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Lactulose Hydrogen Breath Test and Functional Symptoms in Pediatric Patients

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Abstract

Background

The role of small intestinal bacterial overgrowth (SIBO) in functional digestive disorders in the pediatric population is a matter of controversy, since methods currently used to establish this diagnosis are difficult to interpret. The aim of this work was to analyze the characteristics of the lactulose H2 breath test (LHBT) in children with functional gastrointestinal symptoms according to more recent criteria.

Methods

Seventy-two patients and 17 controls were enrolled. A questionnaire was administered regarding digestive symptoms (abdominal pain, bloating, vomiting, and bowel-movement disorders). A lactose hydrogen breath test was performed to rule out lactose malabsorption and a LHBT was used to measure the time elapsed between lactulose oral ingestion and an increment of H2 concentration of 20 ppm over basal.

Results

There were no differences of age and gender between patients and controls. Mean time to 20-ppm change was shorter in patients (56.3 ± 3 min) compared to healthy children (74.7 ± 5 min), p < 0.05. In 39% of patients, rise of H2 occurred during the first 40 min after lactulose ingestion, and in almost all controls, an increment was observed between 50 and 90 min (p < 0.05). Symptoms were unrelated to time to 20-ppm change.

Conclusions

An abnormal LHBT was found in children with functional symptoms of the digestive tract, but the exact mechanism involved, accelerated intestinal transit or SIBO, needs to be confirmed by an additional method.

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References

  1. Rana SV, Bhardwaj SB. Small intestinal bacterial overgrowth. Scand J Gastroenterol. 2008;43:1030–1037.

    Article  PubMed  CAS  Google Scholar 

  2. Quigley EMM, Quera R. Small intestinal bacterial overgrowth: roles of antibiotics, prebiotics, and probiotics. Gastroenterology. 2006;130:S78–S90.

    Article  PubMed  CAS  Google Scholar 

  3. Stewart BA, Karrer FM, Hall RJ, Lilly JR. The blind loop syndrome in children. J Pediatr Surg. 1990;25:905–908.

    Article  PubMed  CAS  Google Scholar 

  4. Jackson CC, Bettolli MM, De Carli CF, et al. Beware of stapled side-to-side bowel anastomoses in small children. Eur J Pediatr Surg. 2007;17:426–427.

    Article  PubMed  Google Scholar 

  5. Maestri L, Fava G, Fontana M, et al. Small bowel overgrowth: a frequent complication after abdominal surgery in newborns. Pediatr Med Chir. 2002;24:374–376.

    PubMed  CAS  Google Scholar 

  6. Duro D, Kamin D, Duggan C. Overview of pediatric short bowel syndrome. J Pediatr Gastroenterol Nutr. 2008;47:S33–S36.

    Article  PubMed  Google Scholar 

  7. Ballesteros P, Vidal Casariego A. Short bowel syndrome: definition, causes, intestinal adaptation and bacterial overgrowth. Nutr Hosp. 2007;22:74–85.

    Google Scholar 

  8. Lisowska A, Wójtowicz J, Walkowiak. Small intestine bacterial overgrowth is frequent in cystic fibrosis: combined hydrogen and methane measurements are required for its detection. Acta Biochimica Polonica. 2009;56:1–4.

    Google Scholar 

  9. Goulet O, Jobert-Giraud A, Michel JL, et al. Chronic intestinal pseudo-obstruction syndrome in pediatric patients. Eur J Pediatr Surg. 1999;9:83–89.

    Article  PubMed  CAS  Google Scholar 

  10. De Boissieu D, Chaussain M, Badoual J, Raymond J, Dupont C. Small-bowel bacterial overgrowth in children with chronic diarrhea, abdominal pain, or both. J Pediatr. 1996;128:203–207.

    Article  PubMed  Google Scholar 

  11. Collins BS, Lin HC. Chronic abdominal pain in children is associated with high prevalence of abnormal microbial fermentation. Dig Dis Sci. 2010;55:124–130.

    Article  PubMed  Google Scholar 

  12. Scarpellini E, Giorgio V, Gabrielli M, et al. Prevalence of small intestinal bacterial overgrowth in children with irritable bowel syndrome: a case–control study. J Pediatr. 2009;155:416–420.

    Article  PubMed  CAS  Google Scholar 

  13. Hocking MP, Davis GL, Franzini DA, Woodward ER. Long-term consequences after jejunoileal bypass for morbid obesity. Dig Dis Sci. 1998;43:2493–2499.

    Article  PubMed  CAS  Google Scholar 

  14. Leung FW, Drenick EJ, Stanley TM. Intestinal bypass complications involving the excluded small bowel segment. Am J Gastroenterol. 1982;77:67–72.

    PubMed  CAS  Google Scholar 

  15. Di Stefano M, Micelli E, Missanelli A, Mazzocchi S, Corazza GR. Absorbable versus non-absorbable antibiotics in the treatment of small intestine bacterial overgrowth in patients with blind-loop syndrome. Aliment Pharmacol Ther. 2005;21:985–992.

    Article  PubMed  Google Scholar 

  16. Pearce VR. The importance of duodenal diverticula in the elderly. Postgrad Med J. 1980;56:777–780.

    Article  PubMed  CAS  Google Scholar 

  17. Parson AJ, Brzechwa-Ajdukiewicz A, McCarthy CF. Intestinal pseudo-obstruction, with bacterial overgrowth in the small intestine. Am J Dig Dis. 1969;14:200–205.

    Article  PubMed  CAS  Google Scholar 

  18. Paerregaard A, Justesen T, Prytz H, Andersen B, Gudmand-Hoeyer E. Metronidazole treatment of bypass-enteropathy after jejunoileal shunt-operation for obesity. Acta Chir Scand. 1982;148:153–156.

    PubMed  CAS  Google Scholar 

  19. Vanner S. The small intestinal bacterial overgrowth. Irritable bowel syndrome hypothesis: implications for treatment. Gut. 2008;57:1315–1321.

    Article  PubMed  CAS  Google Scholar 

  20. Ford AC, Spiegel BM, Talley NJ, Moayyedi P. Small intestinal bacterial overgrowth in irritable bowel syndrome: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2009;7:1279–1286.

    Article  PubMed  Google Scholar 

  21. Lin HC. Small intestinal bacterial overgrowth. A framework for understanding irritable bowel syndrome. JAMA. 2004;292:852–858.

    Article  PubMed  CAS  Google Scholar 

  22. Posserud I, Stotzer P-O, Björnsson ES, Abrahamsson H, Simrén M. Small intestinal bacterial overgrowth in patients with irritable bowel syndrome. Gut. 2007;56:802–808.

    Article  PubMed  Google Scholar 

  23. Pimentel M, Chow EJ, Lin HC. Eradication of small bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol. 2000;95:3503–3506.

    Article  PubMed  CAS  Google Scholar 

  24. 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.

    PubMed  Google Scholar 

  25. Madrid AM, Defilippi CC, Defilippi GC, Slimming AJ, Quera PR. Small intestinal bacterial overgrowth in patients with functional gastrointestinal diseases. Rev Med Chil. 2007;135:1245–1252.

    PubMed  Google Scholar 

  26. Yu D, Cheeseman F, Vanner S. Combined oro-caecal scintigraphy and lactulose hydrogen breath testing demonstrate that breath testing detects oro-caecal transit, not small intestinal bacterial overgrowth in patients with IBS. Gut. 2011;60:334–340.

    Article  PubMed  Google Scholar 

  27. Grand RJ, Montgomery RK. Lactose malabsorption. Curr Treat Opt Gastroenterol. 2008;11:19–25.

    Article  Google Scholar 

  28. Shulman RJ, Eakin MN, Czyzewski DI, Jarrett M, Ou Ch-N. Increased gastrointestinal permeability and gut inflammation in children with functional abdominal pain and irritable bowel syndrome. J Pediatr. 2008;153:646–650.

    Article  PubMed  Google Scholar 

  29. Di Lorenzo C, Youssef NN, Sigurdsson L, et al. Visceral hyperalgesia in children with functional abdominal pain. J Pediatr. 2001;139:838–843.

    Article  PubMed  Google Scholar 

  30. 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.

    Article  PubMed  Google Scholar 

  31. Collins BS, Lin HC. Double-blind, placebo-controlled antibiotic treatment study of small intestinal bacterial overgrowth in children with chronic abdominal pain. J Pediatr Gastroenterol Nutr. 2011;52:382–386.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The authors would like to thank Mr. José Matus F. for his technical assistance and Prof. Antonio Morales M.D. for his careful review of this manuscript.

Conflict of interest

The authors declare no conflict of interests in the present article. The present article did not receive any funding or support from the pharmaceutical industry.

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Authors and Affiliations

  1. Laboratory of Motility and Functional Digestive Disorders, GI Section, Medicine Department, University Hospital, University of Chile, Santos Dumont 999, Santiago, Chile

    Ana María Madrid, Glauben Landskron, Gabriela Klapp, Carolina Pizarro & Carlos Defilippi

  2. Office of Clinical Research, University Hospital, University of Chile, Santiago, Chile

    Alvaro Reyes

Authors
  1. Ana María Madrid
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  2. Glauben Landskron
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  3. Gabriela Klapp
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  4. Alvaro Reyes
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  5. Carolina Pizarro
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  6. Carlos Defilippi
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Correspondence to Ana María Madrid.

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Madrid, A.M., Landskron, G., Klapp, G. et al. Lactulose Hydrogen Breath Test and Functional Symptoms in Pediatric Patients. Dig Dis Sci 57, 1330–1335 (2012). https://doi.org/10.1007/s10620-012-2032-8

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  • DOI: https://doi.org/10.1007/s10620-012-2032-8

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