Article

Digestive Diseases and Sciences

, Volume 45, Issue 3, pp 474-479

First online:

Urinary Choloyl-PABA Excretion in Diagnosing Small Intestinal Bacterial Overgrowth

  • Pradip K. BardhanAffiliated withDepartments of Gastroenterology, Nuclear Medicine, and Internal Medicine, University HospitalDepartment of Internal Medicine, Kantonsspital LiestalDiagnostic Research Department, Hoffman-La Roche Co.
  • , Alain FegerAffiliated withDepartments of Gastroenterology, Nuclear Medicine, and Internal Medicine, University HospitalDepartment of Internal Medicine, Kantonsspital LiestalDiagnostic Research Department, Hoffman-La Roche Co.
  • , Manuela KogonAffiliated withDepartments of Gastroenterology, Nuclear Medicine, and Internal Medicine, University HospitalDepartment of Internal Medicine, Kantonsspital LiestalDiagnostic Research Department, Hoffman-La Roche Co.
  • , Jan MullerAffiliated withDepartments of Gastroenterology, Nuclear Medicine, and Internal Medicine, University HospitalDepartment of Internal Medicine, Kantonsspital LiestalDiagnostic Research Department, Hoffman-La Roche Co.
  • , Dieter GillessenAffiliated withDepartments of Gastroenterology, Nuclear Medicine, and Internal Medicine, University HospitalDepartment of Internal Medicine, Kantonsspital LiestalDiagnostic Research Department, Hoffman-La Roche Co.
  • , C. BeglingerAffiliated withDepartments of Gastroenterology, Nuclear Medicine, and Internal Medicine, University HospitalDepartment of Internal Medicine, Kantonsspital LiestalDiagnostic Research Department, Hoffman-La Roche Co.
  • , Niklaus GyrAffiliated withDepartments of Gastroenterology, Nuclear Medicine, and Internal Medicine, University HospitalDepartment of Internal Medicine, Kantonsspital LiestalDiagnostic Research Department, Hoffman-La Roche Co.

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Abstract

The synthetic substrate cholyl-PABA, developed by conjugating cholic acid with paraaminobenzoic acid, is hydrolyzed by the bacterial enzyme cholyl hydrolase to release free PABA. This study aimed to evaluate whether quantitating urinary excretion of PABA after oral administration of cholyl-PABA can detect small intestinal bacterial overgrowth. In the first phase, investigations were performed on 10 healthy volunteers to study the dynamics of urinary excretion of PABA and any adverse reactions after oral administration of 1.2 g of cholyl-PABA. Another 10 healthy volunteers and 25 adult patients with various gastrointestinal disorders participated in the second phase, where the urinary cholyl-PABA test was compared to the [14C]xylose breath test (XBT). The upper limit of normal levels of urinary PABA excretion at the end of 4 h was 1.1% of the administered dose of cholyl-PABA. The urinary PABA excretion after 4 hr [median (range), in percentage] in the XBT-positive group was 1.6 (0.6–35.0), which was significantly higher than those in the XBT-negative group [0.7 (0.4–1.8)] and the healthy controls [0.7 (0.2–1.1)]. The agreement between the XBT and the urinary cholyl-PABA test was 85.7% (P < 0.01). No adverse effect was noted. In conclusion, the urinary cholyl-PABA test offers a simple, safe, noninvasive, and rapid method for diagnosing small intestinal bacterial overgrowth and warrants further clinical evaluation.

bacterial overgrowth PABA cholic acid xylose breath test