Interpreting the Lactulose Breath Test for the Diagnosis of Small Intestinal Bacterial Overgrowth

Sunny, Joseph; García, César Pascual; McCallum, Richard W.

doi:10.1016/j.amjms.2015.12.008

Cited by 10 publications

(5 citation statements)

References 14 publications

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“…Due to abdominal pain, bloating, diarrhea or constipation all patients initially underwent the lactulose hydrogen breath test (LHBT), using a breath hydrogen analyzer (Gastrolyzer, Bedfont Scientific Ltd, UK). The test result was considered positive (confirming SIBO) when an increase in the concentration of hydrogen in the expired air was above 20 ppm (percent per million) within 60 min of ingesting 25 ml of lactulose in accordance with generally accepted criteria [ 23 ]. Then, in LHBT-positive patients a breath test was performed using 75 mg of 13 C-labeled urea and a FAN-ci 2 device set (Fisher ANalysen Instrumente GmbH).…”

Section: Methodsmentioning

confidence: 99%

Therapeutic efficacy of amoxicillin and rifaximin in patients with small intestinal bacterial overgrowth and Helicobacter pylori infection

Konrad

Chojnacki

Gąsiorowska

et al. 2018

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IntroductionSmall intestinal bacterial overgrowth (SIBO) may coexist with Helicobacter pylori infection, which can be the cause of chronic gastrointestinal complaints.AimEvaluation of the therapeutic efficacy of amoxicillin and rifaximin in the treatment of these diseases.Material and methodsThe lactulose hydrogen breath test (LHBT) and the urea breath test (13C-UBT) were performed in 116 patients. In 62 patients the coexistence of small intestinal bacterial overgrowth and H. pylori infection was observed. Then, in group I (n = 30) pantoprazole (2 × 40 mg), amoxicillin (2 × 1000 mg) and metronidazole (2 × 500 mg) and in group II (n = 32) pantoprazole and amoxicillin at the above doses and rifaximin (3 × 400 mg) were administered for 10 days. After 6 weeks, both breath tests were repeated and the degree of remission of symptoms was measured using a 10-point visual analog scale (VAS).ResultsAfter the treatment the LHBT index decreased in group I from 61.2 ±19.4 ppm to 22.0 ±8.2 ppm (p < 0.001) and in group II from 59.6 ±15.5 ppm to 15.2 ±8.6 ppm (p < 0.001). Eradication of H. pylori (13C-UBT below 4.0‰) was achieved in 63.3% of patients in group I and 59.4% in group II (p > 0.05). The decrease of pain below 3.0 points in the VAS was obtained in 64.8% of patients in group I and in 56.2% in group II.ConclusionsCombination of amoxicillin and rifaximin may be effective in the treatment of patients with small intestinal bacterial overgrowth syndrome and concomitant H. pylori infection.

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Section: Methodsmentioning

confidence: 99%

Therapeutic efficacy of amoxicillin and rifaximin in patients with small intestinal bacterial overgrowth and Helicobacter pylori infection

Konrad

Chojnacki

Gąsiorowska

et al. 2018

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“…While a range of criteria exists for time of determination, including 90-120 minutes 15 , the recommendation of a cut-off of 60-80 min by Sunny et al 16 and 60 min by Eisenmann et al 3 may improve specificity of the lactulose challenge. Current guidelines 8,15 state a peak that occurs before 90 min (assuming normal bowel transit time) is suggestive of a bacterial overgrowth in the small intestine.…”

Section: Discussionmentioning

confidence: 99%

“…Current guidelines 8,15 state a peak that occurs before 90 min (assuming normal bowel transit time) is suggestive of a bacterial overgrowth in the small intestine. The requirement of a further increase of at least 15 ppm hydrogen gas within 180 min as confirmation of colonic fermentation of lactulose has also been specified 16 but this is not widely reported. Rapid oro-cecal transit has been demonstrated after test substrate ingestion 31,32 , yet slower small bowel transit has been demonstrated in the presence of methane 33 -a gas of particular interest in our findings.…”

