title: Reproducible lactulose hydrogen breath test as a measure of mouth-to-cecum transit time.
abstract: Breath hydrogen monitoring after oral lactulose syrup is a conventional measure of mouth-to-cecum transit time (MCTT), but its reproducibility has been questioned. We compared the reproducibility of five measurements of MCTT after a conventional breakfast (380 kcal) taken with tea containing 20 g lactulose to five measurements of MCTT after 20 g lactulose in water in eight normal volunteers. Individual mean breakfast transit time was not significantly different from lactulose transit time in each of the seven subjects, but one had a breakfast transit time of 151 +/- 15 min and a lactulose transit time of 86 +/- 22 minutes (X +/- SD, P less than 0.001). The coefficient of variation of breakfast transit time (11.6 +/- 5.3%, range: 6.9-24.2%) was less than that of lactulose transit time (30.7 +/- 7.8%, range: 22.1-50.0%, P less than 0.001). In a second set of experiments, the liquid phase marker (99mTechnetium-diethylene triamine pentaacetic acid) emptied from the stomach more rapidly after the lactulose solution (T1/2 16.3 +/- 5.4) than after the breakfast (33.9 +/- 10.9 min, P less than 0.01) and MCTT was shorter after lactulose (77 +/- 32 vs 104 +/- 40 min, respectively, P less than 0.05). There was no correlation between MCTT of lactulose and breakfast and between half-time gastric emptying and MCTT of either lactulose or breakfast. We conclude that the ingestion of inert lactulose induces an abnormally rapid MCTT and that breakfast MCTT is a much more reproducible investigation and should be employed in studies requiring serial measurements.
authors.affiliation: Second Department of Internal Medicine-Propaedeutic, Athens University, Evangelismos Hospital, Greece.
authors.forename: S D
authors.initials: SD
authors.lastname: Ladas
authors.forename: C
authors.initials: C
authors.lastname: Latoufis
authors.forename: H
authors.initials: H
authors.lastname: Giannopoulou
authors.forename: J
authors.initials: J
authors.lastname: Hatziioannou
authors.forename: S A
authors.initials: SA
authors.lastname: Raptis
mesh_terms: D000328:Adult; D001944:Breath Tests; D002432:Cecum; D004187:Disaccharides; D005260:Female; D005746:Gastric Emptying; D005772:Gastrointestinal Transit; D006801:Humans; D006859:Hydrogen / Q000032:analysis; D007792:Lactulose; D008297:Male; D009055:Mouth; D009942:Organometallic Compounds; D004369:Pentetic Acid; D015203:Reproducibility of Results; D016284:Technetium Tc 99m Pentetate
chemical_list: D004187:Disaccharides; D009942:Organometallic Compounds; D007792:Lactulose; D004369:Pentetic Acid; D006859:Hydrogen; D016284:Technetium Tc 99m Pentetate