Journal of Gastroenterology

, 44:944

Use of the lactose-[13C]ureide breath test for diagnosis of small bowel bacterial overgrowth: comparison to the glucose hydrogen breath test

  • Heiner K. Berthold
  • Patrick Schober
  • Christian Scheurlen
  • Günter Marklein
  • Regine Horré
  • Ioanna Gouni-Berthold
  • Tilman Sauerbruch
Original Article—Alimentary Tract

DOI: 10.1007/s00535-009-0097-8

Cite this article as:
Berthold, H.K., Schober, P., Scheurlen, C. et al. J Gastroenterol (2009) 44: 944. doi:10.1007/s00535-009-0097-8



The glucose hydrogen breath test (GHBT) is commonly used as a noninvasive test to diagnose small bowel bacterial overgrowth (SBBO) but its validity has been questioned. Our aim was to evaluate the lactose-[13C]ureide breath test (LUBT) to diagnose SBBO and to compare it with the GHBT, using cultures of intestinal aspirates as a gold standard.


In 22 patients with suspected SBBO (14 male, age range 18–73 years) aspirates were taken from the region of the ligament of Treitz under sterile conditions and cultured for bacterial growth. More than 106 colony-forming units/mL fluid or the presence of colonic flora was defined as culture positive (c+). After oral intake of 50 g glucose and 2 g of lactose-[13C]ureide, end-expiratory breath samples were obtained up to 120 min. The 13C/12C ratio in breath CO2 was determined by isotope ratio-mass spectrometry and hydrogen concentration in breath was analyzed electrochemically.


After analyzing receiver operating characteristic curves of the LUBT results, total label recovery of >0.88% at 120 min was considered positive. The test had a sensitivity of 66.7% and a specificity of 100% to predict c+. In the GHBT, an increase of the signal of ≥12 ppm from baseline was considered positive. The sensitivity and specificity of the test were 41.7 and 44.4%, respectively.


The new stable isotope-labeled LUBT has excellent specificity but suboptimal sensitivity. In contrast, the standard GHBT lacks both high sensitivity and specificity. The LUBT is superior to the GHBT for detecting SBBO.


Small bowel bacterial overgrowth Glucose hydrogen breath test Stable isotope breath test Lactose-ureide Glycosyl-ureide 



Colony forming units


Carbon dioxide


Cumulative percent dose recovery


Glucose hydrogen breath test


Lactose-[13C]ureide breath test


Receiver-operator characteristics


Small bowel bacterial overgrowth

Copyright information

© Springer 2009

Authors and Affiliations

  • Heiner K. Berthold
    • 1
    • 2
    • 6
  • Patrick Schober
    • 2
    • 3
  • Christian Scheurlen
    • 2
  • Günter Marklein
    • 4
  • Regine Horré
    • 4
  • Ioanna Gouni-Berthold
    • 5
  • Tilman Sauerbruch
    • 2
  1. 1.Department of Clinical PharmacologyUniversity of BonnBonnGermany
  2. 2.Department of Internal Medicine IUniversity of BonnBonnGermany
  3. 3.Department of AnesthesiologyVU University Medical CenterAmsterdamThe Netherlands
  4. 4.Institute of Medical Microbiology, Immunology and ParasitologyUniversity of BonnBonnGermany
  5. 5.Department of Internal Medicine IIUniversity of CologneCologneGermany
  6. 6.Charité University Medicine Berlin, Research Group on GeriatricsBerlinGermany

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