氢气和甲烷呼气试验(HMBT)是广泛使用的临床研究,但缺乏标准化。为了解决这个问题,北美共识(NAC)小组发布了基于证据的HMBT建议。
为了评估使用NAC对HMBT的建议获得的结果,与使用以前推荐的指南的回顾性数据进行比较。
分析了725名接受小肠细菌过度生长(SIBO)和/或碳水化合物吸收不良(CM)测试的患者的HMBT数据。比较了有关SIBO测试底物剂量的数据(16与10g乳果糖,和50vs.75g葡萄糖)和摄入后采样期对吸收不良测试的影响。检查了SIBO的不同推荐截止值的影响。
底物剂量不影响甲烷产生。与16g乳果糖相比,10g乳果糖显着降低了SIBO阳性结果(42vs.53%,p=0.04)。与50g葡萄糖相比,75g葡萄糖显着增加阳性结果(36vs.22%,p=0.04)。在北美共识和Ledochowski临界值均呈阳性的患者中,诱发症状明显更为普遍。34.5%的患者在180分钟时检测出CM阳性,而在120分钟时检测为28%(不显着,p=0.19)。
10克乳果糖底物产生的阳性SIBO结果少于16克乳果糖,而75g葡萄糖剂量比50g产生更多的阳性SIBO结果。与120分钟相比,进行180分钟的CM呼气测试会增加阳性结果的数量。SIBO截止时间需要进一步调查,但我们的发现广泛支持NAC对SIBO和CM测试的建议。
Hydrogen and
methane breath tests (HMBT) are widely used clinical investigations but lack standardization. To address this, the North American
Consensus (NAC) group published evidence-based recommendations for HMBT.
To evaluate results obtained using NAC recommendations for HMBT, compared to retrospective data that utilized
guidelines previously recommended.
HMBT data from 725 patients referred for small intestinal bacterial overgrowth (SIBO) and/or carbohydrate malabsorption (CM) testing were analyzed. Data were compared regarding dose of substrate for SIBO testing (16 vs. 10 g lactulose, and 50 vs. 75 g glucose) and the effect of post-ingestion sampling period for malabsorption testing. The effect of different recommended cut-off values for SIBO were examined.
Substrate dose did not affect
methane production. 10 g lactulose significantly reduced positive SIBO results compared to 16 g lactulose (42 vs. 53%, p = 0.04). 75 g glucose significantly increased positive results compared to 50 g glucose (36 vs. 22%, p = 0.04). Provoked symptoms were significantly more prevalent in patients testing positive by both North American
Consensus and Ledochowski cut-off values. 34.5% of patients tested positive for CM at 180-min compared to 28% at 120-min (not significant, p = 0.19).
10 g lactulose substrate produces fewer positive SIBO results than 16 g lactulose, while 75 g glucose dose produces more positive SIBO results than 50 g. Performing CM breath tests for 180 min increases number of positive results when compared to 120 min. SIBO cut-off timings require further investigation, but our findings broadly support the NAC recommendations for SIBO and CM testing.