PDF(Pubmed)
Abstract：
BACKGROUND: While colorectal polyps are not cancerous, some types of polyps, known as adenomas, can develop into colorectal cancer over time. Polyps can often be found and removed by colonoscopy; however, this is an invasive and expensive test. Thus, there is a need for new methods of screening patients at high risk of developing polyps.
OBJECTIVE: To identify a potential association between colorectal polyps and small intestine bacteria overgrowth (SIBO) or other relevant factors in a patient cohort with lactulose breath test (LBT) results.
METHODS: A total of 382 patients who had received an LBT were classified into polyp and non-polyp groups that were confirmed by colonoscopy and pathology. SIBO was diagnosed by measuring LBT-derived hydrogen (H) and methane (M) levels according to 2017 North American Consensus recommendations. Logistic regression was used to assess the ability of LBT to predict colorectal polyps. Intestinal barrier function damage (IBFD) was determined by blood assays.
RESULTS: H and M levels revealed that the prevalence of SIBO was significantly higher in the polyp group than in the non-polyp group (41% vs 23%, P < 0.01; 71% vs 59%, P < 0.05, respectively). Within 90 min of lactulose ingestion, the peak H values in the adenomatous and inflammatory/hyperplastic polyp patients were significantly higher than those in the non-polyp group (P < 0.01, and P = 0.03, respectively). In 227 patients with SIBO defined by combining H and M values, the rate of IBFD determined by blood lipopolysaccharide levels was significantly higher among patients with polyps than those without (15% vs 5%, P < 0.05). In regression analysis with age and gender adjustment, colorectal polyps were most accurately predicted with models using M peak values or combined H and M values limited by North American Consensus recommendations for SIBO. These models had a sensitivity of ≥ 0.67, a specificity of ≥ 0.64, and an accuracy of ≥ 0.66.
CONCLUSIONS: The current study made key associations among colorectal polyps, SIBO, and IBFD and demonstrated that LBT has moderate potential as an alternative noninvasive screening tool for colorectal polyps.
OBJECTIVE: To identify a potential association between colorectal polyps and small intestine bacteria overgrowth (SIBO) or other relevant factors in a patient cohort with lactulose breath test (LBT) results.
METHODS: A total of 382 patients who had received an LBT were classified into polyp and non-polyp groups that were confirmed by colonoscopy and pathology. SIBO was diagnosed by measuring LBT-derived hydrogen (H) and methane (M) levels according to 2017 North American Consensus recommendations. Logistic regression was used to assess the ability of LBT to predict colorectal polyps. Intestinal barrier function damage (IBFD) was determined by blood assays.
RESULTS: H and M levels revealed that the prevalence of SIBO was significantly higher in the polyp group than in the non-polyp group (41% vs 23%, P < 0.01; 71% vs 59%, P < 0.05, respectively). Within 90 min of lactulose ingestion, the peak H values in the adenomatous and inflammatory/hyperplastic polyp patients were significantly higher than those in the non-polyp group (P < 0.01, and P = 0.03, respectively). In 227 patients with SIBO defined by combining H and M values, the rate of IBFD determined by blood lipopolysaccharide levels was significantly higher among patients with polyps than those without (15% vs 5%, P < 0.05). In regression analysis with age and gender adjustment, colorectal polyps were most accurately predicted with models using M peak values or combined H and M values limited by North American Consensus recommendations for SIBO. These models had a sensitivity of ≥ 0.67, a specificity of ≥ 0.64, and an accuracy of ≥ 0.66.
CONCLUSIONS: The current study made key associations among colorectal polyps, SIBO, and IBFD and demonstrated that LBT has moderate potential as an alternative noninvasive screening tool for colorectal polyps.
摘要：
背景：虽然结直肠息肉不是癌变，某些类型的息肉,称为腺瘤，随着时间的推移会发展为结直肠癌。息肉通常可以通过结肠镜检查发现和切除；然而，这是一个侵入性和昂贵的测试。因此，需要新的方法来筛查发生息肉的高危患者.
目的：在乳果糖呼气试验（LBT）结果的患者队列中，确定结直肠息肉与小肠细菌过度生长（SIBO）或其他相关因素之间的潜在关联。
方法：将382例接受LBT的患者分为息肉组和非息肉组，经结肠镜和病理证实。根据2017年北美共识建议，通过测量LBT衍生的氢（H）和甲烷（M）水平来诊断SIBO。采用Logistic回归分析评估LBT对结直肠息肉的预测能力。通过血液测定确定肠屏障功能损伤(IBFD)。
结果：H和M水平显示，息肉组SIBO的患病率明显高于非息肉组（41％vs23％，P<0.01；71%vs59%，分别P<0.05)。摄入乳果糖90分钟内，腺瘤性和炎性/增生性息肉患者的峰值H值显着高于非息肉组（分别为P<0.01和P=0.03）。在通过组合H和M值定义的227例SIBO患者中，由血液脂多糖水平确定的IBFD率在息肉患者中明显高于无息肉患者（15％vs5％，P<0.05)。在年龄和性别调整的回归分析中，使用M峰值或合并H和M值的模型最准确地预测结直肠息肉,这些模型受北美共识推荐的SIBO限制.这些模型的敏感性≥0.67，特异性≥0.64，准确性≥0.66。
结论：目前的研究发现了结直肠息肉之间的关键关联，SIBO,和IBFD，并证明LBT作为结直肠息肉的替代无创筛查工具具有中等潜力。
目的：在乳果糖呼气试验（LBT）结果的患者队列中，确定结直肠息肉与小肠细菌过度生长（SIBO）或其他相关因素之间的潜在关联。
方法：将382例接受LBT的患者分为息肉组和非息肉组，经结肠镜和病理证实。根据2017年北美共识建议，通过测量LBT衍生的氢（H）和甲烷（M）水平来诊断SIBO。采用Logistic回归分析评估LBT对结直肠息肉的预测能力。通过血液测定确定肠屏障功能损伤(IBFD)。
结果：H和M水平显示，息肉组SIBO的患病率明显高于非息肉组（41％vs23％，P<0.01；71%vs59%，分别P<0.05)。摄入乳果糖90分钟内，腺瘤性和炎性/增生性息肉患者的峰值H值显着高于非息肉组（分别为P<0.01和P=0.03）。在通过组合H和M值定义的227例SIBO患者中，由血液脂多糖水平确定的IBFD率在息肉患者中明显高于无息肉患者（15％vs5％，P<0.05)。在年龄和性别调整的回归分析中，使用M峰值或合并H和M值的模型最准确地预测结直肠息肉,这些模型受北美共识推荐的SIBO限制.这些模型的敏感性≥0.67，特异性≥0.64，准确性≥0.66。
结论：目前的研究发现了结直肠息肉之间的关键关联，SIBO,和IBFD，并证明LBT作为结直肠息肉的替代无创筛查工具具有中等潜力。
