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breath test for differential diagnosis between small intestinal bacterial overgrowth and irritable bowel disease:An observation on non-absorbable antibiotics

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World Journal of Gastroenterology 2007年第45期13卷 6016-6021页

作者： I Esposito A de Leone G Di Gregorio S Giaquinto L de Magistris A Ferrieri G Riegler Department of Clinical andExperimental Internal Medicine Second University of NaplesItaly

AIM： To estimate the prevalence of small intestine bacterial overgrowth （SIBO） among patients with an earlier diagnosis of irritable bowel disease （IBS） in our geographical area, and to collect information on the use of locally acting non-absorbable antibiotics in the management of SIBO. METHODS： A non-interventional study was conducted in 73 consecutive patients with a symptom-based diagnosis.. RESULTS： When the patients underwent a ＂breath test＂, 33 （45.2%） showed the presence of a SIBO. Arcer treatment with rifaximin 1200 mg/d for seven days in 32 patients, 19 （59.4%） showed a negative ＂breath test＂ one week later as well as a significant reduction of symptoms, thus confirming the relationship between SIBO and many of the symptoms claimed by patients. In the other 13 patients, ＂breath test＂ remained positive, and a further cycle of treatment with ciprofloxacin 500 mg/d was given for 7 additional days, resulting in a negative ＂breath test＂ in one patient only. CONCLUSION：（1） about half of the patients with a symptomatic diagnosis of IBS have actually SIBO, which is responsible for most of the symptoms attributed to IBS; （2） only a ＂breath test＂ with lactulose （or with glucose in subjects with an intolerance to lactose） can provide a differential diagnosis between IBS and SIBO, with almost identical symptoms; and （3） the use of non-absorbable antibiotics may be useful to reduce the degree of SIBO and related symptoms; it must be accompanied, however, by the correction of the wrong alimentary habits underlying SIBO.

关键词： Small intestine bacterial overgrowth Irritablebowel disease breath test Rifaximin Hydrogen Non-absorbable antibiotics

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Point-of-care continuous ^(13)C-methacetin breath test improves decision making in acute liver disease: Results of a pilot clinical trial

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World Journal of Gastroenterology 2009年第8期15卷 966-972页

作者： Gadi Lalazar Tomer Adar Yaron Ilan Gastroenterology and Liver Units Department of Medicine Hadassah-Hebrew University Medical Center Ein-Kerem IL 91120 POB 12000 Jerusalem Israel

AIM: To assess the role of the 13C-methacetin breath test (MBT) in patients with acute liver disease. METHODS: Fifteen patients with severe acute liver disease from diverse etiologies were followed-up with 13C-MBT during the acute phase of their illnesses (range 3-116 d after treatment). Patients fasted for 8 h and ingested 75 mg of methacetin prior to the MBT. We compared results from standard clinical assessment, serum liver enzymes, synthetic function, and breath test scores. RESULTS: Thirteen patients recovered and two patients died. In patients that recovered, MBT parameters improved in parallel with improvements in lab results. Evidence of consistent improvement began on day 3 for MBT parameters and between days 7 and 9 for blood tests. Later convergence to normality occurred at an average of 9 d for MBT parameters and from 13 to 28 d for blood tests. In both patients that died, MBT parameters remained low despite fluctuating laboratory values. CONCLUSION: The 13C-MBT provides a rapid, noninvasive assessment of liver function in acute severe liver disease of diverse etiologies. The results of this pilot clinical trial suggest that the MBT may offer greater sensitivity than standard clinical tests for managing patients with severe acute liver disease.

