Usefulness of Lactulose Breath Test for the Prediction of Small Intestinal Bacterial Overgrowth in Irritable Bowel Syndrome

Jung Soo Park; Jung Hwan Yu; Hyun Chul Lim; Jie-Hyun Kim; Young Hoon Yoon; Hyo Jin Park; Sang In Lee

doi:10.4166/kjg.2010.56.4.242

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Park, Yu, Lim, Kim, Yoon, Park, and Lee: Usefulness of Lactulose Breath Test for the Prediction of Small Intestinal Bacterial Overgrowth in Irritable Bowel Syndrome

Original Article

Korean J Gastroenterol 2010;56(4):242-248.

Published online: 21 February 2010

DOI: https://doi.org/10.4166/kjg.2010.56.4.242

Usefulness of Lactulose Breath Test for the Prediction of Small Intestinal Bacterial Overgrowth in Irritable Bowel Syndrome

Jung Soo Park, M.D., Jung Hwan Yu, M.D., Hyun Chul Lim, M.D., Jie-Hyun Kim, M.D., Young Hoon Yoon, M.D., Hyo Jin Park, M.D., Sang In Lee, M.D.

Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

Correspondence to: Jie-Hyun Kim, M.D. Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 712, Eonjuro, Gangnam-gu, Seoul 135-270, Korea Tel: +82-2-2019-3505, Fax: +82-2-3463-3882 E-mail: otilia94@yuhs.ac

Received 22 January 2010 Accepted 5 July 2010

Abstract

Background/Aims

Lactulose breath test (LBT) has been used as a presumptive surrogate marker for small intestinal bacterial overgrowth (SIBO). However, recent reports suggest that abnormal LBT cannot discriminate patients with irritable bowel syndrome (IBS) from the control. Thus, the aim of this study was to evaluate the usefulness of LBT in IBS.

Methods

LBT from 76 IBS patients, 70 functional bowel disorders (FBD), and 40 controls were examined. LBT was considered positive if (1) baseline breath hydrogen (H₂) ＞20 parts per million (ppm) or rise of breath H₂ ＞20 ppm above the baseline in ＜90 mins, or (2) baseline breath methane (CH₄) ＞10 ppm or rise of breath CH₄ ＞10 ppm above the baseline in ＜90 mins. The subjects were categorized into predominant hydrogen producers (PHP), predominant methane producers (PMP), combined producer, and both negative group based on LBT.

Results

The rate of abnormal LBT in the IBS, FBD, and control group were 44.7%, 41.4%, and 40.0% respectively without significant differences. The rate of PHP or PMP was not significantly different among the IBS, FBD, and control group. When clinical characteristics were analyzed in IBS and FBD according to LBT types, IBS subtypes and symptoms were not significantly different.

Conclusions

LBT was not useful to discriminate IBS/FBD patients from the control. The assessment of SIBO by LBT in IBS should be re-validated in the future.

Keywords: Irritable bowel syndrome, Small intestinal bacterial overgrowth, Lactulose breath test

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Table 1.

Demographic Characteristics of the Subjects

	Control (n=40) (%)	IBS (n=76) (%)	FBD (n=70) (%)	p
Age (years, mean± SD)	42.7±14.1	46.9±14.2	47.3±14.2	0.76
Sex				0.87
Male	18 (45.0)	38 (50.0)	34 (48.6)
Female	22 (55.0)	38 (50.0)	36 (51.4)

IBS, irritable bowel syndrome; FBD, functional bowel disease.

Table 2.

Demographic Characteristics of IBS Patients according to Subtypes

	IBS-C (n=12) (%)	IBS-D (n=45) (%)	IBS-M (n=19) (%)	p
Age (years, mean± SD)	42.5±13.6	48.3±13.5	46.5±16.3	0.67
Sex				0.54
Male	3 (25.0)	26 (57.8)	9 (47.4)
Female	9 (75.0)	19 (42.2)	10 (52.6)

IBS-C, IBS-constipation; IBS-D, IBS-diarrhea; IBS-M, IBS-mixed.

Table 3.

