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Ning Dai - One of the best experts on this subject based on the ideXlab platform.
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Clinical value of radionuclide small inTestine transit time measurement combined with lactulose Hydrogen Breath Test for the diagnosis of bacterial overgrowth in irritable bowel syndrome.
Hellenic journal of nuclear medicine, 2016Co-Authors: Yanli Ning, Zhongke Huang, Huacheng Huang, Bucheng Zhang, Dongfang Chen, Jianmin Zhao, Liang Chen, Ning Dai, Cen Lou, Xia ZhenAbstract:OBJECTIVE Small inTestine bacterial overgrowth (SIBO) may be a pathogenetic factor for irritable bowel syndrome (IBS). This syndrome cannot be explained by structural abnormalities and has no specific diagnostic laboratory Tests or biomarkers. We studied quantitatively and semi-quantitatively, using lactulose Hydrogen Breath Test (LHBT), small inTestinal transit time (SITT) (99m)technetium-diethylene triamine pentaacetic acid ((99m)Tc-DTPA) in order to examine the mobility of small inTestine as an indication of bacterial overgrowth in patients. METHODS Eighty nine consecutive patients who met Rome criteria for IBS were retrospectively studied. According to the diagnostic criteria, all patients were divided into two groups: the SIBO group and the non-SIBO group. The tracer was a mixture of 10g lactulose, 37MBq (99m)Tc-DTPA and 100mL water. The patient drank the whole mixture during 1min and the SITT study started immediately. The SITT and the LHBT followed every 15min for up to 3h after emptying the urine bladder. Spearman's rank correlation was applied to assess the correlation of oro-cecum transit time (OCTT) between imaging and LHBT. The semi-quantitative index between the SIBO group and the non-SIBO group was analyzed with Wilcoxon's rank sum Test. If there was significant group difference, the receiver operating characteristic (ROC) curve was used. P
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Four-sample lactose Hydrogen Breath Test for diagnosis of lactose malabsorption in irritable bowel syndrome patients with diarrhea.
World journal of gastroenterology, 2015Co-Authors: Jianfeng Yang, Mark Fox, Hua Chu, Xia Zheng, Yanqin Long, Daniel Pohl, Michael Fried, Ning DaiAbstract:AIM: To validate 4-sample lactose Hydrogen Breath Testing (4SLHBT) compared to standard 13-sample LHBT in the clinical setting. METHODS: Irritable bowel syndrome patients with diarrhea (IBS-D) and healthy volunteers (HVs) were enrolled and received a 10 g, 20 g, or 40 g dose lactose Hydrogen Breath Test (LHBT) in a randomized, double-blinded, controlled trial. The lactase gene promoter region was sequenced. Breath samples and symptoms were acquired at baseline and every 15 min for 3 h (13 measurements). The detection rates of lactose malabsorption (LM) and lactose intolerance (LI) for a 4SLHBT that acquired four measurements at 0, 90, 120, and 180 min from the same data set were compared with the results of standard LHBT. RESULTS: Sixty IBS-D patients and 60 HVs were studied. The genotype in all participants was C/C-13910. LM and LI detection rates increased with lactose dose from 10 g, 20 g to 40 g in both groups (P < 0.001). 4SLHBT showed excellent diagnostic concordance with standard LHBT (97%-100%, Kappa 0.815-0.942) with high sensitivity (90%-100%) and specificity (100%) at all three lactose doses in both groups. CONCLUSION: Reducing the number of measurements from 13 to 4 samples did not significantly impact on the accuracy of LHBT in health and IBS-D. 4SLHBT is a valid Test for assessment of LM and LI in clinical practice.
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a study of the methodological and clinical validity of the combined lactulose Hydrogen Breath Test with scintigraphic oro cecal transit Test for diagnosing small inTestinal bacterial overgrowth in ibs patients
Neurogastroenterology and Motility, 2014Co-Authors: Jianmin Zhao, Mark Fox, Hua Chu, Xia Zheng, Michael Fried, Yanqun Cong, Ning DaiAbstract:BACKGROUND: Small inTestinal bacterial overgrowth (SIBO) may be a cause of irritable bowel syndrome (IBS); however, current investigations have important limitations. We aimed to identify clinically relevant diagnostic criteria for SIBO based on lactulose Hydrogen Breath Test (LHBT) alone and combined with scintigraphic measurement of oro-cecal transit (SOCT). METHODS: Results of LHBT/SOCT investigation from 89 IBS patients and 13 healthy volunteers were included in a systematic analysis of six published criteria for SIBO diagnosis. Clinical relevance of competing criteria was determined by assessing (i) prevalence of SIBO in IBS patients and healthy volunteers (ii) if SIBO diagnosis predicted improvement in IBS symptoms in a prospective, pilot therapeutic trial of a non-absorbable antibiotic (rifaximin 600 mg b.d.) in IBS patients. KEY RESULTS: Reproducibility of SIBO diagnosis by combined LHBT/SOCT was near perfect. A ≥5 ppm H2 increase prior to appearance of cecal contrast was detected in more IBS patients than healthy volunteers (35/89 vs 1/13; p = 0.026), but not for other diagnostic criteria. IBS patients with SIBO, compared to those without SIBO, reported significantly greater improvement in abdominal symptoms following rifaximin therapy (p < 0.002 overall IBS symptom severity). This improvement was most marked in D-IBS patients in whom all symptoms improved, including stool frequency and consistency (all p < 0.004). CONCLUSIONS AND INFERENCES: Combined LHBT/SOCT Testing using a H2 5 ppm cutoff may identify a subgroup of IBS patients with SIBO. Pilot data examining the clinical response to rifaximin suggest that this subset of IBS patients may benefit more than those with a normal Test.
