Phillip Gu1, Devin Patel2, Krutika Lakhoo2, Jeffrey Ko2, Xiaochen Liu3, Bianca Chang4, Dana Pan5, Greg Lentz6, Matthew Sonesen6, Renier Estiandan6, Eugenia Lin3, Mark Pimentel3, Ali Rezaie3. 1. Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, TX, USA. phillipgu12@gmail.com. 2. Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. 3. Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA. 4. Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, IL, USA. 5. Division of Gastroenterology and Hepatology, University of California in Davis, Sacramento, CA, USA. 6. Enterprise Information Services- Initiate Team, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Abstract
INTRODUCTION: Breath testing (BT) has gained interest for diagnosing small intestinal bacterial overgrowth (SIBO) in IBD patients with irritable bowel syndrome (IBS) overlap. We aim to characterize the rate of SIBO and BT gas patterns in IBD patients with IBS-like symptoms compared to non-IBD patients. METHODS: A database of 14,847 consecutive lactulose BTs was developed from patients with IBS-like symptoms between November 2005 and October 2013. BTs were classified as normal, H2 predominant, CH4 predominant, and flatline based on criteria established from the literature. BT data linkage with electronic health records and chart review identified IBD patients along with disease phenotype, location, severity, and antibiotic response. Poisson loglinear model evaluated differences in gas patterns between the two groups. RESULTS: After excluding patients with repeat breath tests, we identified 486 IBD and 10,505 non-IBD patients with at least one BT. Positive BT was present in 57% (n = 264) of IBD patients. Crohn's disease (odds ratio (OR) 0.21, [95% confidence interval (CI) 0.11-0.38]) and ulcerative colitis (OR 0.39, [95% CI 0.22-0.70]) patients were less likely to produce excess CH4. IBD patients were more likely to have flatline BT (OR 1.82, [95% CI 1.20-2.77]). In IBD patients with SIBO, 57% improved symptomatically with antibiotics. CONCLUSION: In a cohort of IBD patients with IBS-like symptoms, a high rate of patients had positive BT and symptomatic improvement with antibiotics. In IBD, methanogenesis is suppressed and flatline BT is more frequent, suggesting excess hydrogenotrophic bacteria. These findings suggest methanogenic and hydrogenotrophic microorganisms as potential targets for microbiome-driven biomarkers and therapies.
INTRODUCTION: Breath testing (BT) has gained interest for diagnosing small intestinal bacterial overgrowth (SIBO) in IBDpatients with irritable bowel syndrome (IBS) overlap. We aim to characterize the rate of SIBO and BT gas patterns in IBDpatients with IBS-like symptoms compared to non-IBDpatients. METHODS: A database of 14,847 consecutive lactulose BTs was developed from patients with IBS-like symptoms between November 2005 and October 2013. BTs were classified as normal, H2 predominant, CH4 predominant, and flatline based on criteria established from the literature. BT data linkage with electronic health records and chart review identified IBDpatients along with disease phenotype, location, severity, and antibiotic response. Poisson loglinear model evaluated differences in gas patterns between the two groups. RESULTS: After excluding patients with repeat breath tests, we identified 486 IBD and 10,505 non-IBDpatients with at least one BT. Positive BT was present in 57% (n = 264) of IBDpatients. Crohn's disease (odds ratio (OR) 0.21, [95% confidence interval (CI) 0.11-0.38]) and ulcerative colitis (OR 0.39, [95% CI 0.22-0.70]) patients were less likely to produce excess CH4. IBDpatients were more likely to have flatline BT (OR 1.82, [95% CI 1.20-2.77]). In IBDpatients with SIBO, 57% improved symptomatically with antibiotics. CONCLUSION: In a cohort of IBDpatients with IBS-like symptoms, a high rate of patients had positive BT and symptomatic improvement with antibiotics. In IBD, methanogenesis is suppressed and flatline BT is more frequent, suggesting excess hydrogenotrophic bacteria. These findings suggest methanogenic and hydrogenotrophic microorganisms as potential targets for microbiome-driven biomarkers and therapies.