Office Uno Column:　Yoshiharu Uno, PhD

Even in patients who have symptoms of SIBO, there are many cases it is not diagnosed with SIBO by the breath test.

I know the answer to the mystery.

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http://www.ncbi.nlm.nih.gov/pubmed/26038313

Hepatogastroenterology. 2015 Mar-Apr;62(138):268-72.

Association between chronic use of proton pump inhibitors and small- intestinal bacterial overgrowth assessed using lactulose hydrogen breath tests.

Fujiwara Y, Watanabe T, Muraki M, Yamagami H, Tanigawa T, Shiba M, Tominaga K, Arakawa T.

Abstract

BACKGROUND/AIMS:

Several adverse events have been reported in patients who are chronic users of proton pump inhibitors (PPIs); however, the association between PPI use and small-intestinal bacterial overgrowth (SIBO) is controversial. We examined the prevalence of SIBO, as assessed by the lactulose hydrogen breath test (LHBT), based on the use of gastric acid-suppressive drugs in Japanese patients. METH- ODOLOGY: Ninety-four patients who were examined by the LHBT were assessed retrospectively. We used several criteria to define a positive LHBT result. Nine patients received probiotics containing Lactobacillus casei.

RESULTS:

Fifty patients were PPI users, 14 were histamine-2 receptor antagonist (H2RA) users, and were 30 non-PPI and non-H2RA users (controls). There were no significant differences in prevalence of LHBT-positive cases among the three groups. Multiple-adjusted regression showed no significant association between PPI use and being LHBT-positive. Prevalence of postprandial fullness in PPI users was high (46%), but such symptoms were not related to LHBT results. Four (44%) of 9 cases became LHBT-negative and the maximal peak of H2 production decreased significantly after probiotic treatment.

CONCLUSIONS:

PPI treatment is not associated with SIBO in Japanese patients. Mechanisms apart from SIBO could cause the high prevalence of postprandial fullness in PPI users.

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This is a very core research report.

PPI use and abdominal distension was associated.

However, those patients were not diagnosed with SIBO in breath tests.

Why not?

It may not be accurate to diagnosis of SIBO by the breath test.

Please rate the patient when produced abdominal distension.

Thereby, the answer to the mystery appears.

 https://www.youtube.com/watch?v=k0WU1ePzhOI