1
|
Schindler V, Huellner M, Murray F, Schnurre L, Becker AS, Bordier V, Pohl D. Nutrient Challenge Testing Is Not Equivalent to Scintigraphy-Lactulose Hydrogen Breath Testing in Diagnosing Small Intestinal Bacterial Overgrowth. J Neurogastroenterol Motil 2020; 26:514-520. [PMID: 32989187 PMCID: PMC7547189 DOI: 10.5056/jnm19162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 06/07/2020] [Accepted: 07/03/2020] [Indexed: 11/20/2022] Open
Abstract
Background/Aims Small intestinal bacterial overgrowth (SIBO) is a common condition in disorders of gut-brain interaction (DGBI). Recently, a combined scintigraphy–lactulose hydrogen breath test (ScLHBT) was described as an accurate tool diagnosing SIBO. We aim to analyze whether a lactulose nutrient challenge test (NCT), previously shown to separate DGBI from healthy volunteers, is equivalent to ScLHBT in diagnosing SIBO. Methods We studied data of 81 DGBI patients undergoing ScLHBT with 30 g lactulose and 300 mL water as well as NCT with 30 g lactulose and a 400 mL liquid test meal. Differences in proportion of positive SIBO diagnoses according to specified cecal load and time criteria for NCT and ScLHBT, respectively, were tested in an equivalence trial. An odds ratio (OR) range of 0.80-1.25 was considered equivalent. Results Diagnosis of SIBO during NCT was not equivalent to SIBO diagnosis in ScLHBT, considering a hydrogen increase before cecal load of 5.0%, 7.5%, or 10.0%, respectively ([OR, 3.76; 90% CI, 1.99-7.09], [OR, 1.87; 90% CI, 1.06-3.27], and [OR, 1.11; 90% CI, 0.65-1.89]). Considering only time to hydrogen increase as criterion, the odds of a positive SIBO diagnosis in the NCT (0.65) was lower than in ScLHBT (1.70) (OR, 0.38; 90% CI, 0.23-0.65). Conclusions This study could not show an equivalence of NCT and ScLHBT in diagnosing SIBO. A possible explanation might be the different transit times owing to unequal testing substances. The effect of this deviation in relation to consecutive therapy regimens should be tested in further prospective studies.
Collapse
Affiliation(s)
- Valeria Schindler
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Martin Huellner
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Fritz Murray
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Larissa Schnurre
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Anton S Becker
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Valentine Bordier
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Daniel Pohl
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
2
|
Clifford MN, Kerimi A, Williamson G. Bioavailability and metabolism of chlorogenic acids (acyl‐quinic acids) in humans. Compr Rev Food Sci Food Saf 2020; 19:1299-1352. [DOI: 10.1111/1541-4337.12518] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 10/08/2019] [Accepted: 11/13/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Michael N. Clifford
- School of Bioscience and Medicine, Faculty of Health and Medical SciencesUniversity of Surrey Guildford UK
- Department of Nutrition, Dietetics, and Food, School of Clinical Sciences at Monash HealthFaculty of Medicine Nursing and Health SciencesMonash University Notting Hill Victoria Australia
| | - Asimina Kerimi
- Department of Nutrition, Dietetics, and Food, School of Clinical Sciences at Monash HealthFaculty of Medicine Nursing and Health SciencesMonash University Notting Hill Victoria Australia
| | - Gary Williamson
- Department of Nutrition, Dietetics, and Food, School of Clinical Sciences at Monash HealthFaculty of Medicine Nursing and Health SciencesMonash University Notting Hill Victoria Australia
| |
Collapse
|
3
|
Hettiarachchi P, Wickremasinghe AR, Frost GS, Deen KI, Pathirana AA, Murphy KG, Jayaratne SD. Resection of the large bowel suppresses hunger and food intake and modulates gastrointestinal fermentation. Obesity (Silver Spring) 2016; 24:1723-30. [PMID: 27460713 DOI: 10.1002/oby.21550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/15/2016] [Accepted: 04/19/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To assess appetite and gut hormone levels in patients following partial (PR) or total resection (TR) of the large bowel. METHODS A comparative cross sectional study was carried out with healthy controls (n = 99) and patients who had undergone PR (n = 64) or TR (n = 12) of the large bowel. Participants consumed a standard (720 kcal) breakfast meal at 0830 (t = 0) h followed by lactulose (15 g) and a buffet lunch (t = 210 min). Participants rated the subjective feelings of hunger at t = -30, 0, 30, 60, 120, and 180 min. Breath hydrogen (BH) concentrations were also evaluated. In a matched subset (11 controls, 11 PR and 9 TR patients) PYY and GLP-1 concentrations were measured following breakfast. The primary outcome measure was appetite, as measured using visual analogue scales and the buffet lunch. The secondary outcome was BH concentrations following a test meal. RESULTS PR and TR participants had lower hunger and energy intake at the buffet lunch meal compared to controls. PR subjects had higher BH concentrations compared to controls and TR subjects. BH levels correlated with circulating GLP-1 levels at specific time points. CONCLUSIONS PR or TR of the large bowel reduced feelings of hunger and energy intake, and PR increased gastrointestinal fermentation.
