Lactulose Breath Test Gas Production in Childhood IBS Is Associated With Intestinal Transit and Bowel Movement Frequency.
In adults with irritable bowel syndrome (IBS), bacterial gas production (colonic fermentation) is related to both symptom generation and intestinal transit. Whether gas production affects symptom generation, psychosocial distress, or intestinal transit in childhood IBS is unknown.



Children (ages 7-17 years) with pediatric Rome III IBS completed validated psychosocial questionnaires and a 2-week daily diary capturing pain and stooling characteristics. Stool form determined IBS subtype. Subjects then completed a 3-hour lactulose breath test for measurement of total breath hydrogen and methane production. Carmine red was used to determine whole intestinal transit time.



A total of 87 children (mean age 13 ± 2.6 [standard deviation] years) were enrolled, of whom 50 (57.5%) were girls. All children produced hydrogen and 51 (58.6%) produced methane. Hydrogen and methane production did not correlate with either abdominal pain frequency/severity or psychosocial distress. Hydrogen and methane production did not differ significantly by IBS subtype. Methane production correlated positively with whole intestinal transit time (r = 0.31, P < 0.005) and inversely with bowel movement frequency (r = -0.245, P < 0.05). Methane production (threshold 3 ppm) as a marker for identifying IBS-C had a sensitivity of 60% and specificity of 42.9%.



Lactulose breath test total methane production may serve as a biomarker of whole intestinal transit time and bowel movement frequency in children with IBS. In children with IBS, lactulose breath test hydrogen and methane production did not, however, correlate with abdominal pain, IBS subtype, or psychosocial distress.
*Department of Pediatrics, Baylor College of Medicine †Section of Pediatric Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital ‡USDA/ARS Children's Nutrition Research Center, Houston, TX.
Bruno P
BP
Chumpitazi
Erica M
EM
Weidler
Robert J
RJ
Shulman
D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D000293:Adolescent; D015415:Biomarkers / Q000378:metabolism; D001944:Breath Tests; D002648:Child; D003672:Defecation / Q000502:physiology*; D003863:Depression / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005772:Gastrointestinal Transit / Q000502:physiology*; D006801:Humans; D006859:Hydrogen / Q000378:metabolism*; D043183:Irritable Bowel Syndrome / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology / Q000523:psychology; D007792:Lactulose; D008297:Male; D008697:Methane / Q000378:metabolism*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000175:diagnosis / Q000209:etiology
D015415:Biomarkers; D007792:Lactulose; D006859:Hydrogen; D008697:Methane