A Combined Nutrient and Lactulose Challenge Test Allows Symptom-Based Clustering of Patients With Irritable Bowel Syndrome

Nevé, Boris Le; Posserud, Iris; Böhn, Lena; Guyonnet, Denis; Rondeau, Pascale; Tillisch, Kirsten; Naliboff, Bruce D.; Mayer, Emeran A.; Simrén, Magnus

doi:10.1038/ajg.2013.75

Cited by 36 publications

(34 citation statements)

References 51 publications

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“…A combined nutrient and lactulose challenge test was performed as a non-invasive assessment of visceral sensitivity in the patients. 53 The amount of exhaled H 2 and CH 4 were measured at baseline and every 15 minutes for 240 minutes after ingestion of the liquid meal (Breath Tracker model DP Digital MicroLyzer™ by Quintron with Flowrate 120 mL/min in Quintron 400 mL Gas sampler bags), and eight GI symptoms (gas, rumbling, pain, bloating, distension, discomfort, nausea, and urgency) and digestive comfort were rated at the same time points. The area under the curve (AUC) for the 4 hour measurement was calculated for the exhaled gases and the symptoms, including digestive comfort.…”

Section: Lactulose Challenge Testmentioning

confidence: 99%

Anxiety and depression in irritable bowel syndrome: Exploring the interaction with other symptoms and pathophysiology using multivariate analyses

Midenfjord

Polster

Sjövall

et al. 2019

Neurogastroenterology Motil

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Background Anxiety or depression, in other words, psychological distress, are common comorbidities in patients with irritable bowel syndrome (IBS), but their interaction with pathophysiological factors and other symptoms are unclear. Methods Patients with IBS (Rome III criteria), thoroughly characterized regarding pathophysiology (colonic transit time, visceral sensitivity, and autonomic nervous system [ANS] function), symptom profile (IBS severity, somatic symptoms, gastrointestinal [GI]‐specific anxiety and fatigue), and quality of life, were explored for differences regarding pathophysiology and symptoms between patients with and without reported psychological distress in univariate and multivariate analyses (Principal Component Analysis [PCA] with Hotelling's T2 and Orthogonal Partial Least Squares‐Discriminant Analysis [OPLS‐DA]). Key Results When using Hospital Anxiety and Depression Scale score ≥8 as cut‐off score, including both borderline and clinically significant cases, 345 (44.9%) out of 769 IBS patients reported anxiety, and 198 (25.7%) depression. In univariate analyses, patients reporting psychological distress demonstrated more severe GI and non‐GI symptoms, fatigue, GI‐specific anxiety and lower quality of life, and differences for some pathophysiological measures. IBS patients with and without reported psychological distress showed significant differences between the multivariate means in symptom reporting (PCA; both P < 0.001), and in pathophysiological measures in patients with and without anxiety (P = 0.018). Visceral hypersensitivity, altered ANS function, more severe GI‐specific anxiety, fatigue, and higher somatic non‐GI symptoms were the factors that most strongly separated patients with and without psychological distress (OPLS‐DA). Conclusions and Inferences Reported anxiety and depression are common in IBS patients, and our study demonstrates that they are interwoven in the complex pathophysiological and clinical picture of IBS.

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Section: Lactulose Challenge Testmentioning

confidence: 99%

Anxiety and depression in irritable bowel syndrome: Exploring the interaction with other symptoms and pathophysiology using multivariate analyses

Midenfjord

Polster

Sjövall

et al. 2019

Neurogastroenterology Motil

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“…In contrast, the lactulose hydrogen breath test (LHBT) is non‐invasive, simple to perform, and sensitive to the presence of bacteria anywhere in the gastrointestinal tract. Moreover, similar to the lactose HBT in IBS patients with lactase deficiency, concurrent assessment of breath hydrogen and symptoms may provide direct evidence that lactulose fermentation is associated with patient reports of abdominal bloating, pain, or diarrhea in IBS patients …”

Section: Introductionmentioning

confidence: 99%

A study of the methodological and clinical validity of the combined lactulose hydrogen breath test with scintigraphic oro‐cecal transit test for diagnosing small intestinal bacterial overgrowth in IBS patients

Zhao

Zheng

Chu

et al. 2014

Neurogastroenterology Motil

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“…A lactulose challenge test to induce symptoms in patients with IBS has been developed by our laboratory (5) and was used as a tool in our previous study (6); other studies have used a modified test (7,8). Ingestion of a small dose of lactulose may elicit abdominal and systemic symptoms, including chills and fatigue.…”

Section: Introductionmentioning

confidence: 99%

Systemic symptoms in irritable bowel syndrome: An investigative study on the role of enterocyte disintegrity, endotoxemia and inflammation

Undseth

Berstad

Valeur

2016

Molecular Medicine Reports

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Irritable bowel syndrome (IBS) is often accompanied by extra-intestinal symptoms, including fatigue and musculoskeletal pain. The present study aimed to investigate whether these symptoms were associated with markers of enterocyte disintegrity, endotoxemia and inflammation. Patients with IBS were recruited consecutively from our outpatient clinic (n=94) and compared with a group of healthy controls (n=20). Habitual symptoms were assessed using the IBS Severity Scoring System, the Fatigue Impact Scale and Visual Analogue Scales for measuring musculoskeletal pain. A lactulose challenge test was performed to induce post-prandial symptoms, and blood samples were obtained prior to and 90 min following lactulose ingestion to determine levels of intestinal fatty acid binding protein (iFABP), lipopolysaccharide (LPS), the LPS co-receptor soluble cluster of differentiation (sCD) 14, monocyte chemoattractant protein-1 (MCP-1) and calprotectin. Habitual symptom scores were high among the included patients, and lactulose ingestion induced significantly more symptoms in the patient group compared with the healthy control group (P=0.0001). Serum levels of iFABP were reduced in IBS patients compared with healthy controls, prior to and following lactulose ingestion (P=0.0002 and P=0.0001, respectively). Following lactulose ingestion, iFABP levels decreased in IBS patients (P=0.0001) and in healthy controls (P=0.02). Fasting levels of LPS, sCD14, MCP-1 and calprotectin were not significantly different between IBS patients and healthy controls. However, following lactulose ingestion, LPS levels increased in healthy controls (P=0.03), whereas MCP-1 levels decreased in IBS patients (P=0.008). Intestinal and extra-intestinal symptom severities were not correlated with levels of circulating biomarkers. No assessed biomarker in the present study appeared to be associated with symptom development in IBS patients. However, the implications of the low levels of iFABP observed require further investigation.

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A Combined Nutrient and Lactulose Challenge Test Allows Symptom-Based Clustering of Patients With Irritable Bowel Syndrome

Abstract: The lactulose challenge test seems to be a promising tool to assess visceral sensitivity in IBS, and to subgroup IBS patients based on their symptom pattern.

Cited by 36 publications

References 51 publications

Anxiety and depression in irritable bowel syndrome: Exploring the interaction with other symptoms and pathophysiology using multivariate analyses

Anxiety and depression in irritable bowel syndrome: Exploring the interaction with other symptoms and pathophysiology using multivariate analyses

A study of the methodological and clinical validity of the combined lactulose hydrogen breath test with scintigraphic oro‐cecal transit test for diagnosing small intestinal bacterial overgrowth in IBS patients

Systemic symptoms in irritable bowel syndrome: An investigative study on the role of enterocyte disintegrity, endotoxemia and inflammation

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