| A recent publication by M. Pimentel, E.J. Chow
and H.C. Lin has suggested a link between IBS and
bacterial overgrowth. In this study, over 78% of
the 157 patients with IBS tested positive with the
hydrogen breath test. This is an important development
for people that suffer from IBS because bacterial
overgrowth can be successfully treated with antibiotics.
Linking bacterial overgrowth with IBS makes sense
because it relates to the frequent IBS complaint
of bloating after eating. As the bacteria ferment
food, gas is released into the small intestine,
causing painful bloating and other symptoms.
Although the connection between
IBS and bacterial overgrowth is still being studied
it draws attention to the fact that bacterial
overgrowth is a relatively common condition that
can cause symptoms suggestive of IBS. Patients
with IBS should be tested for bacterial overgrowth
if they have diarrhea, abdominal pain and increased
flatulence within 30-45 minutes after eating.
Optimum care of patients with
bacterial overgrowth requires adequate evaluation
and proper antibiotic therapy. However, evaluation
can be difficult due to the often non-specific
nature of the symptoms which overlap with several
common clinical disorders including lactase deficiency,
pancreatic insufficiency, irritable bowel syndrome,
and most important in the elderly, medication
side effects. Usually, bacterial overgrowth is
temporarily eliminated but frequently returns.
Therefore, this condition requires constant monitoring
and therapy.
The Bacterial
Overgrowth Breath Test offered by Metabolic
Solutions is a version of the hydrogen breath
test. It can be performed in a doctor's office
or given to patients to do at their convenience
and in their own homes. It provides a safe, non-invasive,
and cost effective solution to diagnose bacterial
overgrowth.
The production of hydrogen (H2)
or methane (CH4) by small intestinal bacterial
metabolism of lactulose is the basis for the Bacterial
Overgrowth Breath Test. The patient drinks a lactulose
solution and breath samples are collected and
analyzed over two hours. When bacterial overgrowth
is present, a biphasic pattern in breath H2 and
CH4 levels occurs. If bacteria are present in
the upper part of the small intestine, significant
amounts of H2 or CH4 will be produced by bacterial
metabolism of lactulose and will appear in the
aveolar air within 20-60 minutes. A second, alter
peak will appear about one hour or so after lactulose
administration in all patients, with or without
bacterial overgrowth. Bacterial overgrowth is
defined as an early response of H2 or CH4, with
an increase of 20 parts per million over the baseline
breath values, followed by a second peak response
as the sugar reaches the colon.
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