Outcome of breath tests in adult patients with suspected small intestinal bacterial overgrowth

Aim: The aim was to investigate breath test outcomes in patients with suspected SIBO and indicative symptoms of SIBO, diagnosed by breath testing

Background: Breath testing is used to detect small intestinal bacterial overgrowth [SIBO] by measuring hydrogen and methane produced by intestinal bacteria

Methods: This retrospective cross sectional study included 311 patients with gastrointestinal symptoms who underwent the breath test for evaluation of SIBO at Celiac Disease Center at Columbia University, New York, in 2014-2015. The patients were divided into two groups based on the physician's choice: lactulose breath test group [72%] and glucose breath test group [28%]. Among them, 38% had a history of celiac disease or non-celiac gluten sensitivity

Results: In total, 46% had a positive breath test: 18% were positive for methane, 24 % positive for hydrogen and 4% positive for both gases [p=0.014]. Also, 50% had a positive lactulose breath result and 37% had a positive glucose breath result [p=0.036]. The most common symptom for performing the breath test was bloating and the only clinical symptom that significantly showed a positive glucose breath test was increased gas [p=0.028]

Conclusion: Lactulose breath test was more often positive than glucose breath test. Positivity for hydrogen was more common than methane. Bloating was the most frequently perceived symptom of the patients undergoing the breath test but the only statistically significant clinical symptom for a positive glucose breath test was increased gas. Furthermore, the results showed that there was no significant association between positive breath test result and gender, age, non-celiac gluten sensitivity or celiac disease

Characteristics associated with suboptimal bowel preparation prior to colonoscopy: results of a national survey

Inadequate bowel preparation prior to colonoscopy compromises the medical value of the procedure. The aim of this study is to explore the factors associated with pre-colonoscopy sub-optimal bowel preparation from the perspective of the physician. Using a cross-sectional study design, we examined the role of various factors thought to be associated with sub-optimal bowel preparation as reported by a sample of practicing Gastroenterologists across the United States. We conducted a survey among active members of the American College of Gastroenterology to assess Gastroenterologists' perceptions about barriers faced by the patients in the bowel preparation process. Descriptions of factors associated with sub-optimal bowel preparation prior to screening colonoscopy were identified and described, including health conditions, patient cognitive/ behavioral characteristics and medication use. Health conditions [including constipation and diabetes] and particular patient characteristics [including older age] were the most common perceived determinants of sub-optimal bowel preparation. Although some barriers to colonoscopy preparation [e.g., older age], cannot be modified, many are amenable to change through education. This study indicates the potential value of a personalized approach to bowel preparation, which addresses the specific needs of an individual patient like chronic constipation and diabetes and those with poor literacy skills or poor fluency in English. Development and evaluation of educational interventions to address these factors warrants investment