Digestive Diseases and Sciences

, Volume 55, Issue 8, pp 2302–2308

Proton Pump Inhibitor Therapy Does Not Affect Hydrogen Production on Lactulose Breath Test in Subjects with IBS

Original Article

Abstract

Background

Evidence suggests a role for small intestinal bacterial overgrowth (SIBO) in IBS. Recently, the question has arisen whether the lactulose breath test (LBT) is abnormal in IBS subjects due to overlapping GERD and proton-pump inhibitor (PPI) usage.

Aim

The aim of this study was to compare the prevalence of an abnormal LBT in IBS patients either receiving or not receiving PPI therapy.

Methods

Consecutive Rome I positive IBS patients referred for LBT completed a questionnaire regarding their symptoms and medication use. All subjects then underwent an LBT. The prevalence of abnormal breath test results and hydrogen production were compared based on PPI usage.

Results

Of a total of 555 (429 female) subjects, 106 (19.1%) subjects reported current PPI use. Among those on PPI, 46.2% had a positive LBT. This was not different from the 56.3% positive LBT in non-PPI subjects (OR = 0.67, CI = 0.436–1.017, P = 0.06). No differences in hydrogen parameter were seen with PPI. The average amplitude of rise (first peak) in PPI users was 28.0 ± 35.3 ppm from baseline; in non-PPI users it was 27.5 ± 29.1 ppm (P = 0.89). The average rise in the second peak in PPI users was 48.5 ± 43.8 ppm from baseline; in non-PPI users, it was 49.3 ± 37.6 ppm (P = 0.87). The time to first peak in PPI users was 56.4 ± 23.0 min; in non-PPI users, it was 58.2 ± 26.1 min (P = 0.58). However, among subjects receiving PPI only 7.5% had methane detection on LBT, which is significantly different from the 15.4% of subjects not taking PPI.

Conclusion

PPI therapy does not effect hydrogen production on lactulose breath tests in IBS patients. However, there may be an effect on methane.