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A study of the methodological and clinical validity of the combined lactulose Hydrogen Breath Test with scintigraphic oro‐cecal transit Test for diagnosing small inTestinal bacterial overgrowth in IBS patients
Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society, 2014Co-Authors: Jianmin Zhao, Mark Fox, Hua Chu, Xia Zheng, Michael Fried, Yanqun Cong, Ning DaiAbstract:BACKGROUND: Small inTestinal bacterial overgrowth (SIBO) may be a cause of irritable bowel syndrome (IBS); however, current investigations have important limitations. We aimed to identify clinically relevant diagnostic criteria for SIBO based on lactulose Hydrogen Breath Test (LHBT) alone and combined with scintigraphic measurement of oro-cecal transit (SOCT). METHODS: Results of LHBT/SOCT investigation from 89 IBS patients and 13 healthy volunteers were included in a systematic analysis of six published criteria for SIBO diagnosis. Clinical relevance of competing criteria was determined by assessing (i) prevalence of SIBO in IBS patients and healthy volunteers (ii) if SIBO diagnosis predicted improvement in IBS symptoms in a prospective, pilot therapeutic trial of a non-absorbable antibiotic (rifaximin 600 mg b.d.) in IBS patients. KEY RESULTS: Reproducibility of SIBO diagnosis by combined LHBT/SOCT was near perfect. A ≥5 ppm H2 increase prior to appearance of cecal contrast was detected in more IBS patients than healthy volunteers (35/89 vs 1/13; p = 0.026), but not for other diagnostic criteria. IBS patients with SIBO, compared to those without SIBO, reported significantly greater improvement in abdominal symptoms following rifaximin therapy (p < 0.002 overall IBS symptom severity). This improvement was most marked in D-IBS patients in whom all symptoms improved, including stool frequency and consistency (all p < 0.004). CONCLUSIONS AND INFERENCES: Combined LHBT/SOCT Testing using a H2 5 ppm cutoff may identify a subgroup of IBS patients with SIBO. Pilot data examining the clinical response to rifaximin suggest that this subset of IBS patients may benefit more than those with a normal Test.
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su2034 diagnosis of small inTestinal bacterial overgrowth by lactulose Hydrogen Breath Test with scintigraphic oro caecal transit Test methodological validation of diagnostic criteria in healthy controls and patients with diarrhea predominant irritab
Gastroenterology, 2013Co-Authors: Jianmin Zhao, Mark Fox, Hua Chu, Xia Zheng, Michael Fried, Yanqun Cong, Jianjun Zhao, Ning DaiAbstract:INTRODUCTION: The prevalence of small inTestinal bacterial overgrowth (SIBO) in irritable bowel syndrome (IBS) patients remains contentious due to continuing uncertainty regarding diagnostic methodology. The lactulose Hydrogen Breath Test (LHBT) is used to detect SIBO; however, recent papers have suggested that the results are confounded by wide variation of oro-caecal transit time. Combination with an independent, scintigraphic assessment of oro-cecal transit time (SOCTT) may address this problem with SIBO diagnosed when there is a rise in Breath Hydrogen before scintigraphic marker is seen in the caecum. AIM: To determine the most appropriate diagnostic criteria and clinical relevance of SIBO diagnosed using LHBT alone and combined HBT/SOCTT. SUBJECTS: 60 patients with diarrhea predominant irritable bowel syndrome (D-IBS) and 13 healthy controls. METHODS: A systematic analysis of the ability of six published diagnostic criteria to detect SIBO in D-IBS patients and controls was performed (Criteria 1: A H2 rise of ≥20ppm within 180 min; Criteria 2: A H2 rise of ≥20ppm within 90 min; Criteria 3: dual Breath H2 peaks; Initial H2 rise, ≥5ppm (Criteria 4), 10ppm (Criteria 5) and 20ppm (Criteria 6) above baseline before the scintigraphic OCTT). In a subgroup of these patients the clinical relevance of these diagnostic markers was Tested in an open label study of antibiotic therapy (rifaximin 1200mg/d, 10days). The short-term effect of this treatment on D-IBS symptoms in patients with and without SIBO was assessed. RESULTS: There was a close association between the time to Breath H2 increase to 5ppm and 20ppm on LHBT and scintigraphic OCTT in health (R5ppm =0.896, p,0.001; R20ppm =0.860, p=0.003); however this association was lost in D-IBS patients (R5ppm =0.214, p=0.165). A 5ppmH2 increase prior to appearance of cecal contrast (criteria 4) was detected in more D-IBS patients than healthy subjects (28/60 vs. 1/13; p=0.009). This was not the case for other candidate diagnostic markers. Compared to D-IBS patients with negative findings (n=9/32), patients with a positive diagnosis of SIBO based on criteria 4 (n=27/28) had improved D-IBS symptoms following antibiotic therapy (table 1). CONCLUSIONS: Combined LHBT/scintigraphy is required for non-invasive SIBO diagnosis. The presence of a 5ppm increase in Breath H2 prior to the arrival of contrast in the cecum may identify a subset of D-IBS patients with SIBO that have good clinical outcomes following antibiotic therapy.
Jianmin Zhao - One of the best experts on this subject based on the ideXlab platform.
