Bacterial overgrowth and lactose intolerance: how to best assess.
Journal
Current opinion in clinical nutrition and metabolic care
ISSN: 1473-6519
Titre abrégé: Curr Opin Clin Nutr Metab Care
Pays: England
ID NLM: 9804399
Informations de publication
Date de publication:
01 09 2022
01 09 2022
Historique:
pubmed:
16
7
2022
medline:
5
8
2022
entrez:
15
7
2022
Statut:
ppublish
Résumé
To provide an up-to-date review on the clinical assessment of two important gastrointestinal problems with overlapping symptomatology but diverse cause and testing methods. Small intestinal bacterial overgrowth (SIBO) is characterized by the presence of excess bacteria in the small intestine associated with bloating, distention, gas, and diarrhea. Lactose intolerance is caused by lactase enzyme deficiency in the small bowel mucosa leading to lactose malabsorption and symptoms of bloating, gas, and diarrhea. SIBO is assessed by hydrogen/methane breath test using glucose as a substrate and/or small bowel aspirate and culture but these tests have shortcomings. Consequently, several new diagnostic techniques, including novel capsule technologies and other approaches are being evaluated. Lactose intolerance can be assessed by hydrogen/methane breath test using lactose as a substrate, or small bowel mucosal lactase assay, genetic testing and lactose tolerance test, although the efficacy and practicality of these diagnostic modalities are not equal. In clinical practice, gas, bloating, distention, pain, and diarrhea are common gastrointestinal symptoms that often remain unexplained when routine gastrointestinal endoscopy, imaging, and stool tests are negative. These patients should be evaluated for SIBO and/or food intolerances including lactose intolerance.
Identifiants
pubmed: 35838278
doi: 10.1097/MCO.0000000000000861
pii: 00075197-202209000-00012
doi:
Substances chimiques
Hydrogen
7YNJ3PO35Z
Lactase
EC 3.2.1.108
Methane
OP0UW79H66
Types de publication
Journal Article
Review
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
334-340Subventions
Organisme : NIDDK NIH HHS
ID : U01 DK115575
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01 DK121003
Pays : United States
Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Références
Saffouri GB, Shields-Cutler RR, Chen J, et al. Small intestinal microbial dysbiosis underlies symptoms associated with functional gastrointestinal disorders. Nat Commun 2019; 10:2012.
Rao SSC, Bhagatwala J. Small intestinal bacterial overgrowth: clinical features and therapeutic management. Clin Transl Gastroenterol 2019; 10:e00078.
Erdogan A, Rao SS, Gulley D, et al. Small intestinal bacterial overgrowth: duodenal aspiration vs glucose breath test. Neurogastroenterol Motil 2015; 27:481–489.
Rezaie A, Buresi M, Lembo A, et al. Hydrogen and methane-based breath testing in gastrointestinal disorders: the North American Consensus. Am J Gastroenterol 2017; 112:775–784.
Rao SSC, Tan G, Abdulla H, et al. Does colectomy predispose to small intestinal bacterial (SIBO) and fungal overgrowth (SIFO)? Clin Transl Gastroenterol 2018; 9:146.
Pimentel M, Saad RJ, Long MD, Rao SSC. ACG clinical guideline: small intestinal bacterial overgrowth. Am J Gastroenterol 2020; 115:165–178.
Hammer HF, Fox MR, Keller J, et al. European H2-CH4-breath test group. European guideline on indications, performance, and clinical impact of hydrogen and methane breath tests in adult and pediatric patients: European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Neurogastroenterology and Motility, and European Society for Paediatric Gastroenterology Hepatology and Nutrition consensus. United European Gastroenterol J 2022; 10:15–40.
Nichols BL, Baker RD, Baker SS. Overview of breath testing in clinical practice in North America. JPGN Rep 2021; 2:e027.
Losurdo G, Leandro G, Lerardi E, et al. Breath tests for the noninvasive diagnosis of small intestinal bacterial overgrowth: a systematic review with meta-analysis. J Neurogastroenterol Motil 2020; 26:16–28.
Amieva-Balmori M, Coss-Adame E, Rao NS, et al. Diagnostic utility of carbohydrate breath tests for SIBO, fructose, and lactose intolerance. Digest Dis Sci 2020; 65:1405–1413.
Takakura W, Pimentel M, Rao S, et al. A single fasting exhaled methane level correlates with fecal methanogen load, clinical symptoms and accurately detects intestinal methanogen overgrowth. Am J Gastroenterol 2022; 117:470–477.
Birg A, Hu S, Lin HC. Reevaluating our understanding of lactulose breath tests by incorporating hydrogen sulfide measurements. JGH Open 2019; 3:228–233.
Lin EA, Chua KS, Pichetshote N, et al. Measurement of hydrogen sulfide during breath testing correlates to patient symptoms. Gastroenterology 2017; 152.
Karunaratne TB, Sharma A, Rao SSC. Small-bowel aspiration during upper esophagogastroduodenoscopy: Rao technique. VideoGIE 2021; 6:152–154.
Uy P, Jehangir A, Rao S, Yap JE. S3279 diagnostic yield of duodenal aspirates/culture for SIBO or SIFO among patients with cystic fibrosis. J Am Coll Gastroenterol 2021; 116:S1351.
Viswanathan L, Larion S, Shaffer N, et al. Sa1974 - endoscopically assisted glucose breath test (EAGBT): a novel diagnostic approach for distal SIBO. Gastroenterology 2017; 152:S413.
Kalantar-zadeh K, Berean KJ, Ha N, et al. A human pilot trial of ingestible electronic capsules capable of sensing different gases in the gut. Nat Electron 2018; 1:79–87.
Leite G, Morales W, Weitsman S, et al. The duodenal microbiome is altered in small intestinal bacterial overgrowth. PLoS One 2020; 15:e0234906.
Rao SS, Moshiree B, Lee N, et al. S1282 Evaluation of Smart Capsule Bacterial Detection System (SCBDS) Assay and duodenal culture in subjects suspected of SIBO and undergoing upper endoscopy: interim analysis. J Am Coll Gastroenterol 2020; 115:S644.
Fassio F, Facioni MS, Guagnini F. Lactose maldigestion, malabsorption, and intolerance: a comprehensive review with a focus on current management and future perspectives. Nutrients 2018; 10:1599.
Robles L, Priefer R. Lactose intolerance: what your breath can tell you. Diagnostics 2020; 10:412.
Storhaug CL, Fosse SK, Fadnes LT. Country, regional, and global estimates for lactose malabsorption in adults: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2017; 2:738–746.
Catanzaro R, Sciuto M, Marotta F. Lactose intolerance: an update on its pathogenesis, diagnosis, and treatment. Nutr Res 2021; 89:23–34.
Goh LH, Mohd Said R, Goh KL. Lactase deficiency and lactose intolerance in a multiracial Asian population in Malaysia. JGH Open 2018; 2:307–310.
Jansson-Knodell CL, Krajicek EJ, Savaiano DA, Shin AS, editors. Lactose intolerance: a concise review to skim the surface. Mayo Clinic Proceedings; 2020: Elsevier.
Facioni MS, Raspini B, Pivari F, et al. Nutritional management of lactose intolerance: the importance of diet and food labelling. J Transl Med 2020; 18:260.
Viswanathan L, Rao SS, Kennedy K, et al. Prevalence of disaccharidase deficiency in adults with unexplained gastrointestinal symptoms. J Neurogastroenterol Motil 2020; 26:384.
Di Costanzo M, Canani RB. Lactose intolerance: common misunderstandings. Ann Nutr Metab 2018; 73:30–37.