Breath Tests for the Non-invasive Diagnosis of Small Intestinal Bacterial Overgrowth: A Systematic Review With Meta-analysis

Abstract

Background/Aims Small intestinal bacterial overgrowth (SIBO) diagnosis is usually based on non-invasive breath tests (BTs), namely lactulose BT (LBT) and glucose BT (GBT). However, divergent opinions and problems of parameter standardization are still controversial aspects. We aim to perform a meta-analysis to analyze diagnostic performance of LBT/GBT for SIBO diagnosis. Methods We searched in main literature databases articles in which SIBO diagnosis was achieved by LBT/GBT in comparison to jejunal aspirate culture (reference gold standard). We calculated pooled sensitivity, specificity, positive, and negative likelihood ratios and diagnostic odd ratios. Summary receiver operating characteristic curves were drawn and pooled areas under the curve were calculated. Results We selected 14 studies. Pooled sensitivity of LBT and GBT was 42.0% and 54.5%, respectively. Pooled specificity of LBT and GBT was 70.6% and 83.2%, respectively. When delta over baseline cutoff > 20 H 2 parts per million (ppm) was used, GBT sensitivity and specificity were 47.3% and 80.9%; when the cutoff was other than and lower than > 20 ppm, sensitivity and specificity were 61.7% and 86.0%. In patients with abdominal surgery history, pooled GBT sensitivity and specificity gave the impression of having a better performance (81.7% and 78.8%) compared to subjects without any SIBO predisposing condition (sensitivity = 40.6% and specificity = 84.0%). Conclusions GBT seems to work better than LBT. A cutoff of delta H2 expired other than and lower than > 20 ppm shows a slightly better result than > 20 ppm. BTs demonstrate the best effectiveness in patients with surgical reconstructions of gastrointestinal tract.

The effectiveness of rotating versus single course antibiotics for small intestinal bacterial overgrowth

“…However, GBT is a recommended method for SIBO diagnosis and treatment evaluation. 1 GBT is not only a non-invasive method for SIBO diagnosis but also a much more widespread method. Thus, our results are more closely aligned with clinical practice in SIBO therapeutic management.…”

“…A recent systematic review with a meta-analysis suggested that a GBT cut-off value with a delta of less than 20 ppm might be more relevant. 1 Besides, we chose to consider methane F I G U R E 5 Evolution of gastrointestinal quality of life index subscores (pain, bloating, diarrhea and constipation) according to treatment efficacy. Each symptom subscore ranges from 0 to 4.…”

“…1 SIBO is most likely to occur in people with gastrointestinal surgery, motility disorders (gastroparesis, systemic sclerosis), gastrointestinal disorders (Crohn's disease, celiac disease, chronic pancreatitis, irritable bowel syndrome (IBS) and possibly functional dyspepsia (FD)), obesity, immunosuppressive diseases (diabetes mellitus, cirrhosis, renal failure), and prolonged use of proton pump inhibitors (PPIs) or antibiotics. [1][2][3][4] Jejunal aspiration culture (with a bacterial colony count of at least 10 5 colony-forming units/mL) is considered as the gold standard for the diagnosis of SIBO but is an invasive method. 5 Recently, a threshold of 10 3 colony-forming units/mL has been considered for the diagnosis of low-grade SIBO.…”

Serotonin Pathway of Tryptophan Metabolism in Small Intestinal Bacterial Overgrowth—A Pilot Study with Patients Diagnosed with Lactulose Hydrogen Breath Test and Treated with Rifaximin

“…In this study, we employed lactulose breath test, which recently was reported to have lower susceptibility, specificity and worse general performance as compared with its glucose counterpart on the basis of a meta-analysis [ 19 ]. However, lactulose test seems to be more reliable when intestinal motility is impaired [ 17 , 20 ].…”

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

“…(2020 г.) показано, что чувствительность и специфичность ДВТ с лактулозой составляют 42,0 и 70,6%, а ДВТ с глюкозой -54,5 и 83,2% [28]. В свою очередь в метаанализе T. Su и соавт.…”