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clinical value of radionuclide small inTestine transit time measurement combined with lactulose Hydrogen Breath Test for the diagnosis of bacterial overgrowth in irritable bowel syndrome
Hellenic Journal of Nuclear Medicine, 2016Co-Authors: Yanli Ning, Zhongke Huang, Huacheng Huang, Bucheng Zhang, Dongfang Chen, Jianmin Zhao, Liang Chen, Xia ZhenAbstract:OBJECTIVE: Small inTestine bacterial overgrowth (SIBO) may be a pathogenetic factor for irritable bowel syndrome (IBS). This syndrome cannot be explained by structural abnormalities and has no specific diagnostic laboratory Tests or biomarkers. We studied quantitatively and semi-quantitatively, using lactulose Hydrogen Breath Test (LHBT), small inTestinal transit time (SITT) (99m)technetium-diethylene triamine pentaacetic acid ((99m)Tc-DTPA) in order to examine the mobility of small inTestine as an indication of bacterial overgrowth in patients. METHODS: Eighty nine consecutive patients who met Rome criteria for IBS were retrospectively studied. According to the diagnostic criteria, all patients were divided into two groups: the SIBO group and the non-SIBO group. The tracer was a mixture of 10g lactulose, 37MBq (99m)Tc-DTPA and 100mL water. The patient drank the whole mixture during 1min and the SITT study started immediately. The SITT and the LHBT followed every 15min for up to 3h after emptying the urine bladder. Spearman's rank correlation was applied to assess the correlation of oro-cecum transit time (OCTT) between imaging and LHBT. The semi-quantitative index between the SIBO group and the non-SIBO group was analyzed with Wilcoxon's rank sum Test. If there was significant group difference, the receiver operating characteristic (ROC) curve was used. P<0.05 was considered significant. RESULTS: The median and inter-quartile range for OCTT for the LHBT (OCTT-L) for all patients was 90min and 60min, respectively, and 75min and 45min for OCTT for the SITT study (OCTT-i). There was positive correlation between OCTT-L and OCTT-i at the 0.05 level (R=0.290, P=0.000). There were no differences in OCTT-i and in the rate of radioactivity (counts of regions of interest ROI) over the abdomen between the SIBO group and the non-SIBO group (P=0.116 and 0.290). There were significant differences in the temporal association of the Hydrogen (H2) value with OCTT-i (H2-i) and OCTT-L between the two groups (P=0.000 and 0.000). The areas under the curve (AUC) of H2-i and OCTT-L were 0.749 and 0.138 respectively. CONCLUSION: Small inTestinal transit time study using a lactose Hydrogen Breath Test and (99m)Tc-DTPA is a real-time Test for small inTestine bacteria overgrowth in IBS patients and can be used as an indicator of the disease.
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clinical value of radionuclide small inTestine transit time measurement combined with lactulose Hydrogen Breath Test for the diagnosis of bacterial overgrowth in irritable bowel syndrome
Hellenic Journal of Nuclear Medicine, 2016Co-Authors: Yanli Ning, Zhongke Huang, Huacheng Huang, Bucheng Zhang, Dongfang Chen, Jianmin Zhao, Liang Chen, Xia ZhenAbstract:OBJECTIVE: Small inTestine bacterial overgrowth (SIBO) may be a pathogenetic factor for irritable bowel syndrome (IBS). This syndrome cannot be explained by structural abnormalities and has no specific diagnostic laboratory Tests or biomarkers. We studied quantitatively and semi-quantitatively, using lactulose Hydrogen Breath Test (LHBT), small inTestinal transit time (SITT) (99m)technetium-diethylene triamine pentaacetic acid ((99m)Tc-DTPA) in order to examine the mobility of small inTestine as an indication of bacterial overgrowth in patients. METHODS: Eighty nine consecutive patients who met Rome criteria for IBS were retrospectively studied. According to the diagnostic criteria, all patients were divided into two groups: the SIBO group and the non-SIBO group. The tracer was a mixture of 10g lactulose, 37MBq (99m)Tc-DTPA and 100mL water. The patient drank the whole mixture during 1min and the SITT study started immediately. The SITT and the LHBT followed every 15min for up to 3h after emptying the urine bladder. Spearman's rank correlation was applied to assess the correlation of oro-cecum transit time (OCTT) between imaging and LHBT. The semi-quantitative index between the SIBO group and the non-SIBO group was analyzed with Wilcoxon's rank sum Test. If there was significant group difference, the receiver operating characteristic (ROC) curve was used. P<0.05 was considered significant. RESULTS: The median and inter-quartile range for OCTT for the LHBT (OCTT-L) for all patients was 90min and 60min, respectively, and 75min and 45min for OCTT for the SITT study (OCTT-i). There was positive correlation between OCTT-L and OCTT-i at the 0.05 level (R=0.290, P=0.000). There were no differences in OCTT-i and in the rate of radioactivity (counts of regions of interest ROI) over the abdomen between the SIBO group and the non-SIBO group (P=0.116 and 0.290). There were significant differences in the temporal association of the Hydrogen (H2) value with OCTT-i (H2-i) and OCTT-L between the two groups (P=0.000 and 0.000). The areas under the curve (AUC) of H2-i and OCTT-L were 0.749 and 0.138 respectively. CONCLUSION: Small inTestinal transit time study using a lactose Hydrogen Breath Test and (99m)Tc-DTPA is a real-time Test for small inTestine bacteria overgrowth in IBS patients and can be used as an indicator of the disease.
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Clinical value of radionuclide small inTestine transit time measurement combined with lactulose Hydrogen Breath Test for the diagnosis of bacterial overgrowth in irritable bowel syndrome.