关键词： Acute liver disease Methacetin breath test Fulminant hepatitis

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^(13)C-methacetin breath test reproducibility study reveals persistent CYP1A2 stimulation on repeat examinations

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World Journal of Gastroenterology 2011年第45期17卷 4979-4986页

作者： Anna Kasicka-Jonderko Anna Nita Krzysztof Jonderko Magdalena Kamińska Barbara Bońska-Fajfrowska Department of Basic Biomedical Science School of Pharmacy Medical University of Silesia

AIM: To find the most reproducible quantitative parameter of a standard 13C-methacetin breath test (13C-MBT). METHODS: Twenty healthy volunteers (10 female, 10 male) underwent the 13C-MBT after intake of 75 mg 13C-methacetin p.o. on three occasions. Short-and medium-term reproducibility was assessed with paired examinations taken at an interval of 2 and 18 d (medians), respectively. RESULTS: The reproducibility of the 1-h cumulative 13C recovery (AUC0-60), characterized by a coefficient of variation of 10%, appeared to be considerably better than the reproducibility of the maximum momentary 13C recovery or the time of reaching it. Remarkably, as opposed to the short gap between consecutive examinations, the capacity of the liver to handle 13C-methacetin increased slightly but statistically significantly when a repeat dose was administered after two to three *** the AUC0-60, the magnitude of this fixed bias amounted to 7.5%. Neither the time gap between the repeat examinations nor the gender of the subjects affected the 13C-MBT reproducibility. CONCLUSION: 13C-MBT is most reproducibly quantified by the cumulative 13C recovery, but the exactitude thereof may be modestly affected by persistent stimulation of CYP1A2 on repeat examinations.

关键词： 13C-Methacetin breath test Isotope application in medicine Liver Reproducibility

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Effects of ethanol and sex on propionate metabolism evaluated via a faster ^(13)C-propionate breath test in rats

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World Journal of Gastroenterology 2023年第21期29卷 3269-3279页

作者： Yosuke Sasaki Naoyuki Kawagoe Tsunehiko Imai Yoshihisa Urita Department of General Medicine and Emergency Care Toho University School of MedicineTokyo 143-8541Japan

BACKGROUND Alcoholism is regarded as a risk factor for vitamin B_(12)(VB_(12))*** V B_(12) serves as a coenzyme of methylmalonyl-CoA mutase,a key enzyme in propionate metabolism,the ^(13)C-propionate breath test(PBT)has been studied as a non-invasive diagnostic modality for VB_(12) ***,the conventional PBT requires 2 h,which is inconvenient in clinical *** hypothesized that a faster PBT can be used to evaluate propionate metabolism and is more easily adaptable for clinical *** To evaluate a faster PBT for assessing the effects of long-term ethanol consumption on propionate metabolism in ethanol-fed rats(ERs).METHODS ERs were obtained by replacing standard drinking water(for control rats,CRs)with 16%ethanol solution in descendants of F344/DuCrj *** PBT was performed by administering ^(13)C-propionate aqueous solution to male and female ERs and CRs by inserting a metal tubule from the mouth to the stomach;exhaled gas was collected in a bag to measure its ^(13)CO_(2)/12CO_(2) isotope ratio via infrared isotope *** VB_(12) and alanine transaminase(ALT)levels were measured via chemiluminescence immunoassay and the lactate dehydrogenaseultraviolet method,*** evaluated statistical differences in mean body weight,change in ^(13)CO_(2)(Δ^(13)CO_(2)‰),peakΔ^(13)CO_(2)‰,and serum VB_(12) and ALT,between males and females and between ERs and CRs using the t-test and Mann-Whitney U test for normally and non-normally distributed variables,*** Males weighed significantly more than females(P<0.001);CRs weighed significantly more than ERs(P<0.008).Δ^(13)CO_(2) reached a peak(C_(max))at 20 min and 30 min in females and males,respectively,decreasing after 20-30 min without rebound in all *** had significantly higher C_(max) andΔ^(13)CO_(2) at 15-45 min than females(P<0.05;for all pairs).Propionate metabolism was enhanced in male ERs relative to male CRs,whereas metabolism did no

关键词： Alcoholism breath test Carbon isotope Gut flora Propionate Vitamin B12

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Patients with breath test positive are necessary to be identified from irritable bowel syndrome:a clinical trial based on microbiomics and rifaximin sensitivity

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Chinese Medical Journal 2022年第14期135卷 1716-1727页

