T1029 Lack of Utility of Lactulose Breath Testing in the Irritable Bowel Syndrome (IBS)

Sandhu, Davinder K.; Talley, Nicholas J.; Locke, G. Richard; Zinsmeister, Alan R.; Sandberg, Rodney J.; Saito, Yuri

doi:10.1016/s0016-5085(09)62229-0

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“…In contrast to these various studies, Law and Pimentel reported that PPI therapy did not predict LHBT results in IBS patients, 80 and others have found a positive, yet nonsignificant relationship between PPI exposure and SIBO. 9,81,82 Many other confounders could undermine the link between SIBO and IBS. For example, some patients with IBS demonstrate low-grade mucosal inflammation.…”

Section: Is There a Lack Of Confounding Between Sibo And Ibs?mentioning

confidence: 99%

Questioning the Bacterial Overgrowth Hypothesis of Irritable Bowel Syndrome: An Epidemiologic and Evolutionary Perspective

Spiegel

2011

Clinical Gastroenterology and Hepatology

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Although studies indicate that small intestinal bacterial overgrowth (SIBO) is prevalent in irritable bowel syndrome (IBS), it remains unclear whether SIBO causes IBS. This review presents an epidemiologic and evolutionary inquiry that questions the bacterial overgrowth hypothesis of IBS, as follows. (1) Although the hypothesis may be biologically plausible, there is also a strong rationale for competing hypotheses; it is unlikely that SIBO is the predominant cause of IBS in all comers, because competing explanations are sensible and defensible. Moreover, data indicate that the test used to promulgate the SIBO hypothesis - the lactulose hydrogen breath test - may not have measured SIBO in the first place. (2) We do not have evidence of SIBO being absent before IBS symptoms, and present after IBS emerges. (3) There is not a dose-response relationship between small intestinal microbiota and IBS symptoms. (4) The relationship between SIBO and IBS is highly inconsistent among studies. (5) Many effective IBS therapies do not address SIBO at all, yet have a more favorable "number needed to treat" than antibiotics. (6) IBS does not behave like a traditional infectious disease, suggesting that microbes may not principally cause the syndrome. (7) Other factors may confound the relationship between SIBO and IBS, including proton pump inhibitors. (8) Whereas the brain-gut hypothesis is evolutionary sensible, the bacterial hypothesis is harder to defend from an evolutionary perspective. The article concludes that bacteria may contribute to some IBS symptoms, but that bacteria cannot be the only explanation, and a causal link between SIBO and IBS is not secure.

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Section: Is There a Lack Of Confounding Between Sibo And Ibs?mentioning

confidence: 99%

Questioning the Bacterial Overgrowth Hypothesis of Irritable Bowel Syndrome: An Epidemiologic and Evolutionary Perspective

Spiegel

2011

Clinical Gastroenterology and Hepatology

View full text Add to dashboard Cite

show abstract

T1029 Lack of Utility of Lactulose Breath Testing in the Irritable Bowel Syndrome (IBS)

Cited by 1 publication

References 0 publications

Questioning the Bacterial Overgrowth Hypothesis of Irritable Bowel Syndrome: An Epidemiologic and Evolutionary Perspective

Questioning the Bacterial Overgrowth Hypothesis of Irritable Bowel Syndrome: An Epidemiologic and Evolutionary Perspective

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