Hellenic journal of nuclear medicine, 2016Co-Authors: Yanli Ning, Zhongke Huang, Huacheng Huang, Bucheng Zhang, Dongfang Chen, Jianmin Zhao, Liang Chen, Ning Dai, Cen Lou, Xia ZhenAbstract:OBJECTIVE Small inTestine bacterial overgrowth (SIBO) may be a pathogenetic factor for irritable bowel syndrome (IBS). This syndrome cannot be explained by structural abnormalities and has no specific diagnostic laboratory Tests or biomarkers. We studied quantitatively and semi-quantitatively, using lactulose Hydrogen Breath Test (LHBT), small inTestinal transit time (SITT) (99m)technetium-diethylene triamine pentaacetic acid ((99m)Tc-DTPA) in order to examine the mobility of small inTestine as an indication of bacterial overgrowth in patients. METHODS Eighty nine consecutive patients who met Rome criteria for IBS were retrospectively studied. According to the diagnostic criteria, all patients were divided into two groups: the SIBO group and the non-SIBO group. The tracer was a mixture of 10g lactulose, 37MBq (99m)Tc-DTPA and 100mL water. The patient drank the whole mixture during 1min and the SITT study started immediately. The SITT and the LHBT followed every 15min for up to 3h after emptying the urine bladder. Spearman's rank correlation was applied to assess the correlation of oro-cecum transit time (OCTT) between imaging and LHBT. The semi-quantitative index between the SIBO group and the non-SIBO group was analyzed with Wilcoxon's rank sum Test. If there was significant group difference, the receiver operating characteristic (ROC) curve was used. P
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a study of the methodological and clinical validity of the combined lactulose Hydrogen Breath Test with scintigraphic oro cecal transit Test for diagnosing small inTestinal bacterial overgrowth in ibs patients
Neurogastroenterology and Motility, 2014Co-Authors: Jianmin Zhao, Mark Fox, Hua Chu, Xia Zheng, Michael Fried, Yanqun Cong, Ning DaiAbstract:BACKGROUND: Small inTestinal bacterial overgrowth (SIBO) may be a cause of irritable bowel syndrome (IBS); however, current investigations have important limitations. We aimed to identify clinically relevant diagnostic criteria for SIBO based on lactulose Hydrogen Breath Test (LHBT) alone and combined with scintigraphic measurement of oro-cecal transit (SOCT). METHODS: Results of LHBT/SOCT investigation from 89 IBS patients and 13 healthy volunteers were included in a systematic analysis of six published criteria for SIBO diagnosis. Clinical relevance of competing criteria was determined by assessing (i) prevalence of SIBO in IBS patients and healthy volunteers (ii) if SIBO diagnosis predicted improvement in IBS symptoms in a prospective, pilot therapeutic trial of a non-absorbable antibiotic (rifaximin 600 mg b.d.) in IBS patients. KEY RESULTS: Reproducibility of SIBO diagnosis by combined LHBT/SOCT was near perfect. A ≥5 ppm H2 increase prior to appearance of cecal contrast was detected in more IBS patients than healthy volunteers (35/89 vs 1/13; p = 0.026), but not for other diagnostic criteria. IBS patients with SIBO, compared to those without SIBO, reported significantly greater improvement in abdominal symptoms following rifaximin therapy (p < 0.002 overall IBS symptom severity). This improvement was most marked in D-IBS patients in whom all symptoms improved, including stool frequency and consistency (all p < 0.004). CONCLUSIONS AND INFERENCES: Combined LHBT/SOCT Testing using a H2 5 ppm cutoff may identify a subgroup of IBS patients with SIBO. Pilot data examining the clinical response to rifaximin suggest that this subset of IBS patients may benefit more than those with a normal Test.
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A study of the methodological and clinical validity of the combined lactulose Hydrogen Breath Test with scintigraphic oro‐cecal transit Test for diagnosing small inTestinal bacterial overgrowth in IBS patients
Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society, 2014Co-Authors: Jianmin Zhao, Mark Fox, Hua Chu, Xia Zheng, Michael Fried, Yanqun Cong, Ning DaiAbstract:BACKGROUND: Small inTestinal bacterial overgrowth (SIBO) may be a cause of irritable bowel syndrome (IBS); however, current investigations have important limitations. We aimed to identify clinically relevant diagnostic criteria for SIBO based on lactulose Hydrogen Breath Test (LHBT) alone and combined with scintigraphic measurement of oro-cecal transit (SOCT). METHODS: Results of LHBT/SOCT investigation from 89 IBS patients and 13 healthy volunteers were included in a systematic analysis of six published criteria for SIBO diagnosis. Clinical relevance of competing criteria was determined by assessing (i) prevalence of SIBO in IBS patients and healthy volunteers (ii) if SIBO diagnosis predicted improvement in IBS symptoms in a prospective, pilot therapeutic trial of a non-absorbable antibiotic (rifaximin 600 mg b.d.) in IBS patients. KEY RESULTS: Reproducibility of SIBO diagnosis by combined LHBT/SOCT was near perfect. A ≥5 ppm H2 increase prior to appearance of cecal contrast was detected in more IBS patients than healthy volunteers (35/89 vs 1/13; p = 0.026), but not for other diagnostic criteria. IBS patients with SIBO, compared to those without SIBO, reported significantly greater improvement in abdominal symptoms following rifaximin therapy (p < 0.002 overall IBS symptom severity). This improvement was most marked in D-IBS patients in whom all symptoms improved, including stool frequency and consistency (all p < 0.004). CONCLUSIONS AND INFERENCES: Combined LHBT/SOCT Testing using a H2 5 ppm cutoff may identify a subgroup of IBS patients with SIBO. Pilot data examining the clinical response to rifaximin suggest that this subset of IBS patients may benefit more than those with a normal Test.
