Lactulose Breath Test to Assess Oro-cecal Transit Delay and Estimate Esophageal Dysmotility in Scleroderma Patients

Gemignani, Lorenzo; Savarino, Vincenzo; Ghio, Massimo; Parodi, A. Ferretto; Zentilin, Patrizia; Bortoli, Nicola de; Negrini, Simone; Furnari, Manuele; Dulbecco, Pietro; Giambruno, Elisa; Savarino, Edoardo

doi:10.1016/j.semarthrit.2012.09.004

Cited by 31 publications

(28 citation statements)

References 26 publications

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“…The study analysis showed the presence of SIBO in around 39% (18–55%) patients suffering from SSc [10, 12, 18, 19, 21, 23, 24]. …”

Section: Resultsmentioning

confidence: 99%

“…Among the SSc patients the most characteristic clinical pattern included symptoms such as diarrhea, constipation, flatulence, abdominal pain, abdominal tenderness, nausea, vomiting, dysuria, tenesmus, dysphagia, reflux, weight loss and early satiety (Table 4) [10, 12, 18, 21, 24]. …”

Section: Resultsmentioning

confidence: 99%

“…After further investigation, we selected retrospective and prospective clinical studies, cohort studies as well as one-case series study receiving seven results. The studies included in the review are presented in Table 2 [8, 10, 12, 19, 21, 23, 24]. …”

Section: Methodsmentioning

confidence: 99%

“…The results processed by gas chromatography are expressed in ppm (parts per million) [14, 22, 24]. The definite result criteria for both GHBT and LHBT have not been adequately validated yet [10, 12, 18, 19, 21, 23, 24]. Hydrogen breathing tests were the most commonly used diagnostic tools in SSc patients in the performed systematic review (Table 2).…”

Section: Diagnosticsmentioning

confidence: 99%

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Small intestinal bacterial overgrowth in systemic sclerosis: a review of the literature

et al. 2018

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Systemic sclerosis (SSc) is a chronic, connective tissue disease with an autoimmune pattern characterized by inflammation, fibrosis and microcirculation changes leading to internal organs malfunctions. Recently, the presence of uncharacteristic gastrointestinal symptoms in the course of SSc has been underlined. The possible cause of such clinical presentation is the small intestinal bacterial overgrowth (SIBO). Nevertheless, these manifestations resulting from gastrointestinal tract hypomotility may occur in numerous disease entities. The systematic review of the literature was performed on MEDLINE database using the relevant MeSH terms including all sub-headings. After further investigation, the initial number of 56 records was limited to 7 results. The study analysis showed an increased presence of SIBO in 39% of patients suffering from SSc. The average SSc duration was longer in SSc patients with coexisting SIBO. SIBO remains a diagnostic and therapeutic challenge and therefore is a significant clinical problem among patients suffering from SSc.

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“…The study analysis showed the presence of SIBO in around 39% (18–55%) patients suffering from SSc [10, 12, 18, 19, 21, 23, 24]. …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Diagnosticsmentioning

confidence: 99%

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Small intestinal bacterial overgrowth in systemic sclerosis: a review of the literature

et al. 2018

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“…LHBT is a simple, non-invasive and widely-used test that provides indirect measurement of OCTT based on the time from lactulose ingestion to metabolism by colonic microbiota and an increase in breath H 2 E; however, it can be confounded by the presence of SIBO and H 2 non-producers (i.e., colonic microbiota that does not produce H 2 ) (10,11,22,23,27).…”

Section: Discussionmentioning

confidence: 99%

Measurement of oro-caecal transit time by magnetic resonance imaging

Savarino¹,

Savarino

Fox

et al. 2015

Eur Radiol

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OBJECTIVES To assess prospectively the agreement of orocaecal transit time (OCTT) measurements by lactulose hydrogen breath test (LHBT) and magnetic resonance imaging (MRI) in healthy subjects. METHODS Volunteers underwent abdominal 1.5-T MRI using axial and coronal single-shot fast-spin-echo T2-weighted sequences, having fasted and after lactulose ingestion (10 g/125 mL). Imaging and H2 excretion gas-chromatography were performed concurrently every 15 min up to 180 min. MR images were analyzed using semiautomatic segmentation to calculate small bowel gas volume (SBGV) and visually to detect bolus arrival in the caecum. Agreement between MRI-and LHBT-OCTT was assessed. RESULTS Twenty-eight subjects (17 men/11 women; mean age ± standard deviation 30 ± 8 years) were evaluated. Two H2 non-producers on LHBT were excluded. OCTT measured by MRI and LHBT was concordant in 18/26 (69 %) subjects (excellent agreement, k = 0.924). Median SBGV was 49.0 mL (interquartile interval 44.1 -51.6 mL). In 8/26 (31 %) subjects, MRI showed that the lactulose bolus was in the terminal ileum and not the caecum when H2E increased on LHBT. Median OCTT measured by MRI was significantly longer than OCTT measured by LHBT [135 min (120 -150 min) vs. 127.5 min (105 -150 min); p = 0.008]. Above baseline levels, correlation between [H2] and SBGV was significant (r = 0.964; p < 0.001). CONCLUSIONS MRI provides valid measurements of OCTT and gas production in the small bowel. KEY POINTS • MRI is a valid technique to measure OCTT. • Excellent agreement between MRI and LHBT was found. • Measuring gas production using MRI may provide evidence of small bowel fermentation. Methods: Volunteers underwent abdominal 1.5-T MRI using axial and coronal single-shot fast-spin-echo T2-weighted sequences in the fasted condition and after lactulose ingestion (10g/125mL). Imaging and H 2 excretion gas-cromatography were performed concurrently every 15 minutes up to 180 minutes. MR images were analyzed using semiautomatic segmentation to calculate small bowel gas volume (SBGV) and visually to detect bolus arrival in the cecum.Agreement between MRI-and LHBT-OCTT was assessed.Results: Twenty-eight subjects (17 males/11 females;mean age±standard deviation 30±8 years) were evaluated. Two H 2 non-producers on LHBT were excluded. OCTT measured by MRI and LHBT was concordant in 18/26 (69%) subjects (excellent agreement,k=0.924). Median SBGV was 49.0 mL (interquartile interval 44.1-51.6 mL). In 8/26 (31%) subjects, MRI showed the lactulose bolus was in the terminal ileum and not the cecum when H 2 E increased on LHBT. Thus, median OCTT measured by MRI was significantly longer than that measured by min)vs.127.5(105-150min);p=0.008]. Above baseline levels, correlation between [H 2 ] and SBGV was significant (r=0.964;p<0.001).Conclusions: MRI provides valid measurements of OCTT and gas production in the small bowel. Keypoints: MRI is a valid technique to measure OCTT.  Excellent agreement between MRI and LHBT was found. Measuring gas production using MRI may pro...

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The role of small intestinal bacterial overgrowth in cystic fibrosis: a randomized case-controlled clinical trial with rifaximin

et al. 2018

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Lactulose Breath Test to Assess Oro-cecal Transit Delay and Estimate Esophageal Dysmotility in Scleroderma Patients

Cited by 31 publications

References 26 publications

Small intestinal bacterial overgrowth in systemic sclerosis: a review of the literature

Small intestinal bacterial overgrowth in systemic sclerosis: a review of the literature

Measurement of oro-caecal transit time by magnetic resonance imaging

The role of small intestinal bacterial overgrowth in cystic fibrosis: a randomized case-controlled clinical trial with rifaximin

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