Diagnosis of small intestinal bacterial overgrowth in children: the use of lactulose in the breath hydrogen test as a screening test
Keywords:
Bacterial infections/diagnosis, intestines, lactulose, lactase, small intestinal bacterial
Abstract
Introduction.The standard method for diagnosis of small intestinal bacterial overgrowth is a duodenal aspirate that produces a coliform count greater than 105 colonic forming units/ml. Because this is an invasive procedure, the lactulose breath hydrogen test is considered as a non-invasive alternative. Better experimental support is required, however, for the routine use of lactulose in diagnosis.Objective. Experimental evidence is provided to support the use of lactulose in the breath hydrogen test. Validation of the test is accomplished by comparison to the duodenal aspirate culture.
Materials and methods. A rational basis for the use of lactulose was established by a comparison of the kinetics of lactulose and lactose on intestinal lactase. For validation, the hydrogen test was applied to 47 children suffering from gastrointestinal disorders, and the results compared with aspirate culture counts. The validity of the hydrogen test was assessed by a contingency table and the degree of agreement established by the kappa index.
Results. The kinetics data showed that lactase is 240 times less efficient in presence of lactulose than it is in presence of lactose. The sensitivity of the breath hydrogen test was 85.7% (82.0-89.4%), its specificity 90.9% (89.3-92.5%), the predictive positive value 80.0% (76.5-83.5%) and the predictive negative value 93.8% (92.1-95.4%); the kappa index=0.785 (0.54-0.95) showed excellent agreement between the two diagnostic tests.
Conclusion. The results provided experimental support for the use of lactulose in the breath hydrogen test, and it was validated as screening test in the diagnosis of small intestinal bacterial overgrowth.
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References
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18. Rhodes JM, Middleton P, Jewell DP. The lactulose hydrogen breath test as a diagnostic test for smallbowel bacterial overgrowth. Scand J Gastroenterol. 1979;14:333-6.
19. Bishop WP. Breath hydrogen testing for small bowel bacterial overgrowth - A lot of hot air? J Pediatr Gastroenterol Nutr. 1997;25:245-6.
20. Pimentel M, Chow EJ, Lin HC. Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol. 2000;95:3503-6.
21. Ghoshal UC, Ghoshal U, Das K, Misra A. Utilility of hydrogen test in diagnosis of small intestinal bacterial overgrowth in malabsorption syndrome and its relationship with oro-cecal transit time. Indian J Gastroenterol. 2006;25:6-10.
22. Arrieche M,Hernández D, Olza M, Pestana E, Morera C, Jaen D. Sobrecrecimiento bacteriano en el intestino delgado: presentación clínica en la edad pediátrica. Colombia Médica. 2005;36(Suppl.1):58-87.
23. Reis JC, Morais MB, Fagundes-Neto U. Teste do H2 no ar expirado na avaliaçäo de absorçäo de lactose e sobrecrescimento bacteriano no intestino delgado de escolares/Breath hydrogen test to evaluate lactose absorption and small bowel bacterial overgrowth in children. Arq Gastroenterol. 1999;36:169-76.
24. Torres R, León R, Berendson R, Curioso W, Roe E, Biber M. Sobrecrecimiento bacteriano en el intestino delgado en pacientes con diarrea crónica y sujetos controles normales. Rev Gastroenterol Perú. 2003;23:111-4.
2. Casellas F. First principles of gastroenterology: the basis of disease and approach to management. En: Bacterial overgrowth syndrome. First edition. Canadá: AztraZeneca; 1999. p.251-3.
3. Omoike IU, Abiodun PO. Upper small intestinal microflora in diarrhea and malnutrition in Nigerian children. J Pediatr Gastroenterol Nutr. 1989;9:314-21.
