Background and Aim
Functional dyspepsia (FD) is a common disorder of gut–brain interaction with incompletely understood pathophysiology. Consequently, heterogeneous expert opinions on diagnostic tests and assessment of treatment efficacies exist. So far, no consensus about the most relevant diagnostic and outcome tool has been reached. In this study, we aimed to analyze the significance of a combined lactulose hydrogen breath test (LHBT) and liquid meal, yet representing a standardized test in irritable bowel syndrome (IBS), in FD.
Methods
We analyzed data of 146 FD, 204 IBS patients, and 50 healthy volunteers (HV). All patients underwent LHBT with a meal‐drink consisting of 30‐g Lactulose and 400‐mL Ensure®. Effect of abdominal symptom generation in FD/IBS compared with HV was assessed on a patient‐reported Likert‐scale.
Results
There was a significant difference between FD/IBS patients and HV in LHBT‐induced abdominal pain (odds ratio [OR] 246.9, 95% confidence interval [CI] 26.6–2290.7; OR 161.2, 95% CI 16.9–1534.8), abdominal bloating (OR 384.8, 95% CI 92.9–2135.4; OR 524.1, 95% CI 114.7–3432.3), borborygmi (OR 9.9, 95% CI 2.2–46.9; OR 17.7, 95% CI 4.7–67.4), nausea only in FD (OR 174.4, 95% CI 15.5–5375.5), and diarrhea in IBS only (OR 25.8, 95% CI 2.0–7012.6). Hydrogen production was not significantly different in FD/IBS and HV.
Conclusions
In this study, we demonstrated significant differences in postprandial symptom generation in FD and IBS compared with HV after LHBT. This does not only allow us to discriminate FD/IBS from HV but may also represent a diagnostic and monitoring tool for FD/IBS in the future, including monitoring of treatment effects.
The prevalence of JH was significantly higher in IBS-C compared to IBS-D. Abnormalities in the connective tissue biomechanics in those with JH may contribute to a degree of colonic inertia which could result in constipation in JH-positive IBS patients. Further work is needed to determine the colonic biomechanics in patients with JH.
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