Nucera G, Gabrielli M, Lupascu A, Lauritano E C, Santoliquido A, Cremonini F, Cammarota G, Tondi P, Pola P, Gasbarrini G, Gasbarrini A
Internal Medicine Department, Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy.
Aliment Pharmacol Ther. 2005 Jun 1;21(11):1391-5. doi: 10.1111/j.1365-2036.2005.02493.x.
Small intestinal bacterial overgrowth and sugar malabsorption (lactose, fructose, sorbitol) may play a role in irritable bowel syndrome. The lactulose breath test is a reliable and non-invasive test for the diagnosis of small intestinal bacterial overgrowth. The lactose, fructose and sorbitol hydrogen breath tests are widely used to detect specific sugar malabsorption.
To assess the extent to which small intestinal bacterial overgrowth may influence the results of hydrogen sugar breath tests in irritable bowel syndrome patients.
We enrolled 98 consecutive irritable bowel syndrome patients. All subjects underwent hydrogen lactulose, lactose, fructose and sorbitol hydrogen breath tests. Small intestinal bacterial overgrowth patients were treated with 1-week course of antibiotics. All tests were repeated 1 month after the end of therapy.
A positive lactulose breath test was found in 64 of 98 (65%) subjects; these small intestinal bacterial overgrowth patients showed a significantly higher prevalence of positivity to the lactose breath test (P < 0.05), fructose breath test (P < 0.01) and sorbitol breath test (P < 0.01) when compared with the small intestinal bacterial overgrowth-negatives. Small intestinal bacterial overgrowth eradication, as confirmed by negative lactulose breath test, caused a significant reduction in lactose, fructose and sorbitol breath tests positivity (17% vs. 100%, 3% vs. 62%, and 10% vs. 71% respectively: P < 0.0001).
In irritable bowel syndrome patients with small intestinal bacterial overgrowth, sugar breath tests may be falsely abnormal. Eradication of small intestinal bacterial overgrowth normalizes sugar breath tests in the majority of patients. Testing for small intestinal bacterial overgrowth should be performed before other sugar breath tests tests to avoid sugar malabsorption misdiagnosis.
小肠细菌过度生长和糖吸收不良（乳糖、果糖、山梨醇）可能在肠易激综合征中起作用。乳果糖呼气试验是诊断小肠细菌过度生长的一种可靠且非侵入性的检查。乳糖、果糖和山梨醇氢呼气试验被广泛用于检测特定的糖吸收不良。
评估小肠细菌过度生长在多大程度上可能影响肠易激综合征患者氢糖呼气试验的结果。
我们连续纳入了98例肠易激综合征患者。所有受试者均接受了氢乳果糖、乳糖、果糖和山梨醇氢呼气试验。小肠细菌过度生长的患者接受了为期1周的抗生素治疗。治疗结束1个月后重复所有检查。
98例受试者中有64例（65%）乳果糖呼气试验呈阳性；与小肠细菌过度生长阴性的患者相比，这些小肠细菌过度生长的患者乳糖呼气试验阳性率（P < 0.05）、果糖呼气试验阳性率（P < 0.01）和山梨醇呼气试验阳性率（P < 0.01）显著更高。经乳果糖呼气试验阴性证实小肠细菌过度生长已根除后，乳糖、果糖和山梨醇呼气试验阳性率显著降低（分别为17% 对100%、3% 对62%和10% 对71%：P < 0.0001）。
在患有小肠细菌过度生长的肠易激综合征患者中，糖呼气试验可能出现假异常。根除小肠细菌过度生长可使大多数患者的糖呼气试验结果恢复正常。在进行其他糖呼气试验之前应先检测小肠细菌过度生长，以避免误诊糖吸收不良。
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