Collapse
Affiliation(s)
- Priyadarshika Hettiarachchi
- Department of Physiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | - Gary S Frost
- Nutrition and Dietetic Research Group, Department of Medicine, Imperial College, London, UK
| | - Kemal I Deen
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Ajith A Pathirana
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Kevin G Murphy
- Section of Investigative Medicine, Department of Medicine, Imperial College, London, UK
| | - SriLal D Jayaratne
- Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| |
Collapse
|
4
|
Abstract
Accurately measuring the complex motor behaviors of the gastrointestinal tract has tremendous value for the understanding, diagnosis and treatment of digestive diseases. This review synthesizes the literature regarding current tests that are used in both humans and animals. There remains further opportunity to enhance such tests, especially when such tests are able to provide value in both the preclinical and the clinical settings.
Collapse
Key Words
- acute pancreatitis
- biliary pancreatitis
- necroptosis
- apoptosis
- pancreatic cell death
- ac, ascending colon
- cf6, filling the colon at 6 hours
- ct, computed tomography
- gebt, gastric emptying breath test
- hdam, high-definition anorectal pressure manometry/topography
- hram, high-resolution anorectal manometry
- ht, hydroxytryptophan
- iqr, interquartile range
- mmc, migrating motor complex
- mri, magnetic resonance imaging
- 99mtc, technetium-99m
- spect, single-photon emission computed tomography
- 13c, carbon-13
- 3-d, 3-dimensional
- wmc, wireless motility capsule
Collapse
|
5
|
Zhao J, Zheng X, Chu H, Zhao J, Cong Y, Fried M, Fox M, Dai N. A study of the methodological and clinical validity of the combined lactulose hydrogen breath test with scintigraphic oro-cecal transit test for diagnosing small intestinal bacterial overgrowth in IBS patients. Neurogastroenterol Motil 2014; 26:794-802. [PMID: 24641100 DOI: 10.1111/nmo.12331] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 02/21/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Small intestinal bacterial overgrowth (SIBO) may be a cause of irritable bowel syndrome (IBS); however, current investigations have important limitations. We aimed to identify clinically relevant diagnostic criteria for SIBO based on lactulose hydrogen breath test (LHBT) alone and combined with scintigraphic measurement of oro-cecal transit (SOCT). METHODS Results of LHBT/SOCT investigation from 89 IBS patients and 13 healthy volunteers were included in a systematic analysis of six published criteria for SIBO diagnosis. Clinical relevance of competing criteria was determined by assessing (i) prevalence of SIBO in IBS patients and healthy volunteers (ii) if SIBO diagnosis predicted improvement in IBS symptoms in a prospective, pilot therapeutic trial of a non-absorbable antibiotic (rifaximin 600 mg b.d.) in IBS patients. KEY RESULTS Reproducibility of SIBO diagnosis by combined LHBT/SOCT was near perfect. A ≥5 ppm H2 increase prior to appearance of cecal contrast was detected in more IBS patients than healthy volunteers (35/89 vs 1/13; p = 0.026), but not for other diagnostic criteria. IBS patients with SIBO, compared to those without SIBO, reported significantly greater improvement in abdominal symptoms following rifaximin therapy (p < 0.002 overall IBS symptom severity). This improvement was most marked in D-IBS patients in whom all symptoms improved, including stool frequency and consistency (all p < 0.004). CONCLUSIONS & INFERENCES Combined LHBT/SOCT testing using a H2 5 ppm cutoff may identify a subgroup of IBS patients with SIBO. Pilot data examining the clinical response to rifaximin suggest that this subset of IBS patients may benefit more than those with a normal test.