4. Quera R, Quigley E, Madrid A. Small intestinal bacterial overgrowth. An update. Rev Med Chil. 2005;133:1361-70.
5. Gregg CR. Enteric bacterial flora and bacterial overgrowth syndrome. Semin Gastrointest Dis. 2002;13:200-9.
6. Guarner F, Malagelada JR. Gut flora in health and disease. Lancet. 2003;361:512-9.
7. Husebye E. The pathogenesis of gastrointestinal bacterial overgrowth. Chemotherapy. 2005;51 (Suppl.1):1-22.
8. Riordan SM, McCaIver CJ, Walker BM, Ducombe VM, Bolin TD, Thomas MC. The lactulose breath hydrogen test and small intestinal bacterial overgrowth. Am J Gastroentol. 1996;91:1795-803.
9. Alves GM, de Moraes BM, Fagundes-Neto U. Nutritional status and breath hydrogen test with lactose and lactulose in Terena Indian Children. J Pediatr (Rio J). 2002;78:113-9.
10. Gisbert JP, González-Lama Y. Breath tests in the diagnosis of gastrointestinal diseases. Gastroenterol Hepatol. 2005;28:407-16.
11. Skovbjerg H, Noren H. Purification and characterization of amphiphilic lactase fhlorizin hydrolase. Eur J Biochem. 1981;114:653-61.
12. Duodoroff M. D-Galactose dehydrogenase of Pseudomonas saccaharophila. En: Methods in enzymology. Volumen V. New York: Academy Press; 1962. p.339.
13. Lowry OH, Rosebroug NJ, Farr AL, Randall RJ. Protein measurement with the Folin phenol reagent. J Biol Chem. 1951;193:265-72.
14. Ghoshal U, Ghoshal UC, Ranjan P, Naik SR, Ayyagari A. Spectrum and antibiotic sensitivity of bacteria contaminating the upper gut in patients with malabsorption syndrome from the tropics. BMC
Gastroenterol. 2003;3:9.
15. Hamilton LH. Breath tests and gastroenterology. Second edition. Milwaukee: QuinTron Instruments Company; 1998. p.39-49.
16. Rey Calero J, Herruzo R, Rodríguez F. Fundamentos de epidemiología clínica. Madrid: Síntesis; 1996. p.25-35.
17. Dahlqvist A, Gribosky J. Inability of the human small intestinal lactase to hydrolyse lactulose. Biochim Biophys Acta. 1965;110:635-6.
18. Rhodes JM, Middleton P, Jewell DP. The lactulose hydrogen breath test as a diagnostic test for smallbowel bacterial overgrowth. Scand J Gastroenterol. 1979;14:333-6.
19. Bishop WP. Breath hydrogen testing for small bowel bacterial overgrowth - A lot of hot air? J Pediatr Gastroenterol Nutr. 1997;25:245-6.
20. Pimentel M, Chow EJ, Lin HC. Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol. 2000;95:3503-6.
21. Ghoshal UC, Ghoshal U, Das K, Misra A. Utilility of hydrogen test in diagnosis of small intestinal bacterial overgrowth in malabsorption syndrome and its relationship with oro-cecal transit time. Indian J Gastroenterol. 2006;25:6-10.
22. Arrieche M,Hernández D, Olza M, Pestana E, Morera C, Jaen D. Sobrecrecimiento bacteriano en el intestino delgado: presentación clínica en la edad pediátrica. Colombia Médica. 2005;36(Suppl.1):58-87.
23. Reis JC, Morais MB, Fagundes-Neto U. Teste do H2 no ar expirado na avaliaçäo de absorçäo de lactose e sobrecrescimento bacteriano no intestino delgado de escolares/Breath hydrogen test to evaluate lactose absorption and small bowel bacterial overgrowth in children. Arq Gastroenterol. 1999;36:169-76.
24. Torres R, León R, Berendson R, Curioso W, Roe E, Biber M. Sobrecrecimiento bacteriano en el intestino delgado en pacientes con diarrea crónica y sujetos controles normales. Rev Gastroenterol Perú. 2003;23:111-4.
How to Cite
1.
Mendoza E, Crismatt C, Matos R, Sabagh O, Campo M, Cepeda J, et al. Diagnosis of small intestinal bacterial overgrowth in children: the use of lactulose in the breath hydrogen test as a screening test. biomedica [Internet]. 2007 Sep. 1 [cited 2024 May 12];27(3):325-32. Available from: https://revistabiomedica.org/index.php/biomedica/article/view/195
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