Lactulose Challenge Determines Visceral Sensitivity and Severity of Symptoms in Patients With Irritable Bowel Syndrome

Nevé, Boris Le; Brazeilles, Rémi; Derrien, Muriel; Tap, Julien; Guyonnet, Denis; Öhman, Lena; Törnblom, Hans; Simrén, Magnus

doi:10.1016/j.cgh.2015.09.039

Cited by 38 publications

(28 citation statements)

References 39 publications

(28 reference statements)

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“…Regarding the pathophysiological measures, the general pattern was less distinct when it comes to differences between patients with and without reported psychological distress. However, some of the measures in our study are indicating visceral hypersensitivity in patients with reported psychological distress, which is in line with previous studies . Visceral sensitivity measured with the lactulose challenge test was also one of the factors that contributed most to the separation between patients with and without reported psychological distress in this study.…”

Section: Discussioncontrasting

confidence: 93%

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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: Discussioncontrasting

confidence: 93%

“…The area under the curve (AUC) for the 4 hour measurement was calculated for the exhaled gases and the symptoms, including digestive comfort. For the purpose of this study, the AUCs of pain and digestive comfort were used as measures of visceral sensitivity, since these have been two of the most discriminative factors in previous publications …”

Section: Methodsmentioning

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

Self Cite

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“…The diagnostic utility of other nutrient challenges with or without other carbohydrates or different test carbohydrate doses in children with IBS needs to be determined. In addition, the mechanism by which nutrients combined with lactulose may affect GI symptoms and psychosocial distress remains to be elucidated as Le Neve et al did not identify a correlation with fecal microbiota composition (36). …”

Section: Discussionmentioning

confidence: 99%

Lactulose Breath Test Gas Production in Childhood IBS Is Associated With Intestinal Transit and Bowel Movement Frequency

Chumpitazi

Weidler

Shulman

2017

J. pediatr. gastroenterol. nutr.

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Background In adults with irritable bowel syndrome (IBS), bacterial gas production (colonic fermentation) is related to both symptom generation and intestinal transit. Whether gas production affects symptom generation, psychosocial distress, or intestinal transit in childhood IBS is unknown. Methods Children (ages 7-17 years) with pediatric Rome III IBS completed validated psychosocial questionnaires and a 2-week daily diary capturing pain and stooling characteristics. Stool form determined IBS subtype. Subjects then completed a 3-hour lactulose breath test for measurement of total breath hydrogen and methane production. Carmine red was used to determine whole intestinal transit time. Results 87 children (mean age 13 ± 2.6 (SD) years) were enrolled, of whom 50 (57.5%) were female. All children produced hydrogen and 51 (58.6%) produced methane. Hydrogen and methane production did not correlate with either abdominal pain frequency/severity or psychosocial distress. Hydrogen and methane production did not differ significantly by IBS subtype. Methane production correlated positively with whole intestinal transit time (r=0.31, P<0.005) and inversely with bowel movement frequency (r= −0.245, P<0.05). Methane production (threshold 3 ppm) as a marker for identifying IBS-C had a sensitivity of 60% and specificity of 42.9%. Conclusions Lactulose breath test total methane production may serve as a biomarker of whole intestinal transit time and bowel movement frequency in children with IBS. However, in children with IBS, lactulose breath test hydrogen and methane production did not correlate with either abdominal pain, IBS subtype, or psychosocial distress.

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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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Lactulose Challenge Determines Visceral Sensitivity and Severity of Symptoms in Patients With Irritable Bowel Syndrome

Cited by 38 publications

References 39 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

Lactulose Breath Test Gas Production in Childhood IBS Is Associated With Intestinal Transit and Bowel Movement Frequency

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

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