Skip to main content
SpringerLink
Log in

Lower Frequency of MMC Is Found in IBS Subjects with Abnormal Lactulose Breath Test, Suggesting Bacterial Overgrowth

  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

We have recently described an association between irritable bowel syndrome (IBS) and abnormal lactulose breath test, suggesting small intestinal bacterial overgrowth (SIBO). However, the mechanism by which SIBO develops in IBS is unknown. In this case–control study we evaluate the role of small intestinal motility in subjects with IBS and SIBO. Small intestinal motility was studied in consecutive IBS subjects with SIBO on lactulose breath test. After fluoroscopic placement of an eight-channel water-perfused manometry catheter, 4-hr fasting recordings were obtained. Based on this, the number and duration of phase III was compared to 30 control subjects. To test whether there was a relationship between the motility abnormalities seen and the SIBO status of the patient at the time of the motility, subjects with a breath test within 5 days of the antroduodenal manometry were also compared. Sixty-eight subjects with IBS and SIBO were compared to controls. The number of phase III events was 0.7 ± 0.8 in IBS subjects and 2.2 ± 1.0 in controls (P < 0.000001). The duration of phase III was 305 ± 123 sec in IBS subjects and 428 ± 173 in controls (P < 0.001). Subjects whose SIBO was still present at the time of manometry had less frequent phase III events than subjects with eradicated overgrowth (P < 0.05). In conclusion, phase III is reduced in subjects with IBS and SIBO. Eradication of bacterial overgrowth seems to result in some normalization of motility.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Pimentel M, Chow EJ, Lin HC: Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol 95:3503–3506, 2000

    Google Scholar 

  2. Fried M, Siegrist H, Frei R, et al: Duodenal bacterial overgrowth during treatment in outpatients with omeprazole. Gut 35:23-26, 1994

    Google Scholar 

  3. Nelis GF, Engeleage AH, Samson G: Does long-term inhibition of gastric acid secretion with omeprazole lead to small intestinal bacterial overgrowth? Neth J Med 45:93-100, 1994

    Google Scholar 

  4. Lewis SJ, Franco S, Young G, et al: Altered bowel function and duodenal bacterial overgrowth in patients treated with omeprazole. Aliment Pharmacol Ther 10:557-561, 1996

    Google Scholar 

  5. Thorens J, Froelich F, Schwizer W, et al: Bacterial overgrowth during treatment with omeprazole compared with cimetidine: a prospective randomised double blind study. Gut 39:54-59, 1996

    Google Scholar 

  6. Stockbruegger RW: Bacterial overgrowth as a consequence of reduced gastric acidity. Scand J Gastroenterol 111:7-16, 1985

    Google Scholar 

  7. Paiva SA, Sepe TE, Booth SL, et al: Interaction between vitamin K nutriture and bacterial overgrowth in hypochlorhydria induced by omeprazole. Am J Clin Nutr 68:699–704, 1998

    Google Scholar 

  8. Pereira SP, Gainsborough N, Dowling RH: Drug-induced hypochlorhydria causes high duodenal bacterial counts in the elderly. Aliment Pharmacol Ther 12:99–104, 1998

    Google Scholar 

  9. Trespi E, Ferrieri A: Intestinal bacterial overgrowth during chronic pancreatitis. Curr Med Res Opin 15:47–52, 1999

    Google Scholar 

  10. Bode C, Kolepke R, Schager K, et al: Breath hydrogen excretion inpatients with alcoholic liver disease-evidence of small intestinal bacterial overgrowth. Gastroenterol 31:3–7, 1993

    Google Scholar 

  11. Guarner C, Runyon BA, Young S, et al: Intestinal bacterial overgrowth and bacterial translocation in cirrhotic rats with ascites. J Hepatol 26:1372–1378, 1997

    Google Scholar 

  12. Casafont Morencos F, de las Heras Castano G, Martin Ramos L, et al: Small bowel bacterial overgrowth in patients with alcoholic cirrhosis. Dig Dis Sci 41:552–556, 1996

    Google Scholar 

  13. Chang CS, Chen GH, Lien, et al: Small intestinal dysmotility and bacterial overgrowth in cirrhotic patients with spontaneous bacterial peritonitis. Hepatology 28:1187–1190, 1998

    Google Scholar 

  14. Yang CY, Chang CS, Chen GH: Small-intestinal bacterial overgrowth in patients with liver cirrhosis, diagnosed with glucose H2 and CH4 breath tests. Scand J Gastroenterol 33:867–871, 1998

    Google Scholar 

  15. Griffin WO Jr, Richardson JD, Medley ES: Prevention of small bowel contamination by ileocecal valve. S Med J 64:1056–1058, 1971

    Google Scholar 

  16. Rutgeerts P, Ghoos Y, Vantrappen G, et al: Ileal dysfunction and bacterial overgrowth in patients with Crohn's disease. Eur J Clin Invest 11:199–206, 1981

    Google Scholar 

  17. Pignata C, Budillon G, Monaco G, et al: Jejunal bacterial overgrowth and intestinal permeability in children with immunodeficiency syndromes. Gut 31:879–882, 1990