Collapse
Affiliation(s)
- J Zhao
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Division of Gastroenterology & Hepatology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | | | | | | | | | | | | | | |
Collapse
|
6
|
Joint SNMMI and EANM guideline for small-bowel and colon transit: an important step towards long-awaited standardization. Eur J Nucl Med Mol Imaging 2014; 41:405-7. [DOI: 10.1007/s00259-013-2650-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
7
|
Abstract
Transit assessment of the small intestine and colon is relevant in the study of physiology, pathophysiology, and pharmacodynamics, and there is increasing use of small-bowel and colonic transit measurements in clinical practice as well. The main methods that are applied in clinical practice are substrate-hydrogen breath tests for small-bowel transit and radiopaque markers for colonic transit. Over the past 2-3 decades, scintigraphy has become the preferred standard in research studies, particularly for studies of pathophysiology and pharmacodynamics. New approaches include experimental stable isotope measurement of orocecal transit and the recently approved method using a wireless motility capsule that is validated as an accurate measurement of small-bowel and colonic transit.
Collapse
Affiliation(s)
- Lawrence A Szarka
- Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | |
Collapse
|
8
|
Gastric emptying and orocaecal transit time of meals containing lactulose or inulin in men. Br J Nutr 2010; 104:554-9. [PMID: 20370945 DOI: 10.1017/s0007114510000905] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The H(2) breath test is ideal for orocaecal transit time (OCTT) measurement, as it is non-invasive and inexpensive. Indigestible substrates added to a test meal are metabolised by the colonic bacteria, resulting in the production of H(2) which is detected in end-exhalation breath. However, the substrates themselves can alter the transit times in the gastrointestinal tract. The aim of the present study is to compare OCTT and gastric emptying (GE) when lactulose in liquid (L-L), solid lactulose (L-S) and solid inulin (IN-S) are added to a test meal, and subsequently, to examine if inulin alters GE. Firstly, ten male volunteers were tested on three occasions. Volunteers ate a pancake breakfast containing 100 mg of (13)C-octanoic acid and either 12 g of L-L, 12 g of L-S or 12 g of IN-S in a randomised order. Secondly, seven male volunteers were tested twice with meals containing either 12 g of IN-S or no substrate (NO-S). L-L induced the shortest OCTT (85.3 (sd 42.8) min) compared with L-S (162.4 (sd 62.6) min) and inulin (292.4 (sd 66.7) min; P = 0.007). GE half-time and lag phase (L-L: 61 (sd 9); L-S: 57 (sd 10); IN-S: 52 (sd 10) min; P = 0.005) were also affected, with L-L being the slowest. Thirdly, inulin reduced GE lag and latency phases (P < 0.05) compared with NO-S. Lactulose accelerates OCTT but delays GE compared with inulin. Inulin accelerates the onset of stomach emptying, but it has no effect on GE half-time. For these reasons, inulin is the preferred substrate for the H(2) breath test.