Michael Fried - One of the best experts on this subject based on the ideXlab platform.
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Differentiation of functional gastroinTestinal disorders from healthy volunteers by lactulose Hydrogen Breath Test and Test meal.
Journal of gastroenterology and hepatology, 2018Co-Authors: Valeria Schindler, Michael Fried, Stéphanie Giezendanner, Simon Bütikofer, Fritz Murray, Daniel Runggaldier, Larissa Schnurre, Annina Zweig, Daniel PohlAbstract:Background and aim Functional dyspepsia (FD) is a common disorder of gut-brain interaction with incompletely understood pathophysiology. Consequently, heterogeneous expert opinions on diagnostic Tests and assessment of treatment efficacies exist. So far, no consensus about the most relevant diagnostic and outcome tool has been reached. In this study, we aimed to analyze the significance of a combined lactulose Hydrogen Breath Test (LHBT) and liquid meal, yet representing a standardized Test in irritable bowel syndrome (IBS), in FD. Methods We analyzed data of 146 FD, 204 IBS patients, and 50 healthy volunteers (HV). All patients underwent LHBT with a meal-drink consisting of 30-g Lactulose and 400-mL Ensure®. Effect of abdominal symptom generation in FD/IBS compared with HV was assessed on a patient-reported Likert-scale. Results There was a significant difference between FD/IBS patients and HV in LHBT-induced abdominal pain (odds ratio [OR] 246.9, 95% confidence interval [CI] 26.6-2290.7; OR 161.2, 95% CI 16.9-1534.8), abdominal bloating (OR 384.8, 95% CI 92.9-2135.4; OR 524.1, 95% CI 114.7-3432.3), borborygmi (OR 9.9, 95% CI 2.2-46.9; OR 17.7, 95% CI 4.7-67.4), nausea only in FD (OR 174.4, 95% CI 15.5-5375.5), and diarrhea in IBS only (OR 25.8, 95% CI 2.0-7012.6). Hydrogen production was not significantly different in FD/IBS and HV. Conclusions In this study, we demonstrated significant differences in postprandial symptom generation in FD and IBS compared with HV after LHBT. This does not only allow us to discriminate FD/IBS from HV but may also represent a diagnostic and monitoring tool for FD/IBS in the future, including monitoring of treatment effects.
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Four-sample lactose Hydrogen Breath Test for diagnosis of lactose malabsorption in irritable bowel syndrome patients with diarrhea.
World journal of gastroenterology, 2015Co-Authors: Jianfeng Yang, Mark Fox, Hua Chu, Xia Zheng, Yanqin Long, Daniel Pohl, Michael Fried, Ning DaiAbstract:AIM: To validate 4-sample lactose Hydrogen Breath Testing (4SLHBT) compared to standard 13-sample LHBT in the clinical setting. METHODS: Irritable bowel syndrome patients with diarrhea (IBS-D) and healthy volunteers (HVs) were enrolled and received a 10 g, 20 g, or 40 g dose lactose Hydrogen Breath Test (LHBT) in a randomized, double-blinded, controlled trial. The lactase gene promoter region was sequenced. Breath samples and symptoms were acquired at baseline and every 15 min for 3 h (13 measurements). The detection rates of lactose malabsorption (LM) and lactose intolerance (LI) for a 4SLHBT that acquired four measurements at 0, 90, 120, and 180 min from the same data set were compared with the results of standard LHBT. RESULTS: Sixty IBS-D patients and 60 HVs were studied. The genotype in all participants was C/C-13910. LM and LI detection rates increased with lactose dose from 10 g, 20 g to 40 g in both groups (P < 0.001). 4SLHBT showed excellent diagnostic concordance with standard LHBT (97%-100%, Kappa 0.815-0.942) with high sensitivity (90%-100%) and specificity (100%) at all three lactose doses in both groups. CONCLUSION: Reducing the number of measurements from 13 to 4 samples did not significantly impact on the accuracy of LHBT in health and IBS-D. 4SLHBT is a valid Test for assessment of LM and LI in clinical practice.
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a study of the methodological and clinical validity of the combined lactulose Hydrogen Breath Test with scintigraphic oro cecal transit Test for diagnosing small inTestinal bacterial overgrowth in ibs patients
Neurogastroenterology and Motility, 2014Co-Authors: Jianmin Zhao, Mark Fox, Hua Chu, Xia Zheng, Michael Fried, Yanqun Cong, Ning DaiAbstract:BACKGROUND: Small inTestinal bacterial overgrowth (SIBO) may be a cause of irritable bowel syndrome (IBS); however, current investigations have important limitations. We aimed to identify clinically relevant diagnostic criteria for SIBO based on lactulose Hydrogen Breath Test (LHBT) alone and combined with scintigraphic measurement of oro-cecal transit (SOCT). METHODS: Results of LHBT/SOCT investigation from 89 IBS patients and 13 healthy volunteers were included in a systematic analysis of six published criteria for SIBO diagnosis. Clinical relevance of competing criteria was determined by assessing (i) prevalence of SIBO in IBS patients and healthy volunteers (ii) if SIBO diagnosis predicted improvement in IBS symptoms in a prospective, pilot therapeutic trial of a non-absorbable antibiotic (rifaximin 600 mg b.d.) in IBS patients. KEY RESULTS: Reproducibility of SIBO diagnosis by combined LHBT/SOCT was near perfect. A ≥5 ppm H2 increase prior to appearance of cecal contrast was detected in more IBS patients than healthy volunteers (35/89 vs 1/13; p = 0.026), but not for other diagnostic criteria. IBS patients with SIBO, compared to those without SIBO, reported significantly greater improvement in abdominal symptoms following rifaximin therapy (p < 0.002 overall IBS symptom severity). This improvement was most marked in D-IBS patients in whom all symptoms improved, including stool frequency and consistency (all p < 0.004). CONCLUSIONS AND INFERENCES: Combined LHBT/SOCT Testing using a H2 5 ppm cutoff may identify a subgroup of IBS patients with SIBO. Pilot data examining the clinical response to rifaximin suggest that this subset of IBS patients may benefit more than those with a normal Test.
