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Impact of Oral-Cecal Transit Time on the Interpretation of Lactulose Breath Tests After RYGB: a Personalized Approach to the Diagnosis of SIBO

Obesity Surgery volume 29, pages 771–775 (2019)Cite this article

Abstract

Background

Traditionally, small intestinal bacterial overgrowth (SIBO) is diagnosed when there is an early peak in breath hydrogen or methane. Given unclear intestinal transit time in Roux-en-Y gastric bypass (RYGB) patients, it is unknown if the traditional approach at diagnosing SIBO is adequate in this patient population.

Aim

To assess oral-cecal transit time (OCTT) and its impact on the interpretation of breath tests in the diagnosis of SIBO in patients with RYGB.

Methods

This study was a retrospective review of prospectively collected data on RYGB patients who underwent testing for SIBO using lactulose breath test (LBT) with or without small bowel follow-through (SBFT) to assess OCTT. Outcomes of SIBO test based on LBT alone versus LBT with OCTT were compared using a chi-squared test.

Results

Sixty-two of the 151 RYGB patients who underwent LBT underwent an additional SBFT to assess OCTT. Median OCTT was 60 min. Of these, 59.7% had OCTT shorter than 90 min. Based on LBT alone, 36/62 patients (58.1%) were classified as positive SIBO. When LBT results were combined with OCTT, 26/36 patients (72.2%) had hydrogen or methane rise within OCTT, suggesting 27.8% false positive rate. Patients with true positive SIBO based on LBT and OCTT had a higher response rate to antibiotics compared to those with false positive SIBO (78.3% vs. 33.3%, p = 0.03).

Conclusion

A personalized approach of combining LBT with SBFT to assess OCTT may improve the accuracy of SIBO testing and enhance clinical outcomes in patients with RYGB.

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Author information

Affiliations

  1. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Pichamol Jirapinyo, Tracy T. Makuvire, Walter W. Chan & Christopher C. Thompson

  2. Harvard Medical School, Boston, MA, USA

    Pichamol Jirapinyo, Tracy T. Makuvire, Walter W. Chan & Christopher C. Thompson

  3. Stony Brook University, Stony Brook, NY, USA

    William Y. Dong

Authors
  1. Pichamol Jirapinyo
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  2. Tracy T. Makuvire
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  3. William Y. Dong
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  4. Walter W. Chan
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  5. Christopher C. Thompson
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Contributions

Pichamol Jirapinyo: Study design, data collection and analysis, drafting and revision of the manuscript

Tracy T. Makuvire: Data collection

William Y. Dong: Data collection

Walter W. Chan: Study design, study analysis

Christopher C. Thompson: Study design, critical revision of the manuscript

Corresponding author

Correspondence to Christopher C. Thompson.

Ethics declarations

The study was approved by the Institutional Review Board (IRB) (IRB Protocol Number, 2013P001597).

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approvement Statement

For this type of study, formal consent is not required.

Informed Consent Statement

Does not apply.

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Jirapinyo, P., Makuvire, T.T., Dong, W.Y. et al. Impact of Oral-Cecal Transit Time on the Interpretation of Lactulose Breath Tests After RYGB: a Personalized Approach to the Diagnosis of SIBO. OBES SURG 29, 771–775 (2019). https://doi.org/10.1007/s11695-018-3575-3

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  • DOI: https://doi.org/10.1007/s11695-018-3575-3

Keywords

  • RYGB
  • Bariatric
  • SIBO
  • Bacterial overgrowth
  • Breath test
  • Bloating
  • Abdominal pain