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1、ORIGINAL ARTICLELactulose breath test results in patients with persistent abdominal symptoms following Giardia lamblia infectionMETTE H. MORKEN, GUNNAR NYSAETER, ELISABETH A. STRAND, TRYGVE HAUSKEN 43: 141?145(Received 26 June 2007; accepted 6 August 2007)ISSN 0036-5521 print/ISSN 1502-7708 online #
2、 2008 Taylor median age 30 years, range 18?60 years) and 42 controls (4 M, 38 F; median age 27 years, range142M. H. Morken et al.Scand J Gastroenterol Downloaded from by Francis A Countway Library of Medicine on 12/25/12 For personal use only.19?54 years). Two pregnant women were excluded from the
3、study. Microscopy of three stool samples from each patient revealed G. lamblia cysts in 23 (29.8%) of the 77 patients. In stool samples from the remaining 54 patients (70.1%), cysts were not detected.Customary symptomsThe patients most prominent symptoms were nau- sea, abdominal pain, bloating, anor
4、exia and diar- rhoea. Symptom pattern as well as total symptom scores were similar for the two patients groups. Ninety-six percent of the Giardia-infected and 94% of the Giardia-cured patients had IBS according to Rome II criteria, and both patient groups had significantly higher total symptom score
5、s than the normal population (Figure 1, pB0.0001), among whom 26% had IBS according to Rome II criteria.Post-LBT symptomsAlso for post-LBT symptoms, symptom patterns as well as total symptom scores were similar for the two patient groups, and both groups had significantly higher total symptom scores
6、 after lactulose challenge than the normal population (Figure 2, pB0.001). Fifty-four (70%) of the 77 patients claimed that the types of symptoms provoked by lactulose challenge were similar to those of their customary symptoms.Breath hydrogen excretionThe three groups of subjects had similar breath
7、 hydrogen excretion curves (Figure 3). There were no significantdifferencesbetweenmeanvaluesat any time-point. The number of early positive tests (B90 min) and AUCs were also similar for the threegroups (Table I). However, the Giardia-infected persons had significantly more positive LBTs within 180
8、min (92%) than both the Giardia-negatives (65%, p?0.02) and the normal population (69%, p?0.04)(TableI).Therewerenosignificant correlations between symptom scores and hydrogen production. This was true for individual symptoms as well as for total symptom scores. In Figure 4 we show the lack of corre
9、lation between AUC for breath hydrogen and total post-LBT symptom scores or early and long-lasting symptoms in Giardia-cured patients.DiscussionIt is now well established that IBS may appear as a sequelofgastrointestinalinfections14.Why symptoms in some patients persist for months to years after cle
10、arance of the infection is not known. Patients with abdominal symptoms persisting after01020304050Giardia infectedGiardia curedNormal populationabc Pab=0.50 Pac0.0001 Pbc0.0001Symptom scoresFigure 1. Customary symptom scores in Giardia-infected (n?23) and Giardia-cured patients (n?54) and the normal
11、 population (n?42).01020304050Giardia infectedGiardia curedNormal populationabcPab=0.09 Pac=0.029 Pbc0.0001Post LBT- symptom scoresFigure 2. Post-lactulose breath test symptom scores in Giardia- infected (n?23) and Giardia-cured patients (n?54) and the normal population (n?42).0306090120150180010203
12、040506070Giardia infectedGiardia curedNormal populationTime (min)Breath hydrogen (ppm)Figure 3. Breath hydrogen excretion after lactulose ingestion in Giardia-infected (n?23) and Giardia-cured patients (n?54) and the normal population (n?42).Lactulose challenge in post-infectious IBS143Scand J Gastr
13、oenterol Downloaded from by Francis A Countway Library of Medicine on 12/25/12 For personal use only.clearance of G. lamblia infection may constitute such a post-infectious IBS condition. Small intestinal bacterial overgrowth is a condition whereby colonic bacteria expand to include the small intes
14、tine 8. The term bacterial overgrowth syn- drome has been used to define bacterial overgrowth leading to clinical symptoms, without reference to the pathogenesis of the disorder 15. Lactulose is a semisynthetic disaccharide unavailable for human digestion due to lack of naturally occurring appro- pr
15、iate intestinal enzymes 16. However, intestinal bacteriaareabletobreakdownlactulosebyanaerobic fermentation and produce hydrogen and methane as metabolic products. These gases diffuse in the body and appear in exhaled air. Abnormal amounts of exhaled hydrogen following lactulose challenge may indica
16、te bacterial overgrowth 8, which has been related to the pathogenesis of IBS 9. The relief of symptoms and normalization of the test results through antibiotics argue the case for bacterial over- growth as a cause of IBS 17. There is, however, considerable controversy about the criteria to be used fordiagnosingbacterialovergrowthbyLBT 7,18,19. Initial guidelines state that two clearly identifiable hydrogen peaks, with an eas