Prevalence of Positivity to Lactulose Breath Test and Frequency in Gas Producing Type in IBS, FBD and Controls

	Control (n=40) (%)	IBS (n=76) (%)	FBD (n=70) (%)	p
LBT (＋)	16 (40.0)	34 (44.7)	29 (41.4)	0.97
PHP	3 (7.5)	9 (11.8)	16 (22.9)	0.39
PMP	10 (25.0)	19 (25.0)	11 (15.7)	0.11
Combined	3 (7.5)	6 (7.9)	2 (2.9)	0.23
LBT (−)	24 (60.0)	42 (55.3)	41 (58.6)

IBS, irritable bowel syndrome; FBD, functional bowel disease; LBT, lactulose breath test; PHP, predominant hydrogen producer; PMP, predominant methane producer

Table 4.

Clinical Characteristics in IBS according to LBT Types

	LBT (＋) (n=34) (%)	LBT (−) (n=42) (%)	p
Age (mean± SD)	49.8±14.8	44.6±13.5	0.23
Sex			1.00
Male	17 (50.0)	21 (50.0)
Female	17 (50.0)	21 (50.0)
IBS subtypes			0.57
IBS-C	4 (11.8)	8 (19.0)
IBS-D	20 (58.8)	25 (59.5)
IBS-M	10 (29.4)	9 (21.4)
Associated symptoms
Straining	13 (38.2)	19 (45.2)	0.66
Urgency	21 (61.8)	23 (54.8)	0.64
Incomplete evacuation	28 (82.4)	32 (76.2)	0.73
Bloating	30 (88.2)	37 (88.1)	0.92
Flatulence	32 (94.1)	38 (90.5)	0.69

IBS, irritable bowel syndrome; LBT, lactulose breath test; IBS-C, IBS-constipation; IBS-D, IBS-diarrhea; IBS-M, IBS-mixed.

Table 5.

Clinical Characteristics in FBD according to LBT Types

	LBT (＋) (n=29) (%)	LBT (−) (n=41) (%)	p
Age (mean± SD)	42.9±11.6	50.5±15.2	0.12
Sex			0.24
Male	11 (37.9)	23 (56.1)
Female	18 (62.1)	18 (43.9)
Associated symptoms
Straining	14 (48.3)	16 (39.0)	0.38
Urgency	4 (13.8)	15 (36.6)	0.17
Incomplete evacuation	26 (89.7)	29 (70.7)	0.23
Bloating	25 (86.2)	29 (70.7)	0.37
Flatulence	28 (96.6)	34 (82.9)	0.52

FBD, functional bowel disease; LBT, lactulose breath test.

Table 6.

Clinical Characteristics in IBS according to LBT Gas Pattern

	PHP (n=9) (%)	PMP (n=19) (%)	Combined (n=6) (%)	Negative (n=42) (%)	p
Age (mean± SD)	48.7±18.2	53.2±13.5	61.0±16.4	44.6±13.5	0.31
Sex					0.52
Male	2 (22.2)	13 (68.4)	2 (33.3)	21 (50.0)
Female	7 (77.8)	6 (31.6)	4 (66.7)	21 (50.0)
IBS subtypes					0.85
IBS-C	0 (0)	3 (15.8)	1 (16.7)	8 (19.0)
IBS-D	6 (66.7)	12 (63.2)	2 (33.3)	25 (59.5)
IBS-M	3 (33.3)	4 (21.1)	3 (50.0)	9 (21.4)
Associated symptoms
Straining	2 (22.2)	8 (42.1)	3 (50.0)	19 (45.2)	0.34
Urgency	7 (77.8)	11 (57.9)	3 (50.0)	23 (54.8)	0.54
Incomplete evacuation	7 (77.8)	15 (78.9)	6 (100)	32 (76.2)	0.62
Bloating	8 (88.9)	16 (84.2)	6 (100)	37 (88.1)	0.78
Flatulence	8 (88.9)	18 (94.7)	6 (100)	38 (90.5)	0.80

IBS, irritable bowel syndrome; LBT, lactulose breath test; PHP, predominant hydrogen producer; PMP, predominant methane producer; IBS-C, IBS-constipation; IBS-D, IBS-diarrhea; IBS-M, IBS-mixed.

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