Digestive Diseases and Sciences

, Volume 42, Issue 8, pp 1587–1592 | Cite as

Improvement in Specificity of [14C]d-Xylose Breath Test for Bacterial Overgrowth

  • Stephen J. Lewis
  • Gerry Young
  • Michael Mann
  • Sharon Franco
  • Stephen J. D. O'Keefe
Article

Abstract

The aim of the study was to determine whetherthe specificity of the [14C]d-xylose breathtest could be improved, by excluding false-positivetests due to premature colonic metabolism of the[14C]d-xylose caused by rapid colonictransit. Forty-seven patients with suspected small bowelbacterial overgrowth were investigated by (1) aspirationand culture of duodenal fluid and (2) a[14C]d-xylose breath test. Those with either a positiveduodenal culture or breath test had a repeat[14C]d-xylose breath test given with one ofthree transit markers (barium, Gastrografin or99mTc-labeled tin colloid) to determine if the site of metabolism was inthe small bowel or colon. Fourteen patients had positiveduodenal cultures, four of whom had a negative[14C]d-xylose breath test, 15 patients had apositive [14C]d-xylose breath test, three ofwhich were due to colonic metabolism of the xylose.Where transit markers were used, 14C wasdetectable in the breath and serum before barium hadentered the small bowel, thus the barium did not comigrate withthe xylose. Gastrografin accelerated small boweltransit, leading to malabsorption of the xylose in thesmall intestine and subsequent colonic metabolism of the xylose. 99mTc-labeled tincolloid had no obvious disadvantages and appeared to bethe marker of choice. The use of a transit markerincreased the specificity of the[14C]d-xylose breath test from 85% to 94%. The specificity of the[14C]d-xylose breath test for the detectionof small bowel bacterial overgrowth is improved togreater than 90% by the use of an appropriate transitmarker.

BACTERIAL OVERGROWTH BREATH TEST MALABSORPTION 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

REFERENCES

  1. 1.
    Gorbach SL, Plaut AG, Nahas L, Weinstein L, Spanknebel G, Levitan R: Studies of intestinal microflora. Gastroenterology 53:856–867, 1967Google Scholar
  2. 2.
    Drasar BS, Shiner M, McLeod GM: Studies on the intestinal flora. Gastroenterology 56:71–79, 1969Google Scholar
  3. 3.
    Kirsch M: Bacterial overgrowth. Am J Gastroenterol 85:231–237, 1990Google Scholar
  4. 4.
    King CE, Toskes PP: Small intestinal bacterial overgrowth. Gastroenterology 76:1035–1055, 1979Google Scholar
  5. 5.
    Drude RB, Hines C: The pathophysiology of intestinal bacterial overgrowth syndromes. Arch Intern Med 140:1349–1352, 1980Google Scholar
  6. 6.
    Toskes PP: Bacterial overgrowth of the gastrointestinal tract. Adv Intern Med 38:387–407, 1993Google Scholar
  7. 7.
    MacMahon M, Lynch M, Mullins E, et al: Small intestinal bacterial overgrowth-An incidental finding? J Am Geriatr Soc 42:146–149, 1994Google Scholar
  8. 8.
    Tillman R, King C, Toskes P: Continued experience with the xylose breath test: evidence that the small bowel culture as the gold standard for bacterial overgrowth may be tarnished. Gastroenterology 80:1304, 1981Google Scholar
  9. 9.
    Riordan SM, McIver CJ, Bolin TD, Duncombe VM: Fasting breath hydrogen concentrations in gastric and small-intestinal bacterial overgrowth. Scand J Gastroenterol 30:252–257, 1995Google Scholar
  10. 10.
    Donald: The diagnosis of small bowel bacterial overgrowth in elderly patients. J Am Geriatr Soc 40:692–696, 1992Google Scholar
  11. 11.
    Haboubi NY, Mongowery RD: Small bowel overgrowth in elderly people, clinical significance and responce to treatment. Age Ageing 21:13–19, 1992Google Scholar
  12. 12.
    King CE, Toskes PP, Spivey JC, Lorenz E, Welkos S: Detection of small intestinal bacterial overgrowth by means of a 14C-d-xylose breath test. Gastroenterol 77:75–82, 1979Google Scholar
  13. 13.
    King CE, Toskes PP: Comparison of the 1-gram [14C]xylose, 10-gram lactulose-H2, and 80-gram glucose-H2 breath tests in patients with small intestine bacterial overgrowth. Gastroenterology 91:1447–1451, 1986Google Scholar
  14. 14.
    Fromm H, Hofmann AF: Breath test for altered bile-acid metabolism. Lancet 2:621–625, 1971Google Scholar
  15. 15.
    Wren MWD: Multiple selective media for the isolation of anaerobic bacteria from clinical specimens. J Clin Pathol 33:61–65, 1980Google Scholar
  16. 16.
    Young GO, O'Keefe SJD: Assessment of small bowel bacterial overgrowth by the 14C xylose breath test. S Afr J Clin Nutr 1:37–41, 1988Google Scholar
  17. 17.
    Fraser GM, Adam RD: Modifications to the gas-enhanced small bowel barium follow-through using gastrografin and compression. Clin Radiol 39:537–541, 1988Google Scholar

Copyright information

© Plenum Publishing Corporation 1997

Authors and Affiliations

  • Stephen J. Lewis
  • Gerry Young
  • Michael Mann
  • Sharon Franco
  • Stephen J. D. O'Keefe

There are no affiliations available

Personalised recommendations