCP) were higher in the SCH group (p<0.05), and newborn birth weight (BW) was lower than that in the control group (p<0.05). (5) SIBO was negatively correlated with glycocholic acid and BW, and positively correlated with TC. Glycocholic acid was negatively correlated with TG but positively correlated with BW. TG was positively correlated with HDCP.ConclusionDifferential metabolites in the SCH group during pregnancy were disordered with small intestinal bacteria, which may affect pregnancy outcomes, and bile acids and cholesterol may be potential biomarkers for studying their mechanism of action.

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“…It is widely used in the clinic as an important method to diagnose SIBO. However, the sensitivity range of the hydrogen breath test is 20%-90%, possibly because of the lack of uniform diagnostic criteria, which has been resolved by the recently published North American breath test consensus[ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Intestinal bacterial overgrowth in the early stage of severe acute pancreatitis is associated with acute respiratory distress syndrome

Liang¹,

Jia²,

Zhang³

2021

WJG

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BACKGROUND In the early stage of acute pancreatitis (AP), a large number of cytokines induced by local pancreatic inflammation seriously damage the intestinal barrier function, and intestinal bacteria and endotoxins enter the blood, causing inflammatory storm, resulting in multiple organ failure, infectious complications, and other disorders, eventually leading to death. Intestinal failure occurs early in the course of AP, accelerating its development. As an alternative method to detect small intestinal bacterial overgrowth, the hydrogen breath test is safe, noninvasive, and convenient, reflecting the number of intestinal bacteria in AP indirectly. This study aimed to investigate the changes in intestinal bacteria measured using the hydrogen breath test in the early stage of AP to clarify the relationship between intestinal bacteria and acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). Early clinical intervention and maintenance of intestinal barrier function would be highly beneficial in controlling the development of severe acute pancreatitis (SAP). AIM To analyze the relationship between intestinal bacteria change and ALI/ARDS in the early stage of SAP. METHODS A total of 149 patients with AP admitted to the intensive care unit of the Digestive Department, Xuanwu Hospital, Capital Medical University from 2016 to 2019 were finally enrolled, following compliance with the inclusion and exclusion criteria. The results of the hydrogen breath test within 1 wk of admission were collected, and the hydrogen production rates at admission, 72 h, and 96 h were calculated. The higher the hydrogen production rates the more bacteria in the small intestine. First, according to the improved Marshall scoring system in the 2012 Atlanta Consensus on New Standards for Classification of Acute Pancreatitis, 66 patients with a PaO 2 /FiO 2 score ≤ 1 were included in the mild AP (MAP) group, 18 patients with a PaO 2 /FiO 2 score ≥ 2 and duration < 48 h were included in the moderately SAP (MSAP) group, and 65 patients with a PaO 2 /FiO 2 score ≥ 2 and duration > 48 h were included in the SAP group, to analyze the correlation between intestinal bacterial overgrowth and organ failure in AP. Second, ALI (PaO 2 /FiO 2 = 2) and ARDS (PaO 2 /FiO 2 > 2) were defined according to the simplified diagnostic criteria proposed by the 1994 European Union Conference. The MSAP group was divided into two groups according to the PaO 2 /FiO 2 score: 15 patients with PaO 2 /FiO 2 score = 2 were included in group A, and three patients with score > 2 were included in group B. Similarly, the S...

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Diagnosing Small Intestinal Bacterial Overgrowth: A Comparison of Lactulose Breath Tests to Small Bowel Aspirates

Cited by 21 publications

References 17 publications

Breath Test or Duodenal Aspirate for Small Intestinal Bacterial Overgrowth: Still No Breath of Fresh Air

Breath Test or Duodenal Aspirate for Small Intestinal Bacterial Overgrowth: Still No Breath of Fresh Air

Association of Differential Metabolites With Small Intestinal Microflora and Maternal Outcomes in Subclinical Hypothyroidism During Pregnancy

Intestinal bacterial overgrowth in the early stage of severe acute pancreatitis is associated with acute respiratory distress syndrome

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