Small intestinal bacterial overgrowth: duodenal aspiration <i>vs</i> glucose breath test

Erdoğan, Aşkın; Rao, Satish S.C.; Gulley, D. D.; Jacobs, C.; Lee, Yeong Yeh; Badger, Collier

doi:10.1111/nmo.12516

Cited by 119 publications

(133 citation statements)

References 44 publications

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“…Our results show that approximately 20% of patients identified with SIBO only got their SIBO diagnosis by methane identification in the exhaled gas, which is consistent with the results found in the literature (6,16,20) . Thus, it is essential that the breath tests to diagnose SIBO be performed on devices capable of identifying the exhaled H 2 and CH 4 , in order to increase sensitivity and diagnostic accuracy.…”

Section: Discussionsupporting

confidence: 82%

“…The study from Erdogan et al also showed that the prevalence of bacterial overgrowth in patients with intestinal symptoms (diarrhea and flatulence, without changes in digestive endoscopy) was only 27.3% when using the H 2 and CH 4 test (6) . However, when the duodenal culture (gold standard for the diagnosis of SIBO) was also performed this prevalence increased to 44.6%.…”

Section: Discussionmentioning

confidence: 99%

“…There was a significant association between the affirmation of both gases (H 2 and CH 4 ) and gender (P-value 0.020), indicating that the proportion of female patients with positive results (100%) was significantly of carbohydrate fermentation (16) . According to numerous studies that identified CH 4 exhaled in breath tests, it is estimated that 30%-62% of healthy individuals excreting this Gas (6,22) . As about 15% of humans do not produce H 2 , devices capable of detecting both gases, greatly increase the sensitivity of the test, reducing false negative results.…”

Section: Discussionmentioning

confidence: 99%

“…Breath tests capable of identifying exhaled gases begin with acquiring the jejunal sample (baseline) for the measurement of H 2 and/or CH 4 in the exhaled air (6) . After determining the baseline value, which is generally less than 10 parts per million (ppm), the patient ingests the carbohydrate that will be tested on the recommended dose (20 grams of lactulose in 250 ml of water and 25 to 50 g glucose in 250 mg of water) (21) .…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Small Intestine Bacterial Overgrowth in Patients With Gastrointestinal Symptoms

Martins

Chaves

Castro

et al. 2017

Arq. Gastroenterol.

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-Background -Small intestine bacterial overgrowth is a heterogeneous syndrome characterized by an increase in the number and/or the presence of atypical microbiota in the small intestine. The symptoms of small intestine bacterial overgrowth are unspecific, encompassing abdominal pain/distension, diarrhea and flatulence. Due to the increased cost and complexity for carrying out the jejunal aspirate, the gold standard for diagnosis of the syndrome, routinely the hydrogen (H 2 ) breath test has been used, utilizing glucose or lactulose as substrate, which is able to determine, in the exhaled air, the H 2 concentration produced from the intestinal bacterial metabolism. However, due to a number of individuals presenting a methanogenic microbiota, which does not produce H 2 , the testing on devices capable of detecting, concurrently, the concentration of exhaled H 2 and methane (CH 4 ) is justified. Objective -This study aimed to determine the prevalence of small intestine bacterial overgrowth in patients with digestive symptoms, through a comparative analysis of breath tests of H 2 or H 2 and CH 4 associated, using glucose as substrate . Methods -A total of 200 patients of both sexes without age limitation were evaluated, being directed to a Breath Test Laboratory for performing the H 2 test (100 patients) and of exhaled H 2 and CH 4 (100 patients) due to gastrointestinal complaints, most of them patients with gastrointestinal functional disorders. Results -The results indicated a significant prevalence of small intestine bacterial overgrowth in the H 2 test and in the test of exhaled H 2 and CH 4 (56% and 64% respectively) in patients with gastrointestinal symptoms, and higher prevalence in females. It found further that methane gas was alone responsible for positivity in 18% of patients. Conclusion -The data found in this study is consistent with the findings of the current literature and underscores the need for using devices capable of capturing the two gases (exhaled H 2 and CH 4 ) to improve the sensitivity and hence the accuracy of small intestine bacterial overgrowth diagnosis in daily medical practice. HEADINGS -Bacterial growth. Small intestine. Breath tests. Hydrogen. Methane.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prevalence of Small Intestine Bacterial Overgrowth in Patients With Gastrointestinal Symptoms

Martins

Chaves

Castro

et al. 2017

Arq. Gastroenterol.