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A study of the methodological and clinical validity of the combined lactulose Hydrogen Breath Test with scintigraphic oro‐cecal transit Test for diagnosing small inTestinal bacterial overgrowth in IBS patients
Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society, 2014Co-Authors: Jianmin Zhao, Mark Fox, Hua Chu, Xia Zheng, Michael Fried, Yanqun Cong, Ning DaiAbstract:BACKGROUND: Small inTestinal bacterial overgrowth (SIBO) may be a cause of irritable bowel syndrome (IBS); however, current investigations have important limitations. We aimed to identify clinically relevant diagnostic criteria for SIBO based on lactulose Hydrogen Breath Test (LHBT) alone and combined with scintigraphic measurement of oro-cecal transit (SOCT). METHODS: Results of LHBT/SOCT investigation from 89 IBS patients and 13 healthy volunteers were included in a systematic analysis of six published criteria for SIBO diagnosis. Clinical relevance of competing criteria was determined by assessing (i) prevalence of SIBO in IBS patients and healthy volunteers (ii) if SIBO diagnosis predicted improvement in IBS symptoms in a prospective, pilot therapeutic trial of a non-absorbable antibiotic (rifaximin 600 mg b.d.) in IBS patients. KEY RESULTS: Reproducibility of SIBO diagnosis by combined LHBT/SOCT was near perfect. A ≥5 ppm H2 increase prior to appearance of cecal contrast was detected in more IBS patients than healthy volunteers (35/89 vs 1/13; p = 0.026), but not for other diagnostic criteria. IBS patients with SIBO, compared to those without SIBO, reported significantly greater improvement in abdominal symptoms following rifaximin therapy (p < 0.002 overall IBS symptom severity). This improvement was most marked in D-IBS patients in whom all symptoms improved, including stool frequency and consistency (all p < 0.004). CONCLUSIONS AND INFERENCES: Combined LHBT/SOCT Testing using a H2 5 ppm cutoff may identify a subgroup of IBS patients with SIBO. Pilot data examining the clinical response to rifaximin suggest that this subset of IBS patients may benefit more than those with a normal Test.
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su2034 diagnosis of small inTestinal bacterial overgrowth by lactulose Hydrogen Breath Test with scintigraphic oro caecal transit Test methodological validation of diagnostic criteria in healthy controls and patients with diarrhea predominant irritab
Gastroenterology, 2013Co-Authors: Jianmin Zhao, Mark Fox, Hua Chu, Xia Zheng, Michael Fried, Yanqun Cong, Jianjun Zhao, Ning DaiAbstract:INTRODUCTION: The prevalence of small inTestinal bacterial overgrowth (SIBO) in irritable bowel syndrome (IBS) patients remains contentious due to continuing uncertainty regarding diagnostic methodology. The lactulose Hydrogen Breath Test (LHBT) is used to detect SIBO; however, recent papers have suggested that the results are confounded by wide variation of oro-caecal transit time. Combination with an independent, scintigraphic assessment of oro-cecal transit time (SOCTT) may address this problem with SIBO diagnosed when there is a rise in Breath Hydrogen before scintigraphic marker is seen in the caecum. AIM: To determine the most appropriate diagnostic criteria and clinical relevance of SIBO diagnosed using LHBT alone and combined HBT/SOCTT. SUBJECTS: 60 patients with diarrhea predominant irritable bowel syndrome (D-IBS) and 13 healthy controls. METHODS: A systematic analysis of the ability of six published diagnostic criteria to detect SIBO in D-IBS patients and controls was performed (Criteria 1: A H2 rise of ≥20ppm within 180 min; Criteria 2: A H2 rise of ≥20ppm within 90 min; Criteria 3: dual Breath H2 peaks; Initial H2 rise, ≥5ppm (Criteria 4), 10ppm (Criteria 5) and 20ppm (Criteria 6) above baseline before the scintigraphic OCTT). In a subgroup of these patients the clinical relevance of these diagnostic markers was Tested in an open label study of antibiotic therapy (rifaximin 1200mg/d, 10days). The short-term effect of this treatment on D-IBS symptoms in patients with and without SIBO was assessed. RESULTS: There was a close association between the time to Breath H2 increase to 5ppm and 20ppm on LHBT and scintigraphic OCTT in health (R5ppm =0.896, p,0.001; R20ppm =0.860, p=0.003); however this association was lost in D-IBS patients (R5ppm =0.214, p=0.165). A 5ppmH2 increase prior to appearance of cecal contrast (criteria 4) was detected in more D-IBS patients than healthy subjects (28/60 vs. 1/13; p=0.009). This was not the case for other candidate diagnostic markers. Compared to D-IBS patients with negative findings (n=9/32), patients with a positive diagnosis of SIBO based on criteria 4 (n=27/28) had improved D-IBS symptoms following antibiotic therapy (table 1). CONCLUSIONS: Combined LHBT/scintigraphy is required for non-invasive SIBO diagnosis. The presence of a 5ppm increase in Breath H2 prior to the arrival of contrast in the cecum may identify a subset of D-IBS patients with SIBO that have good clinical outcomes following antibiotic therapy.
