A 14-day elemental diet is highly effective in normalizing the lactulose breath test.
Treatment of small intestinal bacterial overgrowth is frustrated by the low efficacy of antibiotics. Elemental diets have been shown to reduce enteric flora. In this study, we evaluate the ability of an elemental diet to normalize the lactulose breath test (LBT) in IBS subjects with abnormal breath test findings. Consecutive subjects with IBS and abnormal LBT suggesting the presence of bacterial overgrowth underwent a 2-week exclusive elemental diet. The diet consisted of Vivonex Plus (Novartis Nutrition Corp., Minneapolis, MN) in a quantity based on individual caloric requirement. On day 15 (prior to solid food), subjects returned for a follow-up breath test and those with an abnormal LBT were continued on the diet for an additional 7 days. The ability of an elemental diet to normalize the LBT was determined for days 15 and 21. A chart review was then conducted to evaluate any clinical benefit 1 month later. Of the 93 subjects available for analysis, 74 (80%) had a normal LBT on day 15 of the elemental diet. When those who continued to day 21 were included, five additional patients normalized the breath test (85%). On chart review, subjects who successfully normalized their breath test had a 66.4 +/- 36.1% improvement in bowel symptoms, compared to 11.9 +/- 22.0% in those who failed to normalize (P < 0.001). An elemental diet is highly effective in normalizing an abnormal LBT in IBS subjects, with a concomitant improvement in clinical symptoms.
GI Motility Program, Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, CSMC Burns & Allen Research Institute, Los Angeles, California 90048, USA. mark.pimentel@cshs.org
Mark
M
Pimentel
Tess
T
Constantino
Yuthana
Y
Kong
Meera
M
Bajwa
Abolghasem
A
Rezaei
Sandy
S
Park
D001944:Breath Tests; D003109:Colonic Diseases, Functional / Q000178:diet therapy* / Q000378:metabolism*; D005503:Food Additives; D005526:Food, Formulated; D006801:Humans; D007792:Lactulose / Q000378:metabolism*; D009930:Organic Chemicals; D012189:Retrospective Studies; D016896:Treatment Outcome
D005503:Food Additives; D009930:Organic Chemicals; D007792:Lactulose; C011567:Vivonex