Differentiation of functional gastrointestinal disorders from healthy volunteers by lactulose hydrogen breath test and test meal

Schindler, Valeria; Giezendanner, Stéphanie; Bütikofer, Simon; Murray, Fritz Ruprecht; Runggaldier, Daniel; Schnurre, Larissa; Zweig, Annina; Fried, Michael; Pohl, Daniel

doi:10.1111/jgh.14551

Cited by 7 publications

(20 citation statements)

References 23 publications

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“…Most researchers emphasize frequent coexistence of IBS and SIBO [14][15][16][17]. Others, however, question the specificity of LHBT and believe that it does not serve to differentiate between the two syndromes [18,19]. The relationship between SIBO and functional dyspepsia may be even more controversial.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of the hydrogen breath test in patients with functional dyspepsia

Chojnacki¹,

Konrad²,

Błońska³

et al. 2020

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Introduction: The pathogenesis of functional dyspepsia is complex and not well understood. Therefore, in this disease there should be considered involvement of different pathogenic factors, including intestinal bacteria.Aim: To evaluate the results of the hydrogen breath test in relation to the clinical picture of functional dyspepsia.Material and methods: The study included 40 healthy subjects (group I), 72 patients with postprandial distress syndrome (PDS, group II), and 84 patients with epigastric pain syndrome (EPS, group III). The diagnosis of functional dyspepsia was based on Rome Criteria IV. The urea breath test (13C-UBT) and lactulose hydrogen breath test (LHBT) were performed in all subjects. Patients with a positive urea breath test were excluded from the study. Patients with a positive LHBT test were assigned to antibiotic therapy (1200 mg daily for 14 days). Before treatment and 6 weeks after the end of antibiotic therapy the LHBT was performed, and severity of dyspeptic symptoms was assessed using a 10-points visual analogue scale.Results: A positive LHBT test was found in 35 (48.6%) patients in the group with PDS, and in 40 (47.6%) patients with EPS (p > 0.05). A positive correlation between the results of the LHBT test and severity of dyspeptic symptoms was found in both group (p < 0.001). After treatment with rifaximin the mean LHBT result and the index of severity of dyspeptic complaints were significantly decreased (p < 0.001).Conclusions: Quantitative and/or qualitative changes in the gut microbiota may be the cause of functional dyspepsia.

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Section: Discussionmentioning

confidence: 99%

Usefulness of the hydrogen breath test in patients with functional dyspepsia

Chojnacki¹,

Konrad²,

Błońska³

et al. 2020

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“…This study did not confirm an equivalence in diagnosing SIBO by NCT as compared to ScLHBT. While NCT was proven to be a good non-invasive test to discriminate IBS and FD patients from healthy volunteers, 11 its role in diagnosing SIBO is not established yet. One reason for the non-equivalence of NCT and ScLHBT may be based on the 2 different testing substances entailing different orocecal transit times (OCTT).…”

Section: Discussionmentioning

confidence: 99%

“…In contrast to our study, most of the studies used LHBT without an additional test meal. However, to better represent physiological conditions and because the NCT was shown useful to discriminate IBS and FD patients from healthy volunteers, 9 - 11 we used the NCT. The test meal might also explain the significant differences in the occurrence of nausea and borborygmi.…”

Section: Discussionmentioning

confidence: 99%

“… 9 However, performing a NCT, originally developed to discriminate IBS patients from healthy volunteers, was recently shown to be useful in discriminating healthy volunteers from subjects with functional dyspepsia (FD), potentially expanding its range of applications. 9 - 11 In this study we aim to analyze whether the NCT, as a cost-effective and radiation-free alternative to scintigraphy, is equivalent to the ScLHBT in diagnosing SIBO.…”

Section: Introductionmentioning

confidence: 99%

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Nutrient Challenge Testing Is Not Equivalent to Scintigraphy−Lactulose Hydrogen Breath Testing in Diagnosing Small Intestinal Bacterial Overgrowth