Section: Discussionmentioning

confidence: 99%

Hydrogen–methane breath testing results influenced by oral hygiene

Erdrich

Tan

Hawrelak

et al. 2021

Sci Rep

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The measurement of hydrogen–methane breath gases is widely used in gastroenterology to evaluate malabsorption syndromes and bacterial overgrowth. Laboratories offering breath testing provide variable guidance regarding oral hygiene practices prior to testing. Given that oral dysbiosis has the potential to cause changes in breath gases, it raises concerns that oral hygiene is not a standard inclusion in current breath testing guidelines. The aim of this study was to determine how a pre-test mouthwash may impact hydrogen–methane breath test results. Participants presenting for breath testing who had elevated baseline gases were given a chlorhexidine mouthwash. If a substantial reduction in expired hydrogen or methane occurred after the mouthwash, breath samples were collected before and after a mouthwash at all breath sample collection points for the duration of testing. Data were evaluated to determine how the mouthwash might influence test results and diagnostic status. In 388 consecutive hydrogen–methane breath tests, modifiable elevations occurred in 24.7%. Administration of a chlorhexidine mouthwash resulted in significantly (p ≤ 0.05) reduced breath hydrogen in 67% and/or methane gas in 93% of those consenting to inclusion. In some cases, this modified the diagnosis. Mean total gas concentrations pre- and post-mouthwash were 221.0 ppm and 152.1 ppm (p < 0.0001) for hydrogen, and 368.9 ppm and 249.8 ppm (p < 0.0001) for methane. Data suggest that a single mouthwash at baseline has a high probability of returning a false positive diagnosis. Variations in gas production due to oral hygiene practices has significant impacts on test interpretation and the subsequent diagnosis. The role of oral dysbiosis in causing gastrointestinal symptoms also demands exploration as it may be an underlying factor in the presenting condition that was the basis for the referral.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hydrogen–methane breath testing results influenced by oral hygiene

Erdrich

Hawrelak

Myers

et al. 2021

Clinical Nutrition ESPEN

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The measurement of hydrogen-methane breath gases is widely used in gastroenterology to evaluate malabsorption syndromes and bacterial overgrowth. Laboratories offering breath testing provide variable guidance regarding oral hygiene practices prior to testing. Given that oral dysbiosis has the potential to cause changes in breath gases, it raises concerns that oral hygiene is not a standard inclusion in current breath testing guidelines. The aim of this study was to determine how a pre-test mouthwash may impact hydrogen-methane breath test results. Participants presenting for breath testing who had elevated baseline gases were given a chlorhexidine mouthwash. If a substantial reduction in expired hydrogen or methane occurred after the mouthwash, breath samples were collected before and after a mouthwash at all breath sample collection points for the duration of testing. Data were evaluated to determine how the mouthwash might influence test results and diagnostic status. In 388 consecutive hydrogen-methane breath tests, modifiable elevations occurred in 24.7%. Administration of a chlorhexidine mouthwash resulted in significantly (p ≤ 0.05) reduced breath hydrogen in 67% and/or methane gas in 93% of those consenting to inclusion. In some cases, this modified the diagnosis. Mean total gas concentrations pre-and post-mouthwash were 221.0 ppm and 152.1 ppm (p < 0.0001) for hydrogen, and 368.9 ppm and 249.8 ppm (p < 0.0001) for methane. Data suggest that a single mouthwash at baseline has a high probability of returning a false positive diagnosis. Variations in gas production due to oral hygiene practices has significant impacts on test interpretation and the subsequent diagnosis. The role of oral dysbiosis in causing gastrointestinal symptoms also demands exploration as it may be an underlying factor in the presenting condition that was the basis for the referral.Hydrogen-methane breath testing is a widely used diagnostic tool, based on the science that these gases are byproducts of saccharide fermentation by gut microorganisms, rather than human metabolism.Glucose, lactose, and fructose are normally absorbed in the small intestine. Increased gas production following their ingestion is associated with malabsorption or premature fermentation due to excessive bacteria in the small intestine. Hydrogen and methane gas are absorbed from the gastrointestinal tract, exhaled via the lungs and are thus measurable in breath. Increased gas production following ingestion of fructose or lactose are used to detect malabsorption of carbohydrates. Similarly, increases in expired breath gases in response to ingestion of non-digestible lactulose, or glucose are used to predict small intestinal bacterial overgrowth (SIBO) [1][2][3][4] .In-depth discussion on the methodology and interpretation of breath testing was published in 2009 5 and a shorter summary in 2011 6 . The concept that expired breath gases may be influenced by the oral microbiome is not yet an integrated component of breath testing guidelines, even though oral dysbiosis h...

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Interpreting the Lactulose Breath Test for the Diagnosis of Small Intestinal Bacterial Overgrowth

Cited by 10 publications

References 14 publications

Therapeutic efficacy of amoxicillin and rifaximin in patients with small intestinal bacterial overgrowth and Helicobacter pylori infection

Therapeutic efficacy of amoxicillin and rifaximin in patients with small intestinal bacterial overgrowth and Helicobacter pylori infection

Hydrogen–methane breath testing results influenced by oral hygiene

Hydrogen–methane breath testing results influenced by oral hygiene

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