Masatoshi Fujishima - One of the best experts on this subject based on the ideXlab platform.
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Small bowel transit time measured by Hydrogen Breath Test in patients with anorexia nervosa
Digestive Diseases and Sciences, 1990Co-Authors: Masahiko Hirakawa, Mitsuo Iida, Takao Okada, Hajime Tamai, Nobuyuki Kobayashi, Tetsuya Nakagawa, Masatoshi FujishimaAbstract:The gastrocecal transit time was measured in 10 patients suffering from anorexia nervosa , using a lactulose Hydrogen Breath Test, and was compared with the orocecal transit time in 11 healthy controls. One of the 10 patients and one of the 11 controls were excluded from this study because of no discernible increase in Hydrogen excretion. The transit time was significantly prolonged in patients with anorexia nervosa compared with controls (117 min ± 31 sd vs 81 min + 33 SD , P < 0.02). In addition to delayed gastric emptying, which has hitherto been well known, the small bowel transit time was considered to be prolonged in patients with anorexia nervosa. Both these abnormalities seem to contribute to the development of various gastroinTestinal symptoms in patients with anorexia nervosa .
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Small bowel transit time measured by Hydrogen Breath Test in patients with anorexia nervosa
Digestive diseases and sciences, 1990Co-Authors: Masahiko Hirakawa, Mitsuo Iida, Takao Okada, Hajime Tamai, Nobuyuki Kobayashi, Tetsuya Nakagawa, Masatoshi FujishimaAbstract:The gastrocecal transit time was measured in 10 patients suffering from anorexia nervosa,using a lactulose Hydrogen Breath Test, and was compared with the orocecal transit time in 11 healthy controls. One of the 10 patients and one of the 11 controls were excluded from this study because of no discernible increase in Hydrogen excretion. The transit time was significantly prolonged in patients with anorexia nervosa compared with controls (117 min ±31 sd vs 81 min + 33 SD, P
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Four-sample lactose Hydrogen Breath Test for diagnosis of lactose malabsorption in irritable bowel syndrome patients with diarrhea.
World journal of gastroenterology, 2015Co-Authors: Jianfeng Yang, Mark Fox, Hua Chu, Xia Zheng, Yanqin Long, Daniel Pohl, Michael Fried, Ning DaiAbstract:AIM: To validate 4-sample lactose Hydrogen Breath Testing (4SLHBT) compared to standard 13-sample LHBT in the clinical setting. METHODS: Irritable bowel syndrome patients with diarrhea (IBS-D) and healthy volunteers (HVs) were enrolled and received a 10 g, 20 g, or 40 g dose lactose Hydrogen Breath Test (LHBT) in a randomized, double-blinded, controlled trial. The lactase gene promoter region was sequenced. Breath samples and symptoms were acquired at baseline and every 15 min for 3 h (13 measurements). The detection rates of lactose malabsorption (LM) and lactose intolerance (LI) for a 4SLHBT that acquired four measurements at 0, 90, 120, and 180 min from the same data set were compared with the results of standard LHBT. RESULTS: Sixty IBS-D patients and 60 HVs were studied. The genotype in all participants was C/C-13910. LM and LI detection rates increased with lactose dose from 10 g, 20 g to 40 g in both groups (P < 0.001). 4SLHBT showed excellent diagnostic concordance with standard LHBT (97%-100%, Kappa 0.815-0.942) with high sensitivity (90%-100%) and specificity (100%) at all three lactose doses in both groups. CONCLUSION: Reducing the number of measurements from 13 to 4 samples did not significantly impact on the accuracy of LHBT in health and IBS-D. 4SLHBT is a valid Test for assessment of LM and LI in clinical practice.
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a study of the methodological and clinical validity of the combined lactulose Hydrogen Breath Test with scintigraphic oro cecal transit Test for diagnosing small inTestinal bacterial overgrowth in ibs patients
Neurogastroenterology and Motility, 2014Co-Authors: Jianmin Zhao, Mark Fox, Hua Chu, Xia Zheng, Michael Fried, Yanqun Cong, Ning DaiAbstract:BACKGROUND: Small inTestinal bacterial overgrowth (SIBO) may be a cause of irritable bowel syndrome (IBS); however, current investigations have important limitations. We aimed to identify clinically relevant diagnostic criteria for SIBO based on lactulose Hydrogen Breath Test (LHBT) alone and combined with scintigraphic measurement of oro-cecal transit (SOCT). METHODS: Results of LHBT/SOCT investigation from 89 IBS patients and 13 healthy volunteers were included in a systematic analysis of six published criteria for SIBO diagnosis. Clinical relevance of competing criteria was determined by assessing (i) prevalence of SIBO in IBS patients and healthy volunteers (ii) if SIBO diagnosis predicted improvement in IBS symptoms in a prospective, pilot therapeutic trial of a non-absorbable antibiotic (rifaximin 600 mg b.d.) in IBS patients. KEY RESULTS: Reproducibility of SIBO diagnosis by combined LHBT/SOCT was near perfect. A ≥5 ppm H2 increase prior to appearance of cecal contrast was detected in more IBS patients than healthy volunteers (35/89 vs 1/13; p = 0.026), but not for other diagnostic criteria. IBS patients with SIBO, compared to those without SIBO, reported significantly greater improvement in abdominal symptoms following rifaximin therapy (p < 0.002 overall IBS symptom severity). This improvement was most marked in D-IBS patients in whom all symptoms improved, including stool frequency and consistency (all p < 0.004). CONCLUSIONS AND INFERENCES: Combined LHBT/SOCT Testing using a H2 5 ppm cutoff may identify a subgroup of IBS patients with SIBO. Pilot data examining the clinical response to rifaximin suggest that this subset of IBS patients may benefit more than those with a normal Test.
