Association between Symptoms of Irritable Bowel Syndrome and Methane and Hydrogen on Lactulose Breath Test

Whether hydrogen and methane gas produced during lactulose breath test (LBT) are associated with symptoms of irritable bowel syndrome (IBS) is not determined. We aimed to investigate whether hydrogen and methane on LBT are associated with IBS symptoms. Sixty-eight IBS patients meeting the Rome III criteria for IBS, and 55 healthy controls, underwent LBT. The IBS subjects recorded their customary gastrointestinal symptoms on a questionnaire using visual analogue scales. LBT positivity was defined to be above 20 ppm rise of hydrogen or 10 ppm rise of methane within 90 min. Gas amounts produced during LBT were determined by calculating area under the curve of hydrogen and methane excretion. Symptom severity scores were not different between the LBT (+) IBS and LBT (-) IBS subjects and also between methane producers and non-methane producers. Gas amounts produced during LBT were not associated with IBS symptoms, except a weak correlation between total gas amounts and a few IBS symptoms such as bloating (r = 0.324, P = 0.039), flatulence (r = 0.314, P = 0.046) and abdominal pain (r = 0.364, P = 0.018) only in LBT (+) IBS. In conclusion, hydrogen and methane gas on LBT are not useful for predicting the customary symptoms and subtypes of IBS.

44 años de avances en Etiopatogenia, Diagnóstico y Tratamiento del Síndrome Flatulencia / Forty-four years of advances in pathogenesis, diagnosis and treatment of Flatulence Syndrome

En el presente artículo, el autor recuerda trabajos de investigación realizados, desde hace cuarenticuatro años, para aclarar la etiopatogenia y mejorar el diagnóstico y tratamiento del síndrome flatulencia.

In the present paper, the author reminds investigations performed, since forty-four years ago, to clarify the ethiopathogenesis and to improve the diagnosis and treatment of the flatulence syndrome.

Lactose intolerance and intestinal villi morphology in Thai people.

OBJECTIVE: To study the relationship of lactose intolerance and intestinal villi morphology in Thai people. MATERIAL AND METHOD: Subjects for this study were patients with functional dyspepsia who had no history of milk allergy and underwent gastroduodenoscopy. Two mucosal biopsy specimens were taken from beyond the distal end of the second part of the duodenum. The specimens were carefully orientated and were graded according to the following scheme: group I: finger shaped villi; group II: mixed finger and leaf shaped villi; group III: clubbing or blunting shaped villi. All subjects were tested for lactose malabsorption by breath hydrogen analysis after consuming 50 gram lactose. Breath hydrogen concentration was analyzed in samples collected intermittently by end-expiratory technique. A rise in breath hydrogen concentration of 20 PPM over baseline was considered evidence of lactose malabsorption. RESULTS: The twenty-five subjects were twenty females (80.0%) and five males (20.0%) who ranged in age from 18 to 53 years (mean 31 +/- 8.29). Sixteen subjects belonged to the finger shaped villi group (64.0%), five to the mixed finger and leaf shaped villi, group (20.0%) and four to the clubbing or blunting shaped villi group (16.0%). Results of breath hydrogen excretion test identified the prevalence of lactose intolerance in 68 per cent of the subjects: 15/16 (93.75%) of group I; 1/5 (20.0%) of group II and 1/4 (25%) of group III respectively (P<0.001). The symptom of diarrhea after lactose loading was correlated well in patients who had positive breath hydrogen analysis. CONCLUSION: As shown in this study, the lactose intolerance is not related to intestinal villi morphology. It is implied that primary lactase deficiency is more common in Thai people than secondary lactase deficiency.

Resultados de la colecistectomía a 10 años plazo / Clinical status of patients subjected to cholecystectomy 10 years after

Background: The post cholecystectomy syndrome comprises a series of vague symptoms referred by patients subjected to this surgical procedure. These symptoms are unspecific and their association with the operation is dubious. Aim: To assess the frequency of digestive symptoms among patients subjected to a cholecystectomy ten years ago. Patients and methods: One hundred patients subjected to a cholecystectomy between 1987 and 1990, were contacted by mail. They were invited to a clinical interview and to an abdominal ultrasound examination. Results: Two invited patients had died of an acute myocardial infarction. Therefore, 98 patients (78 women), aged 30 to 85 years old, were assessed. Seventy two percent had diverse dyspeptic symptoms, 90 percent had no food intolerance and 94 percent had gained weight after the operation. Ninety six percent was satisfied with the surgical results, 3 percent had severe symptoms due to gastroesophageal reflux or depression. One patient had a residual choledocholithiasis and refused any treatment. Conclusions: Cholecystectomy is well tolerated and has good long term results

Absceso hepático formador de gas en el paciente diabético. Una asociación clínica poco reconocida / Gas forming hepatic abscess in the diabetic patient. a rarely known clinical association

El absceso hepático piógeno, frecuentemente es secundario a infecciones intrabdominales. Sin embargo, en el paciente diabético, esta asociación no es un requisito. Los gérmenes formadores de gas afectan al diabético produciendo diversas entidades nosológicas como colecistitis enfisematos, apendicitis gangrenosa, abscesos perinefríticos, fascitis necrosante entre otros. Presentamos el caso de un paciente diabético de 47 años de edad al que se le diagnosticó un absceso hepático por gérmenes formadores de gas que se trató mediante punción percutánea y antibióticos. Se analizan los factores predisponentes a la aparición de esta asociación, así como la forma de manejo en la actualidad