    Google Scholar 

  18. Smith GM, Chesner IM, Asquith P, et al: Small intestinal bacterial overgrowth in patients with chronic lymphocytic leukemia. J Clin Pathol 43:57–59, 1990

    Google Scholar 

  19. Szurszewski JH: A migrating electric complex of the canine small intestine. Am J Physiol 217:1757, 1969

    Google Scholar 

  20. Christensen J: Intestinal motor physiology. In M Feldman, BF Scharschmidt, MH Sleisenger (eds). Gastrointestinal and Liver Disease, 6th ed. Philadelphia, WB Saunders, 1998, p 1443

    Google Scholar 

  21. Kerlin P, Phillips S: Variability of motility of the ileum and jejunum in healthy humans. Gastroenterology 82:694–700, 1982

    Google Scholar 

  22. Soffer EE, Thongswat S, Ellerbroek S: Prolonged ambulatory duodeno-jejunal manometry in humans: Normal values and gender effect. Am J Gastroenterol 93:1318–1323, 1998

    Google Scholar 

  23. Bortolotti M, Annese V, Coccia G: Twenty-four our ambulatory antroduodenal manometry in normal subjects (cooperative study). Neurogastroenterol Motil 12:231–238, 2000

    Google Scholar 

  24. Kellow JE, Borody TJ, Phillips SF, et al: Human interdigestive motility: variations in patterns from esophagus to colon. Gastroenterology 91:386–95, 1986

    Google Scholar 

  25. Vantrappen G, Janssens J, Hellemans J, et al: The interdigestive motor complex of normal subjects and patients with bacterial overgrowth of the small intestine. J Clin Invest 59:1158–66, 1977

    Google Scholar 

  26. Scott LD, Cahall DL: Influence of the interdigestive myoelectric complex on enteric flora in the rat. Gastroenterology 82:737–45, 1982

    Google Scholar 

  27. Kueppers PM, Miller TA, Chen CY, et al: Effect of total parenteral nutrition plus morphine on bacterial translocation in rats. Ann Surg 217:286–92, 1993

    Google Scholar 

  28. Nieuwenhuijs VB, Verheem A, van Duijvenbode-Beumer H, et al: The role of interdigestive small bowel motility in the regulation of gut microflora, bacterial overgrowth, and bacterial translocation in rats. Ann Surg 228:199–93, 1998

    Google Scholar 

  29. Kumar D, Wingate DL: The irritable bowel syndrome: a paroxysmal motor disorder. Lancet 2:973–7, 1985

    Google Scholar 

  30. Kellow JE, Phillips SF: Altered small bowel motility in irritable bowel syndrome is correlated with symptoms. Gastroenterology 92:1885–93, 1987

    Google Scholar 

  31. Kellow JE, Gill RC, Wingate DL: Prolonged ambulant recordings of small bowel motility demonstrate abnormalities in the irritable bowel syndrome. Gastroenterology 98:1208–18, 1990

    Google Scholar 

  32. Simren M, Castedal M, Svedlund J, et al: Abnormal propagation pattern of duodenal pressure waves in the irritable bowel syndrome (IBD). Dig Dis Sci 45:2151–61, 2000

    Google Scholar 

  33. Drossman DA, Richter JE, et al., (eds). Functional Gastrointestinal Disorders: Diagnosis, Pathophysiology and Treatment: A Multinational Consensus. Boston: Little, Brown, 1994

    Google Scholar 

  34. King CE, Toskes PP: Comparison of the 1-gram [14C]xylose, 10-gram lactulose, and 80-gram glucose-H2 breath tests in patients with small intestine bacterial overgrowth. Gastroenterology 83:1217–22, 1986

    Google Scholar 

  35. Joseph F Jr, Rosenberg AJ: Breath testing: diseased versus normal patients. J Pediatr Gastroenterol 7:787–8, 1988

    Google Scholar 

  36. Phillips SF: Small bowel. In An Illustrated Guide to Gastrointestinal Motility. D Kumar, S Gustavsson (eds.). Chichester, John Wiley & Sons, 1988, pp 187–206

    Google Scholar 

  37. Caenepeel P, Janssens J, Vantrappen G, et al: Interdigestive myoelectric complex in germ-free rats. Dig Dis Sci 34:1180–4, 1989

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, CSMC Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, 90048, USA

    Mark Pimentel, Evelyn J. Chow, Yuthana Kong & Henry C. Lin

  2. School of Medicine, University of California, Los Angeles, Los Angeles, California, 90024, USA

    Mark Pimentel, Evelyn J. Chow, Yuthana Kong & Henry C. Lin

  3. Division of Gastroenterology, Cleveland Clinic Foundation, Cleveland, Ohio, 44195, USA

    Edy E. Soffer

Authors
  1. Mark Pimentel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Edy E. Soffer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Evelyn J. Chow
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuthana Kong
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Henry C. Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pimentel, M., Soffer, E.E., Chow, E.J. et al. Lower Frequency of MMC Is Found in IBS Subjects with Abnormal Lactulose Breath Test, Suggesting Bacterial Overgrowth. Dig Dis Sci 47, 2639–2643 (2002). https://doi.org/10.1023/A:1021039032413

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1021039032413

Search

Navigation