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Breath Test Gas Patterns in Inflammatory Bowel Disease with Concomitant Irritable Bowel Syndrome-Like Symptoms: A Controlled Large-Scale Database Linkage Analysis

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Abstract

Introduction

Breath testing (BT) has gained interest for diagnosing small intestinal bacterial overgrowth (SIBO) in IBD patients with irritable bowel syndrome (IBS) overlap. We aim to characterize the rate of SIBO and BT gas patterns in IBD patients with IBS-like symptoms compared to non-IBD patients.

Methods

A database of 14,847 consecutive lactulose BTs was developed from patients with IBS-like symptoms between November 2005 and October 2013. BTs were classified as normal, H2 predominant, CH4 predominant, and flatline based on criteria established from the literature. BT data linkage with electronic health records and chart review identified IBD patients along with disease phenotype, location, severity, and antibiotic response. Poisson loglinear model evaluated differences in gas patterns between the two groups.

Results

After excluding patients with repeat breath tests, we identified 486 IBD and 10,505 non-IBD patients with at least one BT. Positive BT was present in 57% (n = 264) of IBD patients. Crohn’s disease (odds ratio (OR) 0.21, [95% confidence interval (CI) 0.11–0.38]) and ulcerative colitis (OR 0.39, [95% CI 0.22–0.70]) patients were less likely to produce excess CH4. IBD patients were more likely to have flatline BT (OR 1.82, [95% CI 1.20–2.77]). In IBD patients with SIBO, 57% improved symptomatically with antibiotics.

Conclusion

In a cohort of IBD patients with IBS-like symptoms, a high rate of patients had positive BT and symptomatic improvement with antibiotics. In IBD, methanogenesis is suppressed and flatline BT is more frequent, suggesting excess hydrogenotrophic bacteria. These findings suggest methanogenic and hydrogenotrophic microorganisms as potential targets for microbiome-driven biomarkers and therapies.

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Authors and Affiliations

  1. Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, TX, USA

    Phillip Gu

  2. Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Devin Patel, Krutika Lakhoo & Jeffrey Ko

  3. Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Xiaochen Liu, Eugenia Lin, Mark Pimentel & Ali Rezaie

  4. Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, IL, USA

    Bianca Chang

  5. Division of Gastroenterology and Hepatology, University of California in Davis, Sacramento, CA, USA

    Dana Pan

  6. Enterprise Information Services- Initiate Team, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Greg Lentz, Matthew Sonesen & Renier Estiandan

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  1. Phillip Gu
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Gu, P., Patel, D., Lakhoo, K. et al. Breath Test Gas Patterns in Inflammatory Bowel Disease with Concomitant Irritable Bowel Syndrome-Like Symptoms: A Controlled Large-Scale Database Linkage Analysis. Dig Dis Sci 65, 2388–2396 (2020). https://doi.org/10.1007/s10620-019-05967-y

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