Danone Nutricia Research, Life Sciences Department, Palaiseau, France.
Danone Nutricia Research, Life Sciences Department, Palaiseau, France.
Clin Gastroenterol Hepatol. 2016 Feb;14(2):226-33.e1-3. doi: 10.1016/j.cgh.2015.09.039. Epub 2015 Oct 20.
BACKGROUND & AIMS: Patients with irritable bowel syndrome (IBS) can be assigned to groups with different gastrointestinal (GI) symptoms based on results from a combined nutrient and lactulose challenge. We aimed to identify factors that predict outcomes to this challenge and to determine whether this can be used in noninvasive assessment of visceral sensitivity in patients with IBS. METHODS: We performed a prospective study of 100 patients with IBS diagnosed according to Rome III criteria (all subtypes) and seen at a secondary or tertiary care center. After an overnight fast, subjects were given a liquid breakfast (400 mL; Nutridrink) that contained 25 g lactulose. Before the challenge, we assessed visceral sensitivity (via rectal barostat), oro-anal transit time, and fecal microbiota composition (via 16S ribosomal RNA pyrosequencing); we determined IBS severity using questionnaires. The intensity of 8 GI symptoms, the level of digestive comfort, and the amount of exhaled H2 and CH4 in breath were measured before and during a 4-hour period after the liquid breakfast. RESULTS: Based on the intensity of 8 GI symptoms and level of digestive comfort during the challenge, patients were assigned to groups with high-intensity GI symptoms (HGS; n = 39) or low-intensity GI symptoms (LGS; n = 61); patients with HGS had more severe IBS (P < .0001), higher somatization (P < .01), and lower quality of life (P < .05-.01) than patients with LGS. Patients with HGS also had significantly higher rectal sensitivity to random phasic distensions (P < .05-.001, compared with patients with LGS). There were no significant differences between groups in fecal microbiota composition, exhaled gas in breath, or oro-anal transit time. CONCLUSIONS: We found, in a prospective study, that results from a lactulose challenge test could be used to determine visceral sensitivity and severity of IBS. The intensity of patient symptoms did not correlate with the composition of the fecal microbiota. The lactulose challenge test may help better characterize patients with IBS and evaluate the efficacy of new treatments. ClinicalTrial.gov no: NCT01252550.
背景与目的：根据联合营养和乳果糖挑战的结果，可将肠易激综合征（IBS）患者分为具有不同胃肠道（GI）症状的组。我们旨在确定预测该挑战结果的因素，并确定是否可以将其用于非侵入性评估 IBS 患者的内脏敏感性。
方法：我们对 100 名根据罗马 III 标准（所有亚型）诊断为 IBS 的患者进行了前瞻性研究，并在二级或三级护理中心进行了研究。禁食过夜后，受试者给予含有 25 克乳果糖的液体早餐（400 毫升；Nutridrink）。在挑战之前，我们评估了内脏敏感性（通过直肠测压），口腔肛门转运时间和粪便微生物群落组成（通过 16S 核糖体 RNA 焦磷酸测序）；我们使用问卷确定 IBS 严重程度。在液体早餐后 4 小时的时间内，测量了 8 种 GI 症状的强度，消化舒适度水平以及呼气中的 H2 和 CH4 的量。
结果：基于挑战期间 8 种 GI 症状的强度和消化舒适度水平，患者被分为高强度 GI 症状（HGS；n = 39）或低强度 GI 症状（LGS；n = 61）组；HGS 患者的 IBS 更严重（P <.0001），躯体化程度更高（P <.01），生活质量更低（P <.05-.01）比 LGS 患者。HGS 患者对随机相位扩张的直肠敏感性也明显更高（与 LGS 患者相比，P <.05-.001）。两组之间粪便微生物群落组成，呼气中的气体或口腔肛门转运时间无显着差异。
结论：我们在一项前瞻性研究中发现，乳果糖挑战测试的结果可用于确定内脏敏感性和 IBS 的严重程度。患者症状的强度与粪便微生物群落的组成无关。乳果糖挑战测试可能有助于更好地描述 IBS 患者并评估新治疗方法的疗效。ClinicalTrial.gov 号：NCT01252550。
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