Schindler

Huellner

Murray

et al. 2020

J Neurogastroenterol Motil

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Background/Aims Small intestinal bacterial overgrowth (SIBO) is a common condition in disorders of gut-brain interaction (DGBI). Recently, a combined scintigraphy-lactulose hydrogen breath test (ScLHBT) was described as an accurate tool diagnosing SIBO. We aim to analyze whether a lactulose nutrient challenge test (NCT), previously shown to separate DGBI from healthy volunteers, is equivalent to ScLHBT in diagnosing SIBO. Methods We studied data of 81 DGBI patients undergoing ScLHBT with 30 g lactulose and 300 mL water as well as NCT with 30 g lactulose and a 400 mL liquid test meal. Differences in proportion of positive SIBO diagnoses according to specified cecal load and time criteria for NCT and ScLHBT, respectively, were tested in an equivalence trial. An odds ratio (OR) range of 0.80-1.25 was considered equivalent. Results Diagnosis of SIBO during NCT was not equivalent to SIBO diagnosis in ScLHBT, considering a hydrogen increase before cecal load of 5.0%, 7.5%, or 10.0%, respectively ([OR, 3.76; 90% CI, 1.99-7.09], [OR, 1.87; 90% CI, 1.06-3.27], and [OR, 1.11; 90% CI, 0.65-1.89]). Considering only time to hydrogen increase as criterion, the odds of a positive SIBO diagnosis in the NCT (0.65) was lower than in ScLHBT (1.70) (OR, 0.38; 90% CI, 0.23-0.65). Conclusions This study could not show an equivalence of NCT and ScLHBT in diagnosing SIBO. A possible explanation might be the different transit times owing to unequal testing substances. The effect of this deviation in relation to consecutive therapy regimens should be tested in further prospective studies.

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“…They are similar to those of irritable bowel syndrome (IBS), 6 and nearly two-thirds of IBS patients associate symptoms with eating a meal. 7 Besides, small intestinal bacterial overgrowth (SIBO) have similar clinical features, and SIBO increases the likelihood of LI in patients with chronic diarrhea as a direct result of lactose fermentation in the small intestine. 8 However, the most used diagnostic test for SIBO diagnosis is the breath test using glucose or lactulose as reactive.…”

Section: Introductionmentioning

confidence: 99%

Lactose Sensitivity and Lactose Malabsorption: The 2 Faces of Lactose Intolerance

Bouchoucha

Fysekidis

Rompteaux

et al. 2021

J Neurogastroenterol Motil

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Background/Aims Self-reported lactose intolerance (LI) is frequent in patients with functional bowel disorders (FBD) that could be interpreted as irritable bowel syndrome (IBS). The present study aims to characterize the responses of patients with FBD, without small intestinal bacterial overgrowth (SIBO), and LI, in terms of lactose malabsorption (LM) and lactose sensitivity (LS) according to psychological and clinical features. Methods One hundred and fifty-eight consecutive FBD outpatients with LI, and no SIBO, were classified according to the Rome III questionnaire and filled Beck Depression Inventory, and State and Trait Anxiety questionnaires. They underwent a lactose tolerance test in which glycemia during 60 minutes and digestive symptoms for 3 hours were recorded. Results Abnormal lactose tolerance tests were found in 110 patients (70%), 44 (28%) with LM, 96 (61%) with LS, and 30 (19%) having both LM and LS. LM patients had a higher frequency of functional diarrhea ( P = 0.040) and a lower frequency of dysphagia ( P = 0.031). LS patients had a higher depression score ( P = 0.007), higher frequency of globus ( P = 0.042), irritable bowel syndrome (IBS) ( P = 0.027) and mixed IBS ( P = 0.049), and lower frequency of abdominal pain ( P = 0.040). LS was significantly associated with a higher depression score ( P = 0.002), and a higher frequency of globus ( P = 0.046). Conclusions Thirty percent of LI patients have normal lactose absorption and normal LS. In the other 70% of patients, LI could be associated with LM and/or LS.

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Differentiation of functional gastrointestinal disorders from healthy volunteers by lactulose hydrogen breath test and test meal

Cited by 7 publications

References 23 publications

Usefulness of the hydrogen breath test in patients with functional dyspepsia

Usefulness of the hydrogen breath test in patients with functional dyspepsia

Nutrient Challenge Testing Is Not Equivalent to Scintigraphy−Lactulose Hydrogen Breath Testing in Diagnosing Small Intestinal Bacterial Overgrowth

Lactose Sensitivity and Lactose Malabsorption: The 2 Faces of Lactose Intolerance

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