Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome: a double-blind, randomized, placebo-controlled study

Abstract

OBJECTIVE:We have recently found an association between abnormal lactulose breath test (LBT) findings and irritable bowel syndrome (IBS). The current study was designed to test the effect of antibiotic treatment for IBS in a doubleblind fashion. METHODS:Consecutive IBS subjects underwent an LBT with the results blinded. All subjects were subsequently randomized into two treatment groups (neomycin or placebo). The prevalence of abnormal LBT was compared with a gender-matched control group. Seven days after completion of treatment, subjects returned for repeat LBT. A symptom questionnaire was administered on both days. RESULTS:After exclusion criteria were met, 111 IBS subjects (55 neomycin, 56 placebo) entered the study, with 84% having an abnormal LBT, compared with 20% in healthy controls (p Ͻ 0.01). In an intention-to-treat analysis of all 111 subjects, neomycin resulted in a 35.0% improvement in a composite score, compared with 11.4% for placebo (p Ͻ 0.05). Additionally, patients reported a percent bowel normalization of 35.3% after neomycin, compared with 13.9% for placebo (p Ͻ 0.001). There was a graded response to treatment, such that the best outcome was observed if neomycin was successful in normalizing the LBT (75% improvement) (one-way ANOVA, p Ͻ 0.0001). LBT gas production was associated with IBS subgroup, such that methane excretion was 100% associated with constipationpredominant IBS. Methane excretors had a mean constipation severity of 4.1, compared with 2.3 in all other subjects (p Ͻ 0.001). CONCLUSIONS:An abnormal LBT is common in subjects with IBS. Normalization of LBT with neomycin leads to a significant reduction in IBS symptoms. The type of gas seen on LBT is also associated with IBS subgroup. (Am J Gastroenterol 2003;98:412-419.

Moisture Insensitive PMMA Coated Pt-AlGaN/GaN Diode Hydrogen Sensor and Its Thermal Stability

“…There are market-driven needs for robust and sensitive sensors to monitor the concentration of hydrogen under humid ambient in the application of hydrogen fuel cell vehicles and hydrogen breath test in medical dioagnosis. [4][5][6]21,33 Methods to mitigate the effects of absorbed water molecules would be a major step toward expanding these applications. Kumar et al investigated effects of various polymer encapsulations including poly(methyl methacrylate) (PMMA) on selective hydrogen sensing of nanocrystalline In 2 O 3 -doped SnO 2 thin film sensors.…”

“…[1][2][3] In addition, reliable and accurate hydrogen sensor is required in medical diagnosis applications including hydrogen breath test to detect carbohydrate malabsorption and SIBO (small intestinal bacterial overgrowth) of patients. [4][5][6] Among semiconductor-based hydrogen sensors, various types of wide bandgap GaN (3.4 eV) thin film or nanostructured devices contacted with Pt-or Pd-gate metals are attractive for their robustness and wide operating temperature. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] In particular, the availability of piezoelectric AlGaN/GaN heterostructures enables the design of transistor-based sensors with enhanced sensitivity.…”

Low Dose Mesalazine Plus Bismuth Regimen and Symptoms of Irritable Bowel Syndrome in Patients with Bloating: A Quasi-Experimental Study

“…Moreover, some studies showed that short course of antibiotic therapy resulted in significant improvement in GI symptoms of such patients (6). In a double blind clinical trial, neomycin resulted in 25% improvement among the results of lactulose breath test in comparison with that of placebo, and this drug was more effective in relieving clinical symptoms, although its usage was abandoned due to systemic absorption and side effects (18)(19)(20). Accordingly, in another study rifaximin, a non-absorbable antibiotic was more efficacious than placebo to treat bloating; although only 60% of participants in this study fulfilled the Rome II criteria to diagnose IBS and no one suffered through lactulose breath test (13).…”

Treatment of Functional Bowel Disorders: Is There Room for Antibiotics?

“…Altered gastrointestinal motility and sensation, changed activity of the central nervous system, and increased sympathetic drive and immune activation may be interpreted as consequences of the host response to SIBO [16]. To further support abnormal enteric flora as the contributing cause of IBS, two recent studies have shown that metronidazole [29] and neomycin [30] are both able to cause a significant symptomatic improvement in this condition.…”