Lactulose Breath Test Gas Production in Childhood IBS Is Associated With Intestinal Transit and Bowel Movement Frequency

Abstract

Background In adults with irritable bowel syndrome (IBS), bacterial gas production (colonic fermentation) is related to both symptom generation and intestinal transit. Whether gas production affects symptom generation, psychosocial distress, or intestinal transit in childhood IBS is unknown. Methods Children (ages 7-17 years) with pediatric Rome III IBS completed validated psychosocial questionnaires and a 2-week daily diary capturing pain and stooling characteristics. Stool form determined IBS subtype. Subjects then completed a 3-hour lactulose breath test for measurement of total breath hydrogen and methane production. Carmine red was used to determine whole intestinal transit time. Results 87 children (mean age 13 ± 2.6 (SD) years) were enrolled, of whom 50 (57.5%) were female. All children produced hydrogen and 51 (58.6%) produced methane. Hydrogen and methane production did not correlate with either abdominal pain frequency/severity or psychosocial distress. Hydrogen and methane production did not differ significantly by IBS subtype. Methane production correlated positively with whole intestinal transit time (r=0.31, P<0.005) and inversely with bowel movement frequency (r= −0.245, P<0.05). Methane production (threshold 3 ppm) as a marker for identifying IBS-C had a sensitivity of 60% and specificity of 42.9%. Conclusions Lactulose breath test total methane production may serve as a biomarker of whole intestinal transit time and bowel movement frequency in children with IBS. However, in children with IBS, lactulose breath test hydrogen and methane production did not correlate with either abdominal pain, IBS subtype, or psychosocial distress.

Fructans Exacerbate Symptoms in a Subset of Children With Irritable Bowel Syndrome

“…The primary outcome measure (abdominal pain frequency) was assessed using a validated Pain and Stool Diary. 4, 14 Subjects recorded the number of discrete abdominal pain episodes during each of three 8-hour time periods daily as previously described during a one-week baseline period and during each 72-hour dietary intervention period. 15,16 In addition, during each diary time period subjects rated (using 0–10 Likert scale) several symptoms including: abdominal pain severity, bloating, flatulence, nausea, and fatigue.…”

“…Values (ppm) were plotted against time (8-hours) to calculate area under the curve for total hydrogen and methane gas production using the trapezoidal method (expressed as ppm*hr). 22…”

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

“…First, the results of LBT are highly influenced by the bowel transit time. 39 Therefore, since lactulose is not absorbed in the small bowel, it might rapidly pass into the colon where it could be degraded by colonic bacteria with rapid hydrogen production, 40 thus leading to false positivity. Additionally, patients with fast transit will display an early peak that may be misinterpreted as SIBO.…”

Perspective: Assessing Tolerance to Nondigestible Carbohydrate Consumption

“…Several techniques are available for the non-invasive assessment of intestinal transit in children. Carmine red, a non-absorbed material that is easily swallowed, measures whole intestinal transit via determining the time of ingestion to the presentation of red dye in the stool (100). As in adults, breath testing with non-absorbable substrates such as lactulose can estimate oro-cecal transit time (100).…”

“…Carmine red, a non-absorbed material that is easily swallowed, measures whole intestinal transit via determining the time of ingestion to the presentation of red dye in the stool (100). As in adults, breath testing with non-absorbable substrates such as lactulose can estimate oro-cecal transit time (100). Radio-opaque markers also have been used in children to measure intestinal transit time.…”