Does a glucose‐based hydrogen and methane breath test detect bacterial overgrowth in the jejunum?

Sundin, Olof; Mendoza-Ladd, Antonio; Morales, Elisa; Fagan, B. Matthew; Zeng, Mingtao; Díaz-Arévalo, Diana; Ordoñez, Javier; McCallum, Richard W.

doi:10.1111/nmo.13350

Cited by 22 publications

(17 citation statements)

References 28 publications

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“…False negative H 2 BT results may even be found in non-hydrogen producers: in this case, additional measurement of methane in the breath may improve the diagnosis. 41 However, despite 3 among 14 that estimated methane, 22,30,32 only one study expressed results in a way satisfactory to extract data, therefore a metaanalysis was not possible. We believe that this is a relevant limitation of our analysis, since we were not able to assess the impact of methane detection on BT performance.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, it is necessary to use a sterilized catheter and to avoid contact with the oral mucosa, which could cause contamination by oral flora. The limitation of culture for SIBO has been highlighted by Sundin et al, 32 who showed that cultures may frequently underestimate the real bacterial load and that the correlation between microbiological re-sults and BT results is weak. Moreover, metagenomic studies have shown that jejunal culture could not detect up to 80.0% of bacterial species, since there are some strains that are not culturable.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7][8][9][10] In 6 studies the sub-category of patients without any predisposing conditions was considered. 21,22,24,28,30,32 Three hundred and forty patients were enrolled in this subgroup, which was constituted mainly by healthy controls, elderly patients with diarrhea, and IBS patients. Pooled sensitivity, specificity, PLR, and NLR were 40.6%, 84.0%, 1.64, and 0.84, respectively.…”

Section: Sub-analysis According To Population Sub-categoriesmentioning

confidence: 99%

“…A delta value > 20 ppm was used in 7 studies, with 333 patients, 19,21,22,25,27,30,32 while a value other than and lower than > 20 ppm (> 10, > 12, or > 15) was used in 7 papers (306 patients). 20,23,24,26,28,29,31 A cut off > 20 ppm provided a pooled sensitivity of 47.3% and specificity of 80.9%.…”

Section: Glucose Breath Testmentioning

confidence: 99%

“…[19][20][21][22][23][24][25][26][27][28][29][30][31][32] were selected out of 2123 articles found after the literature search. Further details about the process of article selection are reported in the PRISMA flowchart in…”

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confidence: 99%

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Breath Tests for the Non-invasive Diagnosis of Small Intestinal Bacterial Overgrowth: A Systematic Review With Meta-analysis

Losurdo

Leandro

Ierardi

et al. 2020

J Neurogastroenterol Motil

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Background/Aims Small intestinal bacterial overgrowth (SIBO) diagnosis is usually based on non-invasive breath tests (BTs), namely lactulose BT (LBT) and glucose BT (GBT). However, divergent opinions and problems of parameter standardization are still controversial aspects. We aim to perform a meta-analysis to analyze diagnostic performance of LBT/GBT for SIBO diagnosis. Methods We searched in main literature databases articles in which SIBO diagnosis was achieved by LBT/GBT in comparison to jejunal aspirate culture (reference gold standard). We calculated pooled sensitivity, specificity, positive, and negative likelihood ratios and diagnostic odd ratios. Summary receiver operating characteristic curves were drawn and pooled areas under the curve were calculated. Results We selected 14 studies. Pooled sensitivity of LBT and GBT was 42.0% and 54.5%, respectively. Pooled specificity of LBT and GBT was 70.6% and 83.2%, respectively. When delta over baseline cutoff > 20 H 2 parts per million (ppm) was used, GBT sensitivity and specificity were 47.3% and 80.9%; when the cutoff was other than and lower than > 20 ppm, sensitivity and specificity were 61.7% and 86.0%. In patients with abdominal surgery history, pooled GBT sensitivity and specificity gave the impression of having a better performance (81.7% and 78.8%) compared to subjects without any SIBO predisposing condition (sensitivity = 40.6% and specificity = 84.0%). Conclusions GBT seems to work better than LBT. A cutoff of delta H2 expired other than and lower than > 20 ppm shows a slightly better result than > 20 ppm. BTs demonstrate the best effectiveness in patients with surgical reconstructions of gastrointestinal tract.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Sub-analysis According To Population Sub-categoriesmentioning

confidence: 99%

Section: Glucose Breath Testmentioning

confidence: 99%

mentioning

confidence: 99%

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Breath Tests for the Non-invasive Diagnosis of Small Intestinal Bacterial Overgrowth: A Systematic Review With Meta-analysis

Losurdo

Leandro

Ierardi

et al. 2020

J Neurogastroenterol Motil

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Factors Related to the Development of Small‐Bowel Bacterial Overgrowth in Pediatric Intestinal Failure: A Retrospective Cohort Study

Belza¹,

Betts²,

Silva³

et al. 2020

J Parenter Enteral Nutr

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Background Small bowel bacterial overgrowth (SBBO) is a challenge in the management of pediatric intestinal failure (PIF). Our goal was to determine the proportion of patients treated for SBBO and factors related to its development. Methods We completed a retrospective analysis of PIF patients referred between 2008 and 2014. Data were collected on factors related to intestinal failure (IF) and SBBO. The cohort was stratified on the diagnosis of SBBO and refractory SBBO. Statistical testing completed using t‐test, χ2 test, and logistic regression. Results Thirty‐five of 102 patients developed SBBO (34%), and 16 (16%) had refractory SBBO. SBBO was more likely in gastroschisis (40.0% vs 19.4%, P = .025), a shorter residual small bowel (SB) (45.4% vs 66.5%, P = .004), and patients were less likely to wean from parenteral nutrition (PN) (51.4% vs 85.1%, P < .0001). Refractory SBBO patients were likely to have gastroschisis (50.0% vs 22.1%, P = .020) and a shorter residual SB and large bowel remaining (23.2% vs 65.9%, P < .0001 and 60.6% vs 79.4%, P = .03, respectively) and less likely to wean from PN (37.5% vs 80.2%, P = .001). Logistic regression demonstrated that longer SB residual was protective (P = .001; odds ratio [OR], 0.95; 95% CI, 0.93–0.99), and short bowel syndrome (SBS) as a cause of IF was a risk factor (P = .001; OR, 0.04; 95% CI, 0.01–0.27). Conclusion A longer SB remnant was protective against SBBO. Patients with SBBO were more likely to have PIF caused by SBS.

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Small Intestinal Bacterial Overgrowth

Rodríguez

Ryan

Quigley

2021

Textbook of Pediatric Gastroenterology, Hepatology and Nutrition

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Does a glucose‐based hydrogen and methane breath test detect bacterial overgrowth in the jejunum?

Abstract: The glucose-based hydrogen and methane breath test is not sensitive to the overgrowth of jejunal bacteria. However, a positive breath test may indicate altered jejunal function and microbial dysbiosis.

Cited by 22 publications

References 28 publications

Breath Tests for the Non-invasive Diagnosis of Small Intestinal Bacterial Overgrowth: A Systematic Review With Meta-analysis

Breath Tests for the Non-invasive Diagnosis of Small Intestinal Bacterial Overgrowth: A Systematic Review With Meta-analysis

Factors Related to the Development of Small‐Bowel Bacterial Overgrowth in Pediatric Intestinal Failure: A Retrospective Cohort Study

Small Intestinal Bacterial Overgrowth

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