D0267 - Change in Severity of Abdominal Pain and Flatulence During Lactulose Breath Testing Associated With Positive Small Intestinal Bacterial Overgrowth Diagnosis
Jay Kanaparthi, MD1, Aatif Khurshid, MD1, Neil Mehta, MD1, Henry P. Parkman, MD2 1Temple University Hospital, Philadelphia, PA; 2Temple University Health System, Philadelphia, PA
Introduction: Small intestinal bacterial overgrowth (SIBO) can be indirectly diagnosed by assessing expired hydrogen and methane gas peaks during lactulose breath testing (LBT). Ingestion of lactulose for the test can induce gastrointestinal symptoms, some of which mimic the patient’s baseline SIBO symptoms. We seek to evaluate whether these symptoms reported during the LBT predict the ultimate test result.
Methods: Patients that underwent LBT between 11/2018 to 3/2020 were included. LBT was performed using the BreathTracker Analyzer (QuinTron Instruments). SIBO by hydrogen (H-SIBO) was defined as a rise of 20 ppm within the first 90 minutes. SIBO by methane (M-SIBO) was defined as a peak value of >10ppm. Patients answered pretest questionnaires of baseline demographics, Patient Assessment of Gastrointestinal Disorders- Symptom Severity Index (PAGI-SYM), and their symptom severity of eight SIBO symptoms (abdominal distension, abdominal pain, belching, bloating, diarrhea, flatulence, nausea, and stomach fullness). During LBT, patients then re-scored their 8 symptoms at 15-minute increments for the 3-hour test duration. Longitudinal symptom severity over this duration was analyzed with a series of two-level mixed effects regressions estimated for each symptom separately.
Results: 608 patients underwent LBT yielding 103 H-SIBO, 144 M-SIBO, and 141 positives by hydrogen and methane (HM-SIBO). Baseline PAGI-SYM analysis revealed increased symptom severity in the SIBO negative group in nausea (p=0.009), upper abdominal pain (p=0.02), upper abdominal discomfort (p=0.01), and lower abdominal discomfort (p=0.02). Parameter estimates of the mixed models demonstrated significant difference in the SIBO positive and SIBO negative groups in abdominal pain (+0.131, p< 0.05) and flatulence (+0.190, p< 0.01) out of 8 symptoms assessed, presenting early into the testing period. Subgroup analysis revealed H-SIBO and HM-SIBO groups had increases in flatulence severity compared to the negative group by 0.213 (p< 0.01) and 0.323 (p< 0.01), respectively.
Discussion: Despite initially reporting lower baseline PAGI-SYM symptom severity, over the course of LBT, patients with SIBO reported a greater increase in abdominal pain compared to their SIBO negative counterparts. H-SIBO and HM-SIBO was also associated with greater development of flatulence during testing. These results indicate change in symptoms severity during LBT may have diagnostic value for SIBO.
Figure: Figure 1. (A) Mean Change in Reported Symptom Severity over Twelve 15-minute Increments in Lactulose Breath Testing Corrected for Baseline Severity (B) Mean Change in Reported Symptom Severity over Twelve 15-minute Increments in Lactulose Breath Testing Corrected for Baseline Severity with Positive Group Stratified by Respiratory Gas
Disclosures:
Jay Kanaparthi indicated no relevant financial relationships.
Aatif Khurshid indicated no relevant financial relationships.
Neil Mehta indicated no relevant financial relationships.
Henry Parkman indicated no relevant financial relationships.
Jay Kanaparthi, MD1, Aatif Khurshid, MD1, Neil Mehta, MD1, Henry P. Parkman, MD2. D0267 - Change in Severity of Abdominal Pain and Flatulence During Lactulose Breath Testing Associated With Positive Small Intestinal Bacterial Overgrowth Diagnosis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.