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A study of the methodological and clinical validity of the combined lactulose Hydrogen Breath Test with scintigraphic oro‐cecal transit Test for diagnosing small inTestinal bacterial overgrowth in IBS patients
Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society, 2014Co-Authors: Jianmin Zhao, Mark Fox, Hua Chu, Xia Zheng, Michael Fried, Yanqun Cong, Ning DaiAbstract:BACKGROUND: Small inTestinal bacterial overgrowth (SIBO) may be a cause of irritable bowel syndrome (IBS); however, current investigations have important limitations. We aimed to identify clinically relevant diagnostic criteria for SIBO based on lactulose Hydrogen Breath Test (LHBT) alone and combined with scintigraphic measurement of oro-cecal transit (SOCT). METHODS: Results of LHBT/SOCT investigation from 89 IBS patients and 13 healthy volunteers were included in a systematic analysis of six published criteria for SIBO diagnosis. Clinical relevance of competing criteria was determined by assessing (i) prevalence of SIBO in IBS patients and healthy volunteers (ii) if SIBO diagnosis predicted improvement in IBS symptoms in a prospective, pilot therapeutic trial of a non-absorbable antibiotic (rifaximin 600 mg b.d.) in IBS patients. KEY RESULTS: Reproducibility of SIBO diagnosis by combined LHBT/SOCT was near perfect. A ≥5 ppm H2 increase prior to appearance of cecal contrast was detected in more IBS patients than healthy volunteers (35/89 vs 1/13; p = 0.026), but not for other diagnostic criteria. IBS patients with SIBO, compared to those without SIBO, reported significantly greater improvement in abdominal symptoms following rifaximin therapy (p < 0.002 overall IBS symptom severity). This improvement was most marked in D-IBS patients in whom all symptoms improved, including stool frequency and consistency (all p < 0.004). CONCLUSIONS AND INFERENCES: Combined LHBT/SOCT Testing using a H2 5 ppm cutoff may identify a subgroup of IBS patients with SIBO. Pilot data examining the clinical response to rifaximin suggest that this subset of IBS patients may benefit more than those with a normal Test.
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su2034 diagnosis of small inTestinal bacterial overgrowth by lactulose Hydrogen Breath Test with scintigraphic oro caecal transit Test methodological validation of diagnostic criteria in healthy controls and patients with diarrhea predominant irritab
Gastroenterology, 2013Co-Authors: Jianmin Zhao, Mark Fox, Hua Chu, Xia Zheng, Michael Fried, Yanqun Cong, Jianjun Zhao, Ning DaiAbstract:INTRODUCTION: The prevalence of small inTestinal bacterial overgrowth (SIBO) in irritable bowel syndrome (IBS) patients remains contentious due to continuing uncertainty regarding diagnostic methodology. The lactulose Hydrogen Breath Test (LHBT) is used to detect SIBO; however, recent papers have suggested that the results are confounded by wide variation of oro-caecal transit time. Combination with an independent, scintigraphic assessment of oro-cecal transit time (SOCTT) may address this problem with SIBO diagnosed when there is a rise in Breath Hydrogen before scintigraphic marker is seen in the caecum. AIM: To determine the most appropriate diagnostic criteria and clinical relevance of SIBO diagnosed using LHBT alone and combined HBT/SOCTT. SUBJECTS: 60 patients with diarrhea predominant irritable bowel syndrome (D-IBS) and 13 healthy controls. METHODS: A systematic analysis of the ability of six published diagnostic criteria to detect SIBO in D-IBS patients and controls was performed (Criteria 1: A H2 rise of ≥20ppm within 180 min; Criteria 2: A H2 rise of ≥20ppm within 90 min; Criteria 3: dual Breath H2 peaks; Initial H2 rise, ≥5ppm (Criteria 4), 10ppm (Criteria 5) and 20ppm (Criteria 6) above baseline before the scintigraphic OCTT). In a subgroup of these patients the clinical relevance of these diagnostic markers was Tested in an open label study of antibiotic therapy (rifaximin 1200mg/d, 10days). The short-term effect of this treatment on D-IBS symptoms in patients with and without SIBO was assessed. RESULTS: There was a close association between the time to Breath H2 increase to 5ppm and 20ppm on LHBT and scintigraphic OCTT in health (R5ppm =0.896, p,0.001; R20ppm =0.860, p=0.003); however this association was lost in D-IBS patients (R5ppm =0.214, p=0.165). A 5ppmH2 increase prior to appearance of cecal contrast (criteria 4) was detected in more D-IBS patients than healthy subjects (28/60 vs. 1/13; p=0.009). This was not the case for other candidate diagnostic markers. Compared to D-IBS patients with negative findings (n=9/32), patients with a positive diagnosis of SIBO based on criteria 4 (n=27/28) had improved D-IBS symptoms following antibiotic therapy (table 1). CONCLUSIONS: Combined LHBT/scintigraphy is required for non-invasive SIBO diagnosis. The presence of a 5ppm increase in Breath H2 prior to the arrival of contrast in the cecum may identify a subset of D-IBS patients with SIBO that have good clinical outcomes following antibiotic therapy.