作者： Zuojing Liu Shiwei Zhu Meibo He Mo Li Hui Wei Lu Zhang Qinghua Sun Qiong Jia Nan Hu Yuan Fang Lijin Song Chen Zhou Heqing Tao John Y Kao Huaiqiu Zhu Chung Owyang Liping Duan Department of Gastroenterology Peking University Third HospitalHaidian DistrictBeijing 100191China Department of Ultrasound Peking University Third HospitalHaidian DistrictBeijing 100191China Institute of Systems Biomedicine School of Basic Medical SciencesPeking University Health Science CenterBeijing 100191China Department of Biomedical Engineering College of EngineeringPeking UniversityBeijing 100187China Division of Gastroenterology Department of Internal MedicineUniversity of Michigan Health System6520 MSRB ISPC 56821150 West Medical Center DriveAnn ArborMI 48109USA

Background:As a non-invasive and effective diagnostic method for small intestinal bacterial overgrowth(SIBO),wild-use of breath test(BT)has demonstrated a high comorbidity rate in patients with diarrhea-predominant irritable bowel syndrome(IBS-D)and *** overlapping with SIBO respond better to rifaximin therapy than those with IBS-D *** microbiota plays a critical role in both of these two *** aimed to determine the microbial difference between IBS-D overlapping with/without SIBO,and to study the underlying mechanism of its sensitivity to ***:Patients with IBS-D were categorized as BT-negative(IBSN)and BT-positive(IBSP).Healthy volunteers(BT-negative)were enrolled as healthy *** patients were clinically evaluated before and after rifaximin treatment(0.4 g bid,4 weeks).Blood,intestine,and stool samples were collected for cytokine assessment and gut microbial ***:Clinical complaints and microbial abundance were significantly higher in IBSP than in *** contrast,severe systemic inflammation and more active bacterial invasion function that were associated with enrichment of opportunistic pathogens were seen in *** symptoms of IBSP patients were relieved in different degrees after therapy,but the symptoms of IBSN rarely *** also found that the presence of IBSN-enriched genera(Enterobacter and Enterococcus)are unaffected by rifaximin ***:IBS-D patients overlapping with SIBO showed noticeably different fecal microbial composition and function compared with IBS-D *** better response to rifaximin in those comorbid patients might associate with their different gut microbiota,which suggests that BT is necessary before IBS-D diagnosis and use of ***:Chinese Clinical Trial Registry,ChiCTR1800017911.

关键词： Irritable bowel syndrome Small intestinal bacterial overgrowth breath test Gut microbiota Rifaximin

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^(13)C-methacetin breath test parameter S for liver diseases diagnosis

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Science China(Life Sciences) 1996年第1期39卷 87-98页

作者：曾文炳张维成许士元杨志忠刘纯朱德平文启彬申岐祥王先彬 Institute of Modern Physics Chinese Academy of Sciences Lanzhou 730000 China First Subhospital Lanzhou Medical College Lanzhou 730000 China Lanzhou Institute of Geology Chinese Academy of Sciences Lanzhou 730000 China

The mechanism of 13C-methacetin breath test is set forth clearly with the analysis of pharmacokinetics mode, and the measuring method of 13C-methacetin breath test and its clinical applications in the diagnosis of liver diseases are reported in detail. On the basis of comprehensive analysis of the clinical test data, the advanced diagnostic parameter S is of important significance for the application and development of breath test.

关键词： ^(13)C-methacetin breath test parameter S.

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breath tests and irritable bowel syndrome

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World Journal of Gastroenterology 2014年第24期20卷 7587-7601页

作者： Satya Vati Rana Aastha Malik Department of Super Specialty Gastroenterology Post Graduate Institute of Medical Education and ResearchSector 12Chandigarh 160012India