View full text Add to dashboard Cite

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“…While the gold standard for the diagnosis of SIBO is the culture of duodenal or jejunal aspirate, glucose H 2 /CH 4 breath test is commonly used to diagnose SIBO because it is a noninvasive test. In a recent study, Erdogan et al reported an overall agreement of 65.5% and a sensitivity of 42%, specificity of 84%, positive predictive value of 68% and negative predictive value of 64% when glucose H 2 /CH 4 breath test was compared to the duodenal aspirate and culture for the diagnosis of SIBO [41]. Other studies have shown a variable sensitivity of 20% to 93% and a specificity of 30% to 86% of glucose H 2 /CH 4 breath test [42].…”

Section: Discussionmentioning

confidence: 99%

Small Intestinal Bacterial Overgrowth Is Associated with Non- Alcoholic Fatty Liver Disease

Fialho

André

Thota

et al. 2016

JGLD

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Background: Changes in gut bacteria play a role in type 2 diabetes mellitus (DM) and hepatic steatosis. There is a lack of studies evaluating the frequency and risk factors for non-alcoholic fatty liver disease (NAFLD) in patients tested for small intestinal bacterial overgrowth (SIBO). Aim: To evaluate the frequency of NAFLD and associated risk factors in patients tested for SIBO. Methods: In this case-control study, 372 eligible patients submitted to glucose hydrogen/methane breath test for SIBO who also had an abdominal imaging study were included. Patients were divided into SIBO-positive and SIBO-negative groups. Clinical, demographic and laboratory variables were evaluated in addition to the presence of NAFLD on abdominal imaging. Results: Of the 372 eligible patients, 141 (37.9%) were tested positive for SIBO (study group) and 231 (62.1%) were negative for it (control group). NAFLD occurred in 45.4% (64/141) of the study group compared to 17.3% (40/231) of the control group (p<0.001). Patients in the study group were found to have higher rates of elevated aspartate aminotransferase (AST) (20.6% vs. 11.3%; p=0.034) and alanine aminotransferase (ALT) levels (56.0% vs. 40.7%; p= 0.039), type 2 diabetes (23.4% vs. 13.9%; p=0.041), hypertension (54.6% vs. 40.3%; p=0.046) and metabolic syndrome (78.0% vs. 60.2%; p=0.020). In the multivariate analysis, SIBO (odds ratio [OR]: 1.95; 95% confidence interval [CI]: 1.14-3.31; p=0.014), type 2 DM (OR: 3.04; 95%CI: 1.57-5.90; p=0.001) and obesity (OR: 3.58; 95%CI: 1.70-7.54; p=0.001) remained associated with NAFLD.Conclusion: Patients with SIBO have an increased risk for hepatic steatosis and may benefit from aggressive control of the risk factors for NAFLD including metabolic syndrome. Abbreviations: ALT: alanine aminotransferase; AST: aspartate aminotransferase; BMI: body mass index; CTE: computed tomography enterography; DM: diabetes mellitus; ETOH: ethanol; IL: interleukin; LPS: lipopolysaccharide; NAFLD: non-alcoholic fatty liver disease; NASH: non-alcoholic steatohepatitis; PPI: proton pump inhibitor; SIBO: small intestinal bacterial overgrowth; TLR-4: toll-like receptor 4; TMAO: trimethylamine-N-oxide (TMAO); TNF-α: tumor necrosis factor alpha.

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Small Intestinal Bacterial Overgrowth Syndrome

Dharmarajan

Pitchumoni

2021

Geriatric Gastroenterology

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Small intestinal bacterial overgrowth: duodenal aspiration vs glucose breath test

Cited by 119 publications

References 44 publications

Prevalence of Small Intestine Bacterial Overgrowth in Patients With Gastrointestinal Symptoms

Prevalence of Small Intestine Bacterial Overgrowth in Patients With Gastrointestinal Symptoms

Small Intestinal Bacterial Overgrowth Is Associated with Non- Alcoholic Fatty Liver Disease

Small Intestinal Bacterial Overgrowth Syndrome

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