# Small Intestinal Bacterial Overgrowth



## Jeffrey Roberts (Apr 15, 1987)

http://www.Mindbodydigestive.com/recentresearch.html#areview Small Intestinal Bacterial OvergrowthTHE MIND-BODY DIGESTIVE CENTERCharles D. Gerson, M.D.Mary-Joan Gerson, Ph.D.Eradication of Small Intestinal Bacterial Overgrowth Reduces Symptoms of Irritable Bowel Syndrome. Pimental M, Chow EJ, Lin HC. Amer J Gastro 12: 3503-3506, 2000.


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## KateyKat (Jan 4, 2001)

Thanks for posting this Jeffrey; this particular critique is most helpful in shedding light on such a controversial issue.KKat


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## Kathleen M. (Nov 16, 1999)

Here is the abstract for the article they refer to in the review of the article.Title The lactulose breath hydrogen test and small intestinal bacterial overgrowth. Author Riordan SM ; McIver CJ ; Walker BM ; Duncombe VM ; Bolin TD ; Thomas MC Address Department of Gastroenterology, Prince of Wales Hospital, Sydney, Australia. Source Am J Gastroenterol, 91(9):1795-803 1996 Sep Abstract OBJECTIVES: To i) document the sensitivity and specificity of a combined scintigraphic/lactulose breath hydrogen test for small intestinal bacterial overgrowth and ii) investigate the validity of currently accepted definitions of an abnormal lactulose breath hydrogen test based on "double peaks" in breath hydrogen concentrations. METHODS: Twenty-eight subjects were investigated with culture of proximal small intestinal aspirate and a 10-g lactulose breath hydrogen test combined with scintigraphy. Gastroduodenal pH, the presence or absence of gastric bacterial overgrowth, and the in vitro capability of overgrowth flora to ferment lactulose were determined. RESULTS: Sensitivity (16.7%) and specificity (70.0%) of the lactulose breath hydrogen test alone for small intestinal bacterial overgrowth were poor. Combination with scintigraphy resulted in 100% specificity, because double peaks in serial breath hydrogen concentrations may occur as a result of lactulose fermentation by cecal bacteria. Sensitivity increased to 38.9% with scintigraphy, because a single rise in breath hydrogen concentrations, commencing before the test meal reaches the cecum, may occur in this disorder. Sensitivity remained suboptimal irrespective of the definition of small intestinal bacterial overgrowth used, the nature of the overgrowth flora, favorable luminal pH, the presence of concurrent gastric bacterial overgrowth, or the in vitro ability of the overgrowth flora to ferment lactulose. CONCLUSIONS: Definitions of an abnormal lactulose breath hydrogen test based on the occurrence of double peaks in breath hydrogen concentrations are inappropriate. Not even the addition of scintigraphy renders this test a clinically useful alternative to culture of aspirate for diagnosing small intestinal bacterial overgrowth. ------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.My story and what worked for me in greatly easing my IBS: http://www.ibsgroup.org/ubb/Forum17/HTML/000015.html


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