SUMMARY BackgroundThe majority of deleterious health consequences of coeliac disease (CD) are most likely to be secondary to intestinal inflammation; hence, mucosal recovery is a desirable goal of therapy. Follow-up in CD is controversial and serological response is often used as a surrogate for histological recovery.

comorbidities, haemoglobin levels, vitamin B 12 , folate, ferritin and albumin levels. A positive result was a rise in hydrogen of at least 20 ppm, or methane of 12 ppm, over the baseline for each gas. Results 447 patients were identified (120 male, median age 56 years, range 17e90). Overall 84/447 (18.8%) of tests were positive. The patient characteristics associated with a positive result were concurrent use of proton pump inhibitor (PPI) (p¼0.0005), previous partial gastrectomy (p<0.0001), previous right hemicolectomy (p¼0.0004), and age over 75 tears p<0.0001. The laboratory investigations predictive of a positive result were low vitamin B 12 (p¼0.02) and low albumin <30 g/dl (p¼0.03). Conclusion This is the largest single centre study of factors predictive of SIBO as defined by positive GHBT. Use of proton pump inhibitor, partial gastrectomy, right hemicolectomy, age over 75 years, low vitamin B 12 and low albumin were predictive of SIBO.

million (ppm) using a QuinTron BreathTracker DP at baseline, thendafter 75 g oral glucosedat 20 min time points up to 3 h or until positive. Positive test: fasting H 2 $20 or CH 4 $10 ppm or a rise in H 2 $12 or CH 4 $6 ppm. Some patients also had duodenal aspirates collected endoscopically. Positive result: >10 4 colony forming units/ml. Patients with positive tests were treated with antibiotics. Results were assessed retrospectively. Results 126 patients, 66 males and 60 females, median group age 61 years (range 35e86), treated for gynaecological (30%), upper GI (25%), lower GI (9%), urological (28%), other cancers (10%d myeloma, ependymoma, bronchial, breast and lymphoma) were referred. Daily troublesome GI symptoms included flatulence (85%), borborygmi (63%), belching (54%), bloating (52%), abdominal pain (50%), steatorrhoea (38%), nausea/vomiting (23%) and diarrhoea (19%). 60 (48%) had a positive breath testd5% H2, 10% CH4 and 33% both gases. 21 (17%) of 86 patients with D2 aspirates tested positive for Streptococcus (n¼6), E. Coli (3), Candida (3), Klebsiella (2), Enterococcus (2), Pseudomonas (2), Neisseria (1), Aeromonas (1) and Stenotrophomonas (1). 17 (33%) had negative breath tests. Six of these had positive D2 aspirates with 3 (50%) responsive to antibiotics, 11 had negative aspirates but a 73% antibiotic response rate. 24 (46%) tested positive for both gases. 33% of these had a positive D2 aspirate with a 75% response rate to antibiotics and 67% negative aspirates but 81% response. Six patients (12%) were positive only for H2 (all had negative aspirates), 1 responded to antibiotics. 5 (10%) tested positive for CH4 only, of which 1 had a positive D2 aspirate with a response to antibiotics and 4 (80%) had negative aspirate but 2 responded. Conclusion Methane breath testing identifies 10% more patients with SIBO compared to the glucose hydrogen breath test alone. D2 aspirate increases the detection rate by 12%. A trial of antibiotics, with other tests negative, benefits 15% of patients. All current diagnostic methods are flawed. Better diagnostic tests for SIBO are required.

The mouth is an important organ as it is the entry point into the gastrointestinal (GI) tract and damage and disease can compromise dietary intake. Even very minor disorders can have a profound impact on nutritional status.

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