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This Article Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Mangerson, J. Articles by Jones, M. PubMed Articles by Mangerson, J. Articles by Jones, M.

Scintigraphy to validate lactulose hydrogen breath testing as a diagnostic tool for small intestinal bacterial overgrowth

¹ Nuclear Medicine, Northwestern Memorial Hospital, Chicago, Illinois

2206

Objectives: Lactulose hydrogen breath testing (LHBT) is currently used to diagnose small intestinal bacterial overgrowth (SIBO). The diagnostic sensitivity and specificity of this test are not well known and currently proposed criteria for a positive test have not been validated. The aim of this study was to determine the feasibility of combined scintigraphy and LHBT to validate proposed LHBT criteria for SIBO.

Methods: Eleven controls free of digestive complaints were recruited. LHBT/scintigraphy was performed using 10g of lactulose in 4oz of water with 1 mCi of Tc-99m sulfur colloid. End alveolar breath samples were collected every 15min and analyzed using a Quintron Model DP Microlyzer for breath H2 concentration. Imaging was performed continually for 180min using a Siemens ECAM camera. A region of interest was drawn around the cecum. LHBT diagnostic criteria for SIBO included a rise in breath H2>20 ppm, dual H2 peaks or increased H2 concentration within 90min of lactulose administration. Time to diagnostic positivity with the LHBT or orocecal transit time was correlated with cecal arrival of the test meal by scintigraphy.

Results: Nine of 11 subjects met diagnostic criteria for SIBO. Orocecal transit times by LHBT (90+15min) and scintigraphy (83+10min) were highly correlated (r=0.95; p<0.0001). Occurrence of positive criteria for SIBO in all subjects was shown to represent arrival of the test meal in the colon. No rise in breath hydrogen was seen while the test meal remained in the small intestine.

Conclusions: Orocecal transit times as measured were highly correlated. Current criteria for SIBO diagnosis using LHBT reflect test meal arrival in the colon rather than small intestinal microbial fermentation. Scintigraphy is useful to better understand and validate criteria for SIBO by LHBT.

This Article Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Mangerson, J. Articles by Jones, M. PubMed Articles by Mangerson, J. Articles by Jones, M.