OJGas  Vol.5 No.11 , November 2015
Pilot Study on Gas Patterns of Irritable Bowel Syndrome and Small Intestinal Bacterial Overgrowth Following Ingestion of Lactulose
Author(s) Yoshiharu Uno1,2
ABSTRACT
Background & Aims: Fermentation site and increasing time of symptomatic gas would be different between irritable bowel syndrome (IBS) and small intestine bacterial overgrowth (SIBO). The aim of this study was to determine the time for increase in abdominal gas following ingestion of lactulose and the possibility of differential diagnosis of SIBO and IBS. Methods: A prospective study was conducted on a series of IBS patients (n = 14) who were referred to the Oroku-Hospital (Okinawa, Japan) from June 6, 2014 to December 30, 2014. Imaging was first performed in early morning after fasting. After ingestion of lactulose, 1 - 4 plain abdominal radiographs were taken for investigation of increased gas during the indicated timeframe. Regions of interest of the gas areas were highlighted on the images obtained. Gas images were divided into three areas, the stomach, small intestine, and large intestine, and each total area was calculated. Results: At a dose of 10 g lactulose and an observation time of two hours, patients displayed no symptoms, and the gas volume was only slightly increased. However, when the dose of lactulose was increased (13 g/50 kg), and the observation time for the lactulose challenge was extended to 240 - 300 minutes, the results clearly demonstrated an increase in the gas produced in IBS patients. Conclusions: An increased dose of lactulose coupled with an extended observation time for the lactulose challenge clearly demonstrated an increase in the gas produced in IBS patients. Alterations in diet rather than antibiotics might reduce IBS symptoms.

Cite this paper
Uno, Y. (2015) Pilot Study on Gas Patterns of Irritable Bowel Syndrome and Small Intestinal Bacterial Overgrowth Following Ingestion of Lactulose. Open Journal of Gastroenterology, 5, 155-163. doi: 10.4236/ojgas.2015.511025.
References
[1]   Ghoshal, U.C. and Srivastava, D. (2014) Irritable Bowel Syndrome and Small Intestinal Bacterial Overgrowth: Meaningful Association or Unnecessary Hype. World Journal of Gastroenterology, 20, 2484-2491.
http://dx.doi.org/10.3748/wjg.v20.i10.2482

[2]   William, B., Ishaq, N., Bolin, T.D., et al. (2014) Overgrowth of the Indigenous Gut Microbiome and Irritable Bowel Syndrome. World Journal of Gastroenterology, 20, 2449-2455.
http://dx.doi.org/10.3748/wjg.v20.i10.2449

[3]   Rana, S.V. and Malik, A. (2014) Breath Tests and Irritable Bowel Syndrome. World Journal of Gastroenterology, 20, 7587-601.
http://dx.doi.org/10.3748/wjg.v20.i24.7587

[4]   Sachdev, A.H. and Pimentel, M. (2012) Antibiotics for Irritable Bowel Syndrome: Rationale and Current Evidence. Current Gastroenterology Reports, 14, 439-445.
http://dx.doi.org/10.1007/s11894-012-0284-2

[5]   Sachdev, A.H. and Pimentel, M. (2013) Gastrointestinal Bacterial Overgrowth: Pathogenesis and Clinical Significance. Therapeutic Advances in Chronic Disease, 4, 223-231.
http://dx.doi.org/10.1177/2040622313496126

[6]   Pimentel, M., Chow, E.J. and Lin, H.C. (2000) Eradication of Small Intestinal Bacterial Overgrowth Reduces Symptoms of Irritable Bowel Syndrome. The American Journal of Gastroenterology, 95, 3503-3506.
http://dx.doi.org/10.1111/j.1572-0241.2000.03368.x

[7]   Nucera, G., Gabrielli, M., Lupascu, A., et al. (2005) Abnormal Breath Tests to Lactose, Fructose and Sorbitol in Irritable Bowel Syndrome May Be Explained by Small Intestinal Bacterial Overgrowth. Alimentary Pharmacology & Therapeutics, 21, 1391-1395.
http://dx.doi.org/10.1111/j.1365-2036.2005.02493.x

