title: Comparison of lactulose and glucose breath test for diagnosis of small intestinal bacterial overgrowth in patients with irritable bowel syndrome.
abstract: OBJECTIVE
  Validity of the lactulose breath test (LBT) to diagnose small intestinal bacterial overgrowth (SIBO) has been questioned. Therefore, a study was planned to compare LBT with glucose breath test (GBT) to diagnose SIBO in irritable bowel syndrome (IBS) patients and controls.
  
  
  METHODS
  175 diarrhea-predominant IBS patients and 150 apparently healthy controls were enrolled. IBS was diagnosed according to Rome II criteria. Breath samples were collected every 10 min up to 180 min. Breath H₂ and CH₄ were measured using an SC MicroLyzer. SIBO was positive with a sustained increase in breath H₂ or CH₄ or both ≥10 ppm over a baseline value within <90 min in case of LBT and within <120 min in GBT.
  
  
  RESULTS
  SIBO was positive in 60/175 (34.3%) patients by lactulose and in 11/175 (6.2%) patients by GBT. In controls, LBT was positive for SIBO in 45/150 (30%) patients and in 1/150 (0.66%) patients by GBT. Positive LBT for SIBO was not significantly different in patients and controls; while using GBT, SIBO was significantly higher (p < 0.01) in patients as compared to controls. By using GBT as gold standard for SIBO, sensitivity, specificity, positive predictive value and negative predictive value of LBT in IBS patients was 63.6, 67.7, 11.7 and 96.6% respectively.
  
  
  CONCLUSIONS
  LBT is not a good test to discriminate SIBO in IBS patients from controls.
authors.affiliation: Department of Super Specialty of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. svrana25@hotmail.com
authors.forename: S V
authors.initials: SV
authors.lastname: Rana
authors.forename: S
authors.initials: S
authors.lastname: Sharma
authors.forename: J
authors.initials: J
authors.lastname: Kaur
authors.forename: S K
authors.initials: SK
authors.lastname: Sinha
authors.forename: K
authors.initials: K
authors.lastname: Singh
mesh_terms: D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000175:diagnosis* / Q000209:etiology; D001944:Breath Tests / Q000379:methods*; D016022:Case-Control Studies; D005260:Female; D005947:Glucose; D006801:Humans; D007421:Intestine, Small / Q000382:microbiology*; D043183:Irritable Bowel Syndrome / Q000175:diagnosis* / Q000382:microbiology; D007792:Lactulose; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D007792:Lactulose; D005947:Glucose