Scintigraphy Demonstrates High Rate of False-positive Results From Glucose Breath Tests for Small Bowel Bacterial Overgrowth

Lin, Emery C.; Massey, Benson T.

doi:10.1016/j.cgh.2015.07.032

Cited by 77 publications

(54 citation statements)

References 19 publications

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“…We showed that lactulose BT yielded a higher rate of positivity in CD (28%) than glucose BT or jejunal aspirate (19% and 11%, respectively, with a cumulative prevalence of 13%). Therefore, this finding is in agreement with previous data demonstrating that lactulose BT may give false positive results due to colonic fermentation of intraluminal substrates, a common event in CD . On the other hand, we would like to underline that the same report stating the lower accuracy of lactulose compared to glucose BT (ie, Rome Consensus on the use of hydrogen BT) does not discourage its use to diagnose SIBO…”

Section: Discussionsupporting

confidence: 92%

Small intestinal bacterial overgrowth and celiac disease: A systematic review with pooled‐data analysis

Losurdo

Marra

Shahini

et al. 2017

Neurogastroenterology Motil

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Section: Discussionsupporting

confidence: 92%

Small intestinal bacterial overgrowth and celiac disease: A systematic review with pooled‐data analysis

Losurdo

Marra

Shahini

et al. 2017

Neurogastroenterology Motil

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“…A recent retrospective study of subjects undergoing concurrent glucose breath testing with scintigraphy concluded that glucose breath testing has a high false positive rate due to arrival of the scintigraphy in the cecum prior to a rise in hydrogen or methane on testing (46). This is similar to conclusions previously published pertaining to lactulose breath testing (47).…”

Section: Resultsmentioning

confidence: 99%

“…This is similar to conclusions previously published pertaining to lactulose breath testing (47). However, both of these studies rely on the arrival of technetium to the cecum as a determinant of oro-cecal transit—either 5% arrival of technetium in the cecum (47), or the “head of the labeled bolus” (46). If 5% of the lactulose or “the head of the bolus” is in the cecum, the rest of the medium is still in the small intestine; hence, the rise of breath gases is not necessarily due fermentation in the cecum (48).…”

Section: Resultsmentioning

confidence: 99%

Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus

Rezaie

Buresi

Lembo

et al. 2017

American Journal of Gastroenterology

618

734

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Objectives:Breath tests (BTs) are important for the diagnosis of carbohydrate maldigestion syndromes and small intestinal bacterial overgrowth (SIBO). However, standardization is lacking regarding indications for testing, test methodology and interpretation of results. A consensus meeting of experts was convened to develop guidelines for clinicians and research.Methods:Pre-meeting survey questions encompassing five domains; indications, preparation, performance, interpretation of results, and knowledge gaps, were sent to 17 clinician-scientists, and 10 attended a live meeting. Using an evidence-based approach, 28 statements were finalized and voted on anonymously by a working group of specialists.Results:Consensus was reached on 26 statements encompassing all five domains. Consensus doses for lactulose, glucose, fructose and lactose BT were 10, 75, 25 and 25 g, respectively. Glucose and lactulose BTs remain the least invasive alternatives to diagnose SIBO. BT is useful in the diagnosis of carbohydrate maldigestion, methane-associated constipation, and evaluation of bloating/gas but not in the assessment of oro-cecal transit. A rise in hydrogen of ≥20 p.p.m. by 90 min during glucose or lactulose BT for SIBO was considered positive. Methane levels ≥10 p.p.m. was considered methane-positive. SIBO should be excluded prior to BT for carbohydrate malabsorption to avoid false positives. A rise in hydrogen of ≥20 p.p.m. from baseline during BT was considered positive for maldigestion.Conclusions:BT is a useful, inexpensive, simple and safe diagnostic test in the evaluation of common gastroenterology problems. These consensus statements should help to standardize the indications, preparation, performance and interpretation of BT in clinical practice and research.

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“…Two studies (using concurrent radioscintigraphy and breath H 2 and CH 4 measurements) have confirmed that abnormal rise in H 2 or CH 4 measured in the LHBT (based on >15 or 20 parts per million above baseline within 90 minutes of ingestion) can occur from variations in orocecal transit time in IBS patients, rather than SIBO. 46,47 In one study, 46 at the time of increase in H 2 , there was 5% accumulation of 99m Tc in the cecum (indicating the arrival of the leading edge of chyme in the colon) in 88% of cases. In the second study, 47 48% of breath tests in 139 patients were false-positives.…”

Section: Functional Gastrointestinal Disordersmentioning

confidence: 95%

“…46,47 In one study, 46 at the time of increase in H 2 , there was 5% accumulation of 99m Tc in the cecum (indicating the arrival of the leading edge of chyme in the colon) in 88% of cases. In the second study, 47 48% of breath tests in 139 patients were false-positives.…”

Section: Functional Gastrointestinal Disordersmentioning

confidence: 95%

Enhancing High Value Care in Gastroenterology Practice

Camilleri

Katzka

2016

Clinical Gastroenterology and Hepatology

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The objective of this review is to identify common areas in gastroenterology practice where studies performed provide an opportunity for enhancing value or lowering costs. We provide examples of topics in gastroenterology where we could enhance value by either using less invasive testing, choosing a single best test, or by using patient symptoms to guide additional testing. The topics selected for review are selected in esophageal, pancreatic and colorectal cancer, functional gastrointestinal diseases (irritable bowel syndrome, bacterial overgrowth, constipation), immune-mediated gastrointestinal diseases, and pancreatico-biliary pathology, and we propose guidance to alter practice based on current evidence. These studies support the need to review current practice and to continue performing research to further validate the proposed guidance in order to enhance value of care in gastroenterology and hepatology.

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Scintigraphy Demonstrates High Rate of False-positive Results From Glucose Breath Tests for Small Bowel Bacterial Overgrowth

Cited by 77 publications

References 19 publications

Small intestinal bacterial overgrowth and celiac disease: A systematic review with pooled‐data analysis

Small intestinal bacterial overgrowth and celiac disease: A systematic review with pooled‐data analysis

Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus

Enhancing High Value Care in Gastroenterology Practice

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