[8]   Posserud, I., Stotzer, P.O., Bjornsson, E.S., et al. (2007) Small Intestinal Bacterial Overgrowth in Patients with Irritable Bowel Syndrome. Gut, 56, 802-808.
http://dx.doi.org/10.1136/gut.2006.108712

[9]   Scarpellini, E., Giorgio, V., Gabrielli, M., et al. (2009) Prevalence of Small Intestinal Bacterial Overgrowth in Children with Irritable Bowel Syndrome: A Case-Control Study. The Journal of Pediatrics, 155, 416-420.
http://dx.doi.org/10.1016/j.jpeds.2009.03.033

[10]   Ford, A.C., Spiegel, B.M., Talley, N.J., et al. (2009) Small Intestinal Bacterial Overgrowth in Irritable Bowel Syndrome: Systematic Review and Meta-Analysis. Clinical Gastroenterology and Hepatology, 7, 1279-1286.
http://dx.doi.org/10.1016/j.cgh.2009.06.031

[11]   Parodi, A., Dulbecco, P., Savarino, E., et al. (2009) Positive Glucose Breath Testing Is More Prevalent in Patients with IBS-Like Symptoms Compared with Controls of Similar Age and Gender Distribution. Journal of Clinical Gastroenterology, 43, 962-966.
http://dx.doi.org/10.1097/MCG.0b013e3181a099a5

[12]   Reddymasu, S.C., Sostarich, S. and McCallum, R.W. (2010) Small Intestinal Bacterial Overgrowth in Irritable Bowel Syndrome: Are There Any Predictors? BMC Gastroenterology, 10, 23.
http://dx.doi.org/10.1186/1471-230X-10-23

[13]   Ghoshal, U.C., Kumar, S., Mehrotra, M., et al. (2010) Frequency of Small Intestinal Bacterial Overgrowth in Patients with Irritable Bowel Syndrome and Chronic Non-Specific Diarrhea. Journal of Neurogastroenterology and Motility, 16, 40-46.
http://dx.doi.org/10.5056/jnm.2010.16.1.40

[14]   Bratten, J.R., Spanier, J. and Jones, M.P. (2008) Lactulose Breath Testing Does Not Discriminate Patients with Irritable Bowel Syndrome from Healthy Controls. The American Journal of Gastroenterology, 103, 958-963.
http://dx.doi.org/10.1111/j.1572-0241.2008.01785.x

[15]   Vanner, S. (2008) The Lactulose Breath Test for Diagnosing SIBO in IBS Patients: Another Nail in the Coffin. The American Journal of Gastroenterology, 103, 964-965.
http://dx.doi.org/10.1111/j.1572-0241.2008.01798.x

[16]   Pimentel, M., Lembo, A., Chey, W.D., et al. (2011) Rifaximin Therapy for Patients with Irritable Bowel Syndrome without Constipation. New England Journal of Medicine, 364, 22-32.
http://dx.doi.org/10.1056/NEJMoa1004409

[17]   Vanner, S. (2008) The Small Intestinal Bacterial Overgrowth. Irritable Bowel Syndrome Hypothesis: Implications for Treatment. Gut, 57, 1315-1321.
http://dx.doi.org/10.1136/gut.2007.133629

[18]   Lacy, B.E., Gabbard, S.L. and Crowell, M.D. (2011) Pathophysiology, Evaluation, and Treatment of Bloating: Hope, Hype, or Hot Air? Gastroenterology and Hepatology, 7, 729-739.

[19]   Harder, H., Serra, J., Azpiroz, F., et al. (2003) Intestinal Gas Distribution Determines Abdominal Symptoms. Gut, 52, 1708-1713.
http://dx.doi.org/10.1136/gut.52.12.1708

[20]   Gabrielli, M., D’Angelo, G., Di Rienzo, T., et al. (2013) Diagnosis of Small Intestinal Bacterial Overgrowth in the Clinical Practice. European Review for Medical and Pharmacological Sciences, 17, 30-35.

