http://www.ncbi.nlm.nih.gov/entrez/query.f...t_uids=12645795Dig Dis Sci. 2003 Jan;48(1):86-92. Related Articles, Links Methane production during lactulose breath test is associated with gastrointestinal disease presentation.Pimentel M, Mayer AG, Park S, Chow EJ, Hasan A, Kong Y.GI Motility Program, Bums and Allen Research Center, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.It has recently been determined that there is an increased prevalence of bacterial overgrowth in IBS. Since there are two gases (hydrogen and methane) measured on lactulose breath testing, we evaluated whether the different gas patterns on lactulose breath testing coincide with diarrhea and constipation symptoms in IBS and IBD. Consecutive patients referred to the gastrointestinal motility program at Cedars-Sinai Medical Center for lactulose breath testing were given a questionnaire to evaluate their gastrointestinal symptoms. Symptoms were graded on a scale of 0-5. Upon completion of the breath test, the results were divided into normal, hydrogen only, hydrogen and methane, and methane only positive breath tests. A comparison of all subjects and IBS subjects was undertaken to evaluate diarrhea and constipation with regards to the presence or absence of methane. This was further contrasted to Crohn's and ulcerative colitis (UC) patients in the database. After exclusion criteria, 551 subjects from the database were available for comparison. Of the 551 subjects (P < 0.05, one-way ANOVA) and in a subgroup of 296 IBS subjects (P < 0.05, one-way ANOVA), there was a significant association between the severity of reported constipation and the presence of methane. The opposite was true for diarrhea (P < 0.001). If a breath test was methane positive, this was 100% associated with constipation predominant IBS. Furthermore, IBS had a greater prevalence of methane production than Crohn's or UC. In fact, methane was almost nonexistent in the predominantly diarrheal conditions of Crohn's and UC. In conclusion, a methane positive breath test is associated with constipation as a symptom.
http://www.docguide.com/news/content.nsf/n...5256CD40031C0FF Normalising Abnormal Lactulose Breath Tests With Neomycin Reduces Irritable Bowel SymptomsA DGReview of :"Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome. a double-blind, randomized, placebo-controlled study."American Journal of Gastroenterology02/26/2003By Elda HauschildtNormalising abnormal lactulose breath testing (LBT) results with neomycin therapy leads to a significant reduction in symptoms among irritable bowel syndrome (IBS) patients, researchers from the United States have found.Investigators from Cedars-Sinai Medical Centre in Los Angeles, California, also say excretion of methane gas seen on LBT is associated 100% with constipation-dominant IBS.Prevalence of abnormal LBTs was compared in 111 IBS patients and a gender-matched control group. The effect of using antibiotics to treat IBS was tested in the IBS consecutive patients, with 55 patients receiving neomycin for seven days and 56 given placebo. Participants returned for repeat LBTs following treatment.Results indicate that 84% of the IBS patients had an abnormal LBT. This compared with 20% of the controls.Neomycin resulted in a 35% improvement in a composite score in intention-to-treat analysis of IBS patients. Placebo resulted in an 11.4% improvement. IBS patients reported 35.3% bowel normalisation after neomycin therapy, compared with 13.9% after placebo.A graded response to treatment was observed, with the best outcome (75% improvement) seen when neomycin was successful in normalising LBT results.LBT gas production results indicate that methane excretion was 100% associated with constipation-dominant IBS. Patients who excreted methane had a mean constipation severity of 4.1. This compared with 2.3 severity in all other participants. American Journal of Gastroenterology, 2003;98:2:412-419. "Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome. a double-blind, randomized,
Well i have to see him first to be refered at the "special Mcgill university lab".I think we will do the Lactulose breath test first to detect the SIBO.After,we can go from there.I'm pretty sure SIBO need to be rule out at first.
Cedars web site:http://www.csmc.edu/2645.htmlGI Motility ResearchCedars-Sinai's GI Motility Program is conducting leading-edge research in several areas, including irritable bowel syndrome (IBS), small intestinal bacterial overgrowth (SIBO) and motility of the esophagus, stomach and small intestine, as well as studies of movements and controlling mechanisms of the small intestine. Dr. Mark Pimentel's research interests lie in the field of IBS as it relates to bacteria in the small intestine. Recent findings suggest a very high prevalence of SIBO (a condition in which there is an inappropriate quantity of bacteria in the small intestine). This relationship has resulted in further research demonstrating that the elimination of these bacteria results in the most dramatic improvement in IBS symptoms ever published. As such, the demand for breath testing to rule out SIBO has increased. Follow-up research on this topic has resulted in finding some of the moving problems of the intestine possibly responsible for this development of bacteria. Furthermore, treatments to prevent the recurrence of the bacteria and the IBS symptoms have been developed and have been found to be very effective. We are currently conducting clinical studies related to SIