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Use of the lactose-[13C]ureide breath test for diagnosis of small bowel bacterial overgrowth: comparison to the glucose hydrogen breath test

  • Original Article—Alimentary Tract
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Abstract

Purpose

The glucose hydrogen breath test (GHBT) is commonly used as a noninvasive test to diagnose small bowel bacterial overgrowth (SBBO) but its validity has been questioned. Our aim was to evaluate the lactose-[13C]ureide breath test (LUBT) to diagnose SBBO and to compare it with the GHBT, using cultures of intestinal aspirates as a gold standard.

Methods

In 22 patients with suspected SBBO (14 male, age range 18–73 years) aspirates were taken from the region of the ligament of Treitz under sterile conditions and cultured for bacterial growth. More than 106 colony-forming units/mL fluid or the presence of colonic flora was defined as culture positive (c+). After oral intake of 50 g glucose and 2 g of lactose-[13C]ureide, end-expiratory breath samples were obtained up to 120 min. The 13C/12C ratio in breath CO2 was determined by isotope ratio-mass spectrometry and hydrogen concentration in breath was analyzed electrochemically.

Results

After analyzing receiver operating characteristic curves of the LUBT results, total label recovery of >0.88% at 120 min was considered positive. The test had a sensitivity of 66.7% and a specificity of 100% to predict c+. In the GHBT, an increase of the signal of ≥12 ppm from baseline was considered positive. The sensitivity and specificity of the test were 41.7 and 44.4%, respectively.

Conclusions

The new stable isotope-labeled LUBT has excellent specificity but suboptimal sensitivity. In contrast, the standard GHBT lacks both high sensitivity and specificity. The LUBT is superior to the GHBT for detecting SBBO.

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Abbreviations

c.f.u.:

Colony forming units

CO2 :

Carbon dioxide

cPDR:

Cumulative percent dose recovery

GHBT:

Glucose hydrogen breath test

LUBT:

Lactose-[13C]ureide breath test

ROC:

Receiver-operator characteristics

SBBO:

Small bowel bacterial overgrowth

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Acknowledgments

We would like to express our thanks to all patients participating in this study. The authors thank Drs. M. Neubrand, M. Schepke, and A. Al-Mubarak for their clinical assistance. We are indebted to Ms. A. Gey, Ms. U. Klanke, and Ms. A. Pfundstein for their excellent technical assistance.

Conflict of interest statement

No conflicts of interest exist.

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Authors and Affiliations

  1. Department of Clinical Pharmacology, University of Bonn, Bonn, Germany

    Heiner K. Berthold

  2. Department of Internal Medicine I, University of Bonn, Bonn, Germany

    Heiner K. Berthold, Patrick Schober, Christian Scheurlen & Tilman Sauerbruch

  3. Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands

    Patrick Schober

  4. Institute of Medical Microbiology, Immunology and Parasitology, University of Bonn, Bonn, Germany

    Günter Marklein & Regine Horré

  5. Department of Internal Medicine II, University of Cologne, Cologne, Germany

    Ioanna Gouni-Berthold

  6. Charité University Medicine Berlin, Research Group on Geriatrics, Reinickendorfer Strasse 61, 13347, Berlin, Germany

    Heiner K. Berthold

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  1. Heiner K. Berthold
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Correspondence to Heiner K. Berthold.

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Berthold, H.K., Schober, P., Scheurlen, C. et al. Use of the lactose-[13C]ureide breath test for diagnosis of small bowel bacterial overgrowth: comparison to the glucose hydrogen breath test. J Gastroenterol 44, 944–951 (2009). https://doi.org/10.1007/s00535-009-0097-8

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  • DOI: https://doi.org/10.1007/s00535-009-0097-8

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