breath tests are non-invasive tests and can detect H2 and CH4 gases which are produced by bacterial fermentation of unabsorbed intestinal carbohydrate and are excreted in the breath. These tests are used in the diagnosis of carbohydrate malabsorption, small intestinal bacterial overgrowth, and for measuring the orocecal transit time. Malabsorption of carbohydrates is a key trigger of irritable bowel syndrome (IBS)-type symptoms such as diarrhea and/or constipation, bloating, excess flatulence, headaches and lack of energy. Abdominal bloating is a common nonspecific symptom which can negatively impact quality of life. It may reflect dietary imbalance, such as excess fiber intake, or may be a manifestation of IBS. However, bloating may also represent small intestinal bacterial overgrowth. Patients with persistent symptoms of abdominal bloating and distension despite dietary interventions should be referred for H2 breath testing to determine the presence or absence of bacterial overgrowth. If bacterial overgrowth is identified, patients are typically treated with antibiotics. Evaluation of IBS generally includes testing of other disorders that cause similar symptoms. Carbohydrate malabsorption (lactose, fructose, sorbitol) can cause abdominal fullness, bloating, nausea, abdominal pain, flatulence, and diarrhea, which are similar to the symptoms of IBS. However, it is unclear if these digestive disorders contribute to or cause the symptoms of IBS. Research studies show that a proper diagnosis and effective dietary intervention significantly reduces the severity and frequency of gastrointestinal symptoms in IBS. Thus, diagnosis of malabsorption of these carbohydrates in IBS using a breath test is very important to guide the clinician in the proper treatment of IBS patients.

关键词： Bacterial overgrowth breath test Carbohydrate malabsorption Irritable bowel syndrome Lactulose breath test Small intestine Sorbitol breath test

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Methane production and small intestinal bacterial overgrowth in children living in a slum

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World Journal of Gastroenterology 2012年第41期18卷 5932-5939页

作者： Carolina Santos Mello Soraia Tahan Lígia Cristina FL Melli Mirian Silva do Carmo Rodrigues Ricardo Martin Pereira de Mello Isabel Cristina Affonso Scaletsky Mauro Batista de Morais Pediatric Gastroenterology Division Federal University of Sao Paulo04039-031 Sao PauloBrazil Center Foundation Institute of Education for Osasco 06020-190 Sao PauloBrazil Infectology Division Federal University of Sao Paulo04025-010 Sao PauloBrazil Microbiology Immunology and Parasitology DivisionFederal University of Sao Paulo 04023-062 Sao PauloBrazil

AIM:To analyze small intestinal bacterial overgrowth in school-aged children and the relationship between hydrogen and methane production in breath ***:This transversal study included 85 children residing in a slum and 43 children from a private school,all aged between 6 and 10 years,in Osasco,*** characterization of the groups,data regarding the socioeconomic status and basic housing sanitary conditions were *** data was obtained in children from both *** children completed the hydrogen(H 2) and methane(CH 4) breath test in order to assess small intestinal bacterial overgrowth(SIBO).SIBO was diagnosed when there was an increase in H 2 ≥ 20 ppm or CH 4 ≥ 10 ppm with regard to the fasting value until 60 min after lactulose ***:Children from the slum group had worse living conditions and lower nutritional indices than children from the private *** was found in 30.9%(26/84) of the children from the slum group and in 2.4%(1/41) from the private school group(P = 0.0007).Greater hydrogen production in the small intestine was observed in children from the slum group when compared to children from the private school(P = 0.007).A higher concentration of hydrogen in the small intestine(P < 0.001) and in the colon(P < 0.001) was observed among the children from the slum group with SIBO when compared to children from the slum group without *** production was observed in 63.1%(53/84) of the children from the slum group and in 19.5%(8/41) of the children from the private school group(P < 0.0001).Methane production was observed in 38/58(65.5%) of the children without SIBO and in 15/26(57.7%) of the children with SIBO from the *** production of hydrogen was lower in methaneproducing children(P = 0.017).CONCLUSION:Children who live in inadequate environmental conditions are at risk of bacterial overgrowth and methane *** is a substrate for methane production in the colon.

关键词： Bacterial overgrowth breath test Children Colon Hydrogen Methane Small intestine

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Small intestinal bacterial overgrowth syndrome

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World Journal of Gastroenterology 2010年第24期16卷 2978-2990页

作者： Jan Bures Jiri Cyrany Darina Kohoutova Miroslav Frstl Stanislav Rejchrt Jaroslav Kvetina Viktor Vorisek Marcela Kopacova 2nd Department of Medicine Charles University in Praha Faculty of Medicine at Hradec Kralove University Teaching Hospital Institute of Clinical Microbiology Charles University in Praha Faculty of Medicine at Hradec Kralove University Teaching Hospital Institute of Experimental Biopharmaceutics Joint Research Centre of Czech Academy of Sciences and PRO.MED.CS Praha a.s. Institute of Clinical Biochemistry and Diagnostics Charles University in Praha Faculty of Medicine at Hradec Kralove University Teaching Hospital