Collapse
|
9
|
Casellas F, Torrejón A, Vilaseca J, Aparici A, Casaus M, Rodríguez P, Guarner F. Influence of colectomy on hydrogen excretion in breath. Int J Colorectal Dis 2010; 25:485-9. [PMID: 19902224 DOI: 10.1007/s00384-009-0832-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2009] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Hydrogen breath test is the most commonly used method to analyze carbohydrate absorption and diagnose carbohydrate malabsorption. The result of the H(2) breath test is influenced by different factors, which are mostly related to quantitative or qualitative aspects of colonic flora. A scarcely studied variable is the effect of colonic anatomical integrity on H(2) excretion in breath. PURPOSE The present study aims to determine whether loss of colonic integrity reduces H(2) excretion capacity after an oral load of an unabsorbable carbohydrate. METHODS An observational study was conducted in three patient groups: controls with preserved colon, patients with partial colectomy, and patients with complete colectomy and ileostomy. H(2) concentration in breath was measured by gas chromatography every 10 min for 3 h after oral lactulose administration. RESULTS Twenty-two patients with partial colectomy, 18 controls with preserved colon, and seven patients with ileostomy were included. H(2) excretion after lactulose did not differ between patients with partial colectomy and controls (basal excretion = 8.5 vs 4 ppm; delta increase = 50.0 vs 47.5 ppm; area under the curve = 4,480.0 vs 4,710.5 ppm/min). In contrast, H(2) excretion was significantly lower in the ileostomy group. CONCLUSIONS Partial colectomy does not influence the capacity for H(2) excretion after oral unabsorbable carbohydrate administration.
Collapse
Affiliation(s)
- Francesc Casellas
- Digestive System Research Unit, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona 08035, Spain.
| | | | | | | | | | | | | |
Collapse
|
10
|
Tursi A, Brandimarte G, Giorgetti G, Nasi G. Assessment of orocaecal transit time in different localization of Crohn's disease and its possible influence on clinical response to therapy. Eur J Gastroenterol Hepatol 2003; 15:69-74. [PMID: 12544697 DOI: 10.1097/00042737-200301000-00012] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND A study on orocaecal transit time (OCTT) in patients with different localizations of Crohn's disease (CD) is not available. Because slow-release drug formulations are increasingly available for the treatment, there is a concrete risk that delayed OCTT may impair the efficacy of these formulations. AIMS We investigated OCTT before and after therapy using lactulose H2-breath test and we studied whether OCTT can influence the clinical response to therapy with slow-release mesalazine formulations in adult CD patients.(2) PATIENTS AND METHODS We studied 45 adult patients with non-obstructive CD and Crohn's Disease Activity Index (CDAI) <200 (29 men, 16 women; mean age 42 years, range 22-73 years). Twenty patients had ileocolonic, 16 colonic and 9 ileal localization of CD. The control group consisted of 20 healthy subjects (13 men, seven women; mean age 53 years, range 22-71 years). After OCTT assessment, 29 patients were treated with time-dependent mesalazine 3.6 g/day, while 16 patients were treated with pH-dependent mesalazine 3.6 g/day. If bacterial overgrowth was detected, the patients were also treated with rifaximin 800 mg/day for 7 days. RESULTS OCTT was delayed (120 min, range 115-210 min) in 30 of the 45 CD patients (67%). Four patients (9%) showed bacterial overgrowth, while OCTT was regular (82.5 min, range 75-90 min) in 11 patients (24%). In the control group, the mean OCTT was 88.2 min (range 75-135 min); (P<0.01). OCTT was more prolonged in ileal localization (182.2 min, range 150-210 min), rather than in patients with ileocolonic (122 min, range 75-180 min) or colonic (106 min, range 75-150 min) localization of CD; (P<0.01). Thirty-nine patients showed normal OCTT after starting therapy (83 min, range 75-105 min), while OCTT remained slightly delayed in the remaining patients (110 min, range 105-115 min); (P<0.01). CDAI was <100 (mean value 83) in all patients with reduction of OCTT to normal value 4 months after starting therapy, while it was >140 (mean value 143) in patients with a slight reduction but not normalization of OCTT respectively (five patients with ileal and one with ileocolonic localization of CD) with a statistically significant correlation between OCTT and CDAI (P<0.01). CONCLUSIONS This study shows clearly for the first time that OCTT is not only delayed in patients with active CD, but also that it is prolonged in ileal and ileocolonic rather than colonic localization of CD. Moreover we obtained these results using a simple, sensitive, non-invasive and repeatable method, namely, a lactulose hydrogen breath test.
Collapse
Affiliation(s)
- Antonio Tursi
- Department of Emergency, L Bonomo Hospital, Andria, Cristo Re Hospital, Rome, Italy.
| | | | | | | |
Collapse
|