Keywords

Proton pump inhibitor IBS Lactulose breath test 

References

  1. 1.
    Bommelaer G, Poynard T, Le Pen C, et al. Prevalence of irritable bowel syndrome (IBS) and variability of diagnostic criteria. Gastroenterol Clin Biol. 2004;28:554–561.CrossRefPubMedGoogle Scholar
  2. 2.
    Wilson S, Roberts L, Roalfe A, Bridge P, Singh S. Prevalence of irritable bowel syndrome: a community survey. Br J Gen Pract. 2004;54:495–502.PubMedGoogle Scholar
  3. 3.
    Gwee KA, Wee S, Wong ML, Png DJ. The prevalence, symptom characteristics, and impact of irritable bowel syndrome in an Asian urban community. Am J Gastroenterol. 2004;99:924–931.CrossRefPubMedGoogle Scholar
  4. 4.
    El-Serag HB. Impact of irritable bowel syndrome: prevalence and effect on health-related quality of life. Rev Gastroenterol Disord. 2003;3(Suppl 2):S3–S11. PubMedGoogle Scholar
  5. 5.
    Hungin AP, Whorwell PJ, Tack J, Mearin F. The prevalence, patterns and impact of irritable bowel syndrome: an international survey of 40,000 subjects. Ailment Pharmacol Ther. 2003;17:643–650.CrossRefGoogle Scholar
  6. 6.
    Agreus L, Svardsudd K, Nyren O, Tibblin G. Irritable bowel syndrome and dyspepsia in the general population: overlap and lack of stability over time. Gastroenterology. 1995;109:671–680.CrossRefPubMedGoogle Scholar
  7. 7.
    Drossman DA, Richter JE, Talley NJ, et al. (eds) Functional gastrointestinal disorders: diagnosis, pathophysiology and treatment: a multinational consensus. Boston: Little Brown, 1994.Google Scholar
  8. 8.
    Pimentel M, Chow EJ, Lin HC. Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol. 2000;95:3503–3506.CrossRefPubMedGoogle Scholar
  9. 9.
    Pimentel M, Chow EJ, Lin HC. Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome: a double-blind, randomized, placebo-controlled study. Am J Gastroenterol. 2003;98:412–419.PubMedGoogle Scholar
  10. 10.
    Lupascu A, Gabrielli M, Lauritano EC, et al. Hydrogen glucose breath test to detect small intestinal bacterial overgrowth: a prevalence case-control study in irritable bowel syndrome. Aliment Pharmacol Ther. 2005;22:1157–1160.CrossRefPubMedGoogle Scholar
  11. 11.
    Grover M, Kanazawa M, Palsson OS, et al. Small intestinal bacterial overgrowth in irritable bowel syndrome: association with colon motility, bowel symptoms, psychological distress. Neurogastroenterol Motil. 2008;20(9):998–1008.CrossRefPubMedGoogle Scholar
  12. 12.
    McCallum R, Schultz C, Sostarich S. Evaluating the role of small intestinal bacterial overgrowth (SIBO) in diarrhea predominant irritable bowel syndrome (IBS-D) patients utilizing the glucose breath test (GBT). Gastroenterol. 2005;128:A460.Google Scholar
  13. 13.
    Pimentel M, Park S, Mirocha J, et al. The effect of a nonabsorbed oral antibiotic (rifaximin) on the symptoms of the irritable bowel syndrome: a randomized trial. Ann Intern Med. 2006;145:557–563.PubMedGoogle Scholar
  14. 14.
    Al Shahara, Aoun E, Abdul-Baki H, Mounzer R, Sidani S, ElHajj I. A randomized double-blind placebo-controlled trial of rifaximin in patients with abdominal bloating and flatulence. Am J Gastroenterol. 2006;101:326–333.CrossRefGoogle Scholar
  15. 15.
    Lembo A, Zakko S, Ferreira N, et al. Rifaximin for the treatment of diarrhea-associated irritable bowel syndrome: short term treatment leading to long term sustained response. Gastroenterology. 2008;134:A-545.Google Scholar
  16. 16.
    Nastaskin I, Mehdikhani E, Conklin J, et al. Studying the overlap between IBS and GERD: a systematic review of the literature. Dig Dis Sci. 2006;51:2113–2120.CrossRefPubMedGoogle Scholar
  17. 17.
    Posserud I, Stotzer PO, Bjornsson ES, Abrahamsson H, Simren M. Small intestinal bacterial overgrowth in patients with irritable bowel syndrome. Gut. 2007;56(6):802–808.CrossRefPubMedGoogle Scholar
  18. 18.
    Spiegel BMR, Chey WD, Chang L. Bacterial overgrowth and irritable bowel syndrome: unifying hypothesis or a spurious consequence of proton pump inhibitors? Am J Gastroenterol. 2006;103:2972–2976.CrossRefGoogle Scholar
  19. 19.
    Khoshini R, Dai SC, Lezcano S, Pimentel M. A systematic review of diagnostic tests for small intestinal bacterial overgrowth. Dig Dis Sci. 2008;53:1443–1454.CrossRefPubMedGoogle Scholar
  20. 20.
    Riedl A, Schmidtmann M, Stengel A, et al. Somatic comorbidities of IBS: a systematic analysis. J Psychosom Res. 2008;64(6):573–582.CrossRefPubMedGoogle Scholar
  21. 21.
    Williams C, McColl KEL. Review article: proton pump inhibitors and bacterial overgrowth. Aliment Pharmacol Ther. 2006;23:3–10.CrossRefPubMedGoogle Scholar
  22. 22.
    Theisen J, Nehra D, Citron D, et al. Suppression of gastric acid secretion in patients with gastroesophageal reflux disease results in gastric bacterial overgrowth and deconjugation of bile acids. J Gastrointest Surg. 2000;4:50–54.CrossRefPubMedGoogle Scholar
  23. 23.
    Lewis SJ, Franco S, Young G, O’Keefe SJD. Altered bowel function and duodenal bacterial overgrowth in patients treated with omeprazole. Aliment Pharm Ther. 1996;10:557–561.CrossRefGoogle Scholar
  24. 24.
    Pereira SP, Gainsborough N, Dowling RH. Drug-induced hypochlorhydria causes high duodenal bacterial counts in the elderly. Aliment Pharmacol Ther. 1998;12:99–104.CrossRefPubMedGoogle Scholar
  25. 25.
    Fried M, Siegrist H, Frei R, et al. Duodenal bacterial overgrowth during treatment in outpatients with omeprazole. Gut. 1994;35:23–26.CrossRefPubMedGoogle Scholar
  26. 26.
    Pimentel M, Mayer AG, Park S, et al. Methane production during lactulose breath test is associated with gastrointestinal disease presentation. Dig Dis Sci. 2003;48:86–92.CrossRefPubMedGoogle Scholar
  27. 27.
    Pimentel M, Lin HC, Enayati P, et al. Methane, a gas produced by enteric bacteria, slows intestinal transit and augments ileal contractile activity. Am J Physiol Gastrointest Liver Physiol. 2006;290:G1089–G1095.CrossRefPubMedGoogle Scholar
  28. 28.
    Locke GR 3rd, Zinsmeister AR, Fett SL, et al. Overlap of gastrointestinal symptom complexes in a US community. Neurogastroenterol Motil. 2005;14:29–34.CrossRefGoogle Scholar
  29. 29.
    Thorens J, Froehlich F, Schwizer W, et al. Bacterial overgrowth during treatment with omeprazole compared with cimetidine: a prospective randomized double blind study. Gut. 1996;39:54–59.CrossRefPubMedGoogle Scholar
  30. 30.
    Rubinstein E, Mark Z, Haspel J, et al. Antibacterial activity of the pancreatic fluid. Gastroenterol. 1985;88:927–932.Google Scholar
  31. 31.
    Fass R, Shapiro M, Dekel R, Sewell J. Systematic review: proton-pump inhibitor failure in gastro-oesophageal reflux disease––where next? Aliment Pharmacol Ther. 2005;22:79–94.CrossRefPubMedGoogle Scholar
  32. 32.
    Neal KR, Scott HM, Slack RCB, Logan RFA. Omeprazole as a risk factor for Campylobacter gastroenteritis: case-control study. BMJ. 1996;312:414–415.PubMedGoogle Scholar
  33. 33.
    Dial S, Alrasadi K, Manoukian C, Huang A, Menzies D. Risk of Clostridium difficile diarrhea among hospital inpatients prescribed proton pump inhibitors: cohort and case-control studies. Can Med Assoc J. 2004;6:33–38.CrossRefGoogle Scholar
  34. 34.
    Cunningham R, Dale B, Undy B, Gaunt N. Proton pump inhibitors as a risk factor for Clostridium difficile diarrhoea. J Hosp Infect. 2003;54:243–245.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.GI Motility Program, Cedars-Sinai Medical CenterLos AngelesUSA

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