Abstract
Background
Small intestinal bacterial overgrowth (SIBO) has been reported with varying prevalence,
depending upon the criteria used for diagnosis. Lactulose and glucose breath tests
are the most used in clinical settings. Early rises of hydrogen excretion during a
lactose breath test suggest SIBO, but the finding could result from accelerated mouth-to-caecum
transit time.
Aims
Defining the prevalence of early hydrogen peaks during lactose breath tests and assessing
the proportion of patients affected by SIBO.
Methods
An early (≤ 60′) hydrogen excretion peak was observed in 120/663 patients with positive
lactose hydrogen breath test. Eighty-one of them underwent a 50 g-9sample-glucose
hydrogen breath test to diagnose SIBO.
Results
The glucose breath test proved positive in 11/81 (13.6%) patients. The positivity
rate was 18.2% (2/11) in those with the first peak detected at 30′ and 12.8% (9/70)
in those with the peak occurring at 60′.
Conclusions
Early hydrogen excretion peaks are rarely associated with SIBO. The low positive predictive
value indicates that the finding does not help identifying patients at high risk for
this condition. Indirectly, the present data support the opinion that the prevalence
of SIBO diagnosed by standard lactulose breath tests is much lower than reported,
and the reliability of the test is low.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Digestive and Liver DiseaseAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prevalence and predictors of small intestinal bacterial overgrowth in irritable bowel syndrome: a systematic review and metanalysis.J Gastroenterol. 2018; 53: 807-818
- The Spectrum of Small Intestinal Bacterial Overgrowth (SIBO).Curr Gastroenterol Rep. 2019; 21: 3
- The diagnosis of small intestinal bacterial overgrowth: Two steps forward, one step backwards?.Neurogastroenterol Motil. 2018; 30: e13494https://doi.org/10.1111/nmo.13494
- Use and abuse of hydrogen breath tests.Gut. 2006; 55: 297-303
- Diagnostic Utility of Carbohydrate Breath Tests for SIBO, Fructose, and Lactose Intolerance.Dig Dis Sci. 2019 Oct 15; https://doi.org/10.1007/s10620-019-05889-9
- Methodology and indications of H2-breath testing in gastrointestinal diseases: the Rome Consensus Conference.Aliment Pharmacol Ther. 2009; 29: 1-49
- Hydrogen and methane-based breath testing in gastrointestinal disorders: the North American Consensus.Am J Gastroenterol. 2017; 112: 775-784
- Small intestinal bacterial overgrowth: duodenal aspiration vs glucose breath test.Neurogastroenterol Motil. 2015; 27: 481-489
- Combined oro-caecal scintigraphy and lactulose hydrogen breath testing demonstrate that breath testing detects oro-caecal transit, not small intestinal bacterial overgrowth in patients with IBS.Gut. 2011; 60: 334-340
- Does a glucose- based hydrogen and methane breath test detect bacterial overgrowth in the jejunum?.Neurogastroenterol Motil. 2018; 30: e13350
- Prevalence of primary adult lactose malabsorption and awareness of milk intolerance in Italy.Am J Clin Nutr. 1984; 39: 100-104
- Hydrogen breath test for the diagnosis of lactose intolerance, is the routine sugar load the best one?.World J Gastroenterol. 2008; 14: 6204-6207
- The role of small intestinal bacterial overgrowth and false positive diagnosis of lactose intolerance in southwest Hungary—A retrospective observational study.Plos One. 2020 May 8; 15 (eCollection 2020)e0230784https://doi.org/10.1371/journal.pone.0230784
- Small intestinal bacterial overgrowth as an uncommon cause of false positive lactose hydrogen breath test among patients with diarrhea-predominant irritable bowel syndrome in Asia.J Gastroenterol Hepatol. 2015; 30: 995-1000
- H2 breath testing for small intestinal bacterial overgrowth.Aliment Pharmacol Ther. 2009; 29: 18-22
- Scintigraphy demonstrates high rate of false-positive results from glucose breath tests for small bowel bacterial overgrowth.Clin Gastroenterol Hepatol. 2016; 14: 203-208
- The lactulose breath hydrogen test and small intestinal bacterial overgrowth.AM J Gastroenterol. 1996; 91: 1795-1803
- Diagnosing small intestinal bacterial overgrowth: a comparison of lactulose breath tests to small bowel aspirates.Dig Dis Sci. 2020; (ahead of print) PMID: 32681227https://doi.org/10.1007/s10620-020-06484-z
- Eradication of small intestinal bacterial overgrowth correlates with symptom improvement in irritable bowel syndrome: a double blind, randomized controlled study.Am J Gastroenterol. 2000; 95: 3503-3506
Article info
Publication history
Published online: August 29, 2020
Accepted:
July 31,
2020
Received:
July 1,
2020
Identification
Copyright
© 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
