Abstract
Introduction
Based on literature review, a positive lactulose breath test (LBT) for small intestinal
bacterial overgrowth requires an initial peak value of hydrogen within 100 minutes
of lactulose ingestion with a second peak before 180 minutes. However, using scintigraphic monitoring of lactulose transit time, mean oral-cecal
arrival time has been reported as 73 minutes. The goal was to propose new criteria for analysing the LBT to overcome false
positive interpretations.
Methods
LBTs from our referral center were interpreted as positive after ingestion of 10 g of lactulose using the following approach for hydrogen concentrations: (1) The literature guidelines: greater than 20 ppm from a baseline less than 10 ppm achieved within 100 minutes followed by a further rise of greater than 15 ppm within 180 minutes. (2) The proposed criteria: greater than 20 ppm from a baseline less than 10 ppm within either 60 or 80 minutes followed by a further rise of greater than 15 ppm during the 180-minute test.
Results
A total of 153 patients with symptoms suspicious for small-bowel bacterial overgrowth
underwent testing. Of all, 26.1% patients tested positive by 100 minutes, 11.8% patients tested positive by 60 minutes and 18.3% patients tested positive by 80 minutes. The percentage of positive LBTs at 60 and 80 minutes was significantly lesser than for the 100 minutes criteria (P < 0.05).
Conclusions
The first hydrogen peak increase should occur by either 60 or 80 minutes to increase the specificity of LBT for small intestinal bacterial overgrowth
based on the reality of lactulose cecal arrival times.
Key Indexing Terms
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Article info
Publication history
Accepted:
September 30,
2015
Received:
April 16,
2015
Footnotes
☆Abstract presented at Digestive Disease Week 2014 Chicago on May 4, 2014.
☆☆RWM has been on the Advisory Board of Smart Pill Corporation and Prostrakan Pharma. He has been a consultant for Tranzyme, Inc, Evoke, Rhythm and Medtronic Corporation, and has received research funding from Tranzyme, Takada, Salix, Novartis, Red Hill Pharma and Rhythm as well as current NIH funding from NIDDK—Gastroparesis Consortium. JS and CG have no declaration of personal interests. This research project had no specific source of funding.
Identification
Copyright
© 2016 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
