Usefulness of the hydrogen breath test in patients with functional dyspepsia

Abstract

Introduction: The pathogenesis of functional dyspepsia is complex and not well understood. Therefore, in this disease there should be considered involvement of different pathogenic factors, including intestinal bacteria.Aim: To evaluate the results of the hydrogen breath test in relation to the clinical picture of functional dyspepsia.Material and methods: The study included 40 healthy subjects (group I), 72 patients with postprandial distress syndrome (PDS, group II), and 84 patients with epigastric pain syndrome (EPS, group III). The diagnosis of functional dyspepsia was based on Rome Criteria IV. The urea breath test (13C-UBT) and lactulose hydrogen breath test (LHBT) were performed in all subjects. Patients with a positive urea breath test were excluded from the study. Patients with a positive LHBT test were assigned to antibiotic therapy (1200 mg daily for 14 days). Before treatment and 6 weeks after the end of antibiotic therapy the LHBT was performed, and severity of dyspeptic symptoms was assessed using a 10-points visual analogue scale.Results: A positive LHBT test was found in 35 (48.6%) patients in the group with PDS, and in 40 (47.6%) patients with EPS (p > 0.05). A positive correlation between the results of the LHBT test and severity of dyspeptic symptoms was found in both group (p < 0.001). After treatment with rifaximin the mean LHBT result and the index of severity of dyspeptic complaints were significantly decreased (p < 0.001).Conclusions: Quantitative and/or qualitative changes in the gut microbiota may be the cause of functional dyspepsia.

Helicobacter pylori infection and small intestinal bacterial overgrowth–more than what meets the eye

“…The symptoms of SIBO and H. pylori infection are largely due to malabsorption of nutrients, inflammation and immune activation as a result of a high bacterial load and its byproducts. Although no single symptom is attributed to all cases of bacterial overgrowth, dyspepsia appears to be the most commonly reported in both SIBO[ 23 ] and H. pylori infection[ 3 ]. In up to two-thirds of patients with SIBO, symptoms include flatulence, bloating, abdominal cramping and diarrhea.…”

“…Confirmation of H. pylori infection can be performed directly on biopsy specimens collected during endoscopy, by stool antigen test or by urea breath test. PPI therapy can impair the accuracy of these tests and should be discontinued prior to testing[ 23 ]. Stool antigen testing, however, maintains a high level of sensitivity 94% (95%CI: 93-95) and specificity 97% (95%CI: 96-98) regardless of PPI use[ 25 ].…”

Prevalence of small bowel bacterial overgrowth in patients with functional dyspepsia: a meta-analysis

“…Вероятность наличия значимого публикационного смещения оценивалась при помощи построения воронкообразной диаграммы рассеяния, а также расчета корреляционного теста Бегга-Мазумдара и теста регрессии Эггера. Характеристика включенных исследований В итоговый анализ включено 7 исследований с участием 1248 пациентов с ФД, выполненных в Бразилии [18], Японии [19], Индии [20], Германии [21], США [22], Гватемале [23] и Польше [24]. В 3 исследованиях в качестве метода определения СИБР применялся ДВТ с лактулозой [18,23,24], в других 3 работах -ДВТ с глюкозой [19,20,22] [25,26].…”

“…Характеристика включенных исследований В итоговый анализ включено 7 исследований с участием 1248 пациентов с ФД, выполненных в Бразилии [18], Японии [19], Индии [20], Германии [21], США [22], Гватемале [23] и Польше [24]. В 3 исследованиях в качестве метода определения СИБР применялся ДВТ с лактулозой [18,23,24], в других 3 работах -ДВТ с глюкозой [19,20,22] [25,26]. Согласно последней работе, систематизирующей эпидемиологические данные о ФД в разных регионах мира, показано, что распространенность заболевания в западной популяции составляет 9,8-20,2%, а в восточной -5,3-12,8% [27].…”

“…В проведенных к настоящему времени исследованиях частота СИБР у пациентов с ФД варьирует в широком диапазоне -от 7,1 до 56,5% [18][19][20][21][22][23][24]. Настоящий метаанализ, объединивший результаты 7 исследований, продемонстрировал, что обобщенная частота СИБР у пациентов с ФД составила 34,73% (95% ДИ 24,807-45,383).…”