[21]   Koide, A., Yamaguchi, T., Odaka, T., et al. (2000) Quantitative Analysis of Bowel Gas Using Plain Abdominal Radiograph in Patients with Irritable Bowel Syndrome. The American Journal of Gastroenterology, 95, 1735-1741.
http://dx.doi.org/10.1111/j.1572-0241.2000.02189.x

[22]   Morken, M.H., Berstad, A.E., Nysaeter, G., et al. (2007) Intestinal Gas in Plain Abdominal Radiographs Does Not Correlate with Symptoms after Lactulose Challenge. European Journal of Gastroenterology & Hepatology, 19, 589-593.
http://dx.doi.org/10.1097/MEG.0b013e328133f2e7

[23]   Youn, Y.H., Park, J.S., Jahng, J.H., et al. (2011) Relationships among the Lactulose Breath Test, Intestinal Gas Volume, and Gastrointestinal Symptoms in Patients with Irritable Bowel Syndrome. Digestive Diseases and Sciences, 56, 2059-2066.
http://dx.doi.org/10.1007/s10620-011-1569-2

[24]   Mc Williams, S.R., Mc Laughlin, P.D., O’Connor, O.J., et al. (2012) Computed Tomography Assessment of Intestinal Gas Volumes in Functional Gastrointestinal Disorders. Journal of Neurogastroenterology and Motility, 18, 419-425.
http://dx.doi.org/10.5056/jnm.2012.18.4.419

[25]   Roland, B.C., Ciarleglio, M.M., Clarke, J.O., et al. (2015) Small Intestinal Transit Time Is Delayed in Small Intestinal Bacterial Overgrowth. Journal of Clinical Gastroenterology, 49, 571-576.

[26]   Longstreth, G.F., Thompson, W.G., Chey, W.D., et al. (2006) Functional Bowel Disorders. Gastroenterology, 130, 1480-1491.
http://dx.doi.org/10.1053/j.gastro.2005.11.061

[27]   Bond Jr., J.H. and Levitt, M.D. (1972) Use of Pulmonary Hydrogen (H2) Measurements to Quantitate Carbohydrate Absorption. Study of Partially Gastrectomized Patients. Journal of Clinical Investigation, 51, 1219-1225.
http://dx.doi.org/10.1172/JCI106916

[28]   Ghoshal, U.C., Ghoshal, U., Ayyagari, A., et al. (2003) Tropical Sprue Is Associated with Contamination of Small Bowel with Aerobic Bacteria and Reversible Prolongation of Orocecal Transit Time. Journal of Gastroenterology and Hepatology, 18, 540-547.
http://dx.doi.org/10.1046/j.1440-1746.2003.03006.x

[29]   Lu, C.L., Chen, C.Y., Chang, F.Y., et al. (1998) Characteristics of Small Bowel Motility in Patients with Irritable Bowel Syndrome and Normal Humans: An Oriental Study. Clinical Science, 95, 165-169.
http://dx.doi.org/10.1042/cs0950165

[30]   Gibson, P.R. and Shepherd, S.J. (2005) Personal View: Food for Thought—Western Lifestyle and Susceptibility to Crohn’s Disease. The FODMAP Hypothesis. Alimentary Pharmacology and Therapeutics, 21, 1399-1409.
http://dx.doi.org/10.1111/j.1365-2036.2005.02506.x

[31]   Gibson, P.R. and Shepherd, S.J. (2012) Foodchoiceas a Key Management Strategy for Functional Gastrointestinal Symptoms. The American Journal of Gastroenterology, 107, 657-666.
http://dx.doi.org/10.1038/ajg.2012.49

[32]   Blaser, M. (2011) Antibiotic Overuse: Stop the Killing of Beneficial Bacteria. Nature, 476, 393-394.

 
 
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