Human intestinal microbiota create a complex polymi-crobial ecology. This is characterised by its high population density, wide diversity and complexity of interaction. Any dysbalance of this complex intestinal microbiome, both qualitative and quantitative, might have serious health consequence for a macro-organism, including small intestinal bacterial overgrowth syndrome (SIBO).SIBO is defined as an increase in the number and/or alteration in the type of bacteria in the upper gastro-intestinal tract. There are several endogenous defence mechanisms for preventing bacterial overgrowth: gastric acid secretion, intestinal motility, intact ileo-caecal valve, immunoglobulins within intestinal secretion and bacte-riostatic properties of pancreatic and biliary secretion. Aetiology of SIBO is usually complex, associated with disorders of protective antibacterial mechanisms (e.g. achlorhydria, pancreatic exocrine insuff iciency, immuno-deficiency syndromes), anatomical abnormalities (e.g. small intestinal obstruction, diverticula, f istulae, surgical blind loop, previous ileo-caecal resections) and/or motility disorders (e.g. scleroderma, autonomic neuropathy in diabetes mellitus, post-radiation enteropathy, small intestinal pseudo-obstruction). In some patients more than one factor may be involved. Symptoms related to SIBO are bloating, diarrhoea, malabsorption, weight loss and malnutrition. The gold standard for diagnosing SIBO is still microbial investigation of jejunal aspirates. Noninvasive hydrogen and methane breath tests are most commonly used for the diagnosis of SIBO using glucose or lactulose. Therapy for SIBO must be com-plex, addressing all causes, symptoms and complica-tions, and fully individualised. It should include treatment of the underlying disease, nutritional support and cyclical gastro-intestinal selective antibiotics. Prognosis is usually serious, determined mostly by the underlying disease that led to SIBO.

关键词： Bacterial overgrowth breath test Hydrogen Methane Small intestine

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A new oral formulation for the release of sodium butyrate in the ileo-cecal region and colon

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World Journal of Gastroenterology 2007年第7期13卷 1079-1084页

作者： Aldo Roda Patrizia Simoni Maria Magliulo Paolo Nanni Mario Baraldini Giulia Roda Enrico Roda Department of Pharmaceutical Sciences University of Bologna Via Belmeloro 6 Bologna 40126 Italy Department of Internal Medicine and Gastroenterology University of Bologna via Massarenti 9 Bologna 40126 Italy

AIM： To develop a new formulation with hydroxy propyl methyl cellulose and Shellac coating for extended and selective delivery of butyrate in the ileo-caecal region and colon. METHODS： One-gram sodium butyrate coated tablets containing ^13C-butyrate were orally administered to 12 healbhy subjects and 12 Crohn＇s disease patients and the rate of ^13C-butyrate absorption was evaluated by t3CO2 breath test analysis for eight hours. Tauroursodeoxycholic acid （500 rag） was co-administered as a biomarker of oro-ileal transit time to determine also the site of release and absorption of butyrate by the time of its serum maximum concentration. RESULTS： The coated formulation delayed the ^13C-butyrate release by 2-3 h with respect to the uncoated tablets. Sodium butyrate was delivered in the intestine of all subjects and a more variable transit time was found in Crohn＇s disease patients than in healthy subjects. The variability of the peak ^13CO2 in the kinetic release of butyrate was explained by the inter-subject variability in transit time. However, the coating chosen ensured an efficient release of the active compound even in patients with a short transit time. CONCLUSION： Simultaneous evaluation of breath ^13CO2 and tauroursodeoxycholic acid concentrationtime curves has shown that the new oral formulation consistently releases sodium butyrate in the ileo-cecal region and colon both in healthy subjects and Crohn＇s disease patients with variable intestinal transit time. This formulation may be of therapeutic value in inflammatory bowel disease patients due to the appropriate release of the active compound.

关键词： Sodium butyrate Inflammatory boweldiseases Ulcerative colitis Crohn's disease Controlledrelease formulation Pharmacokinetics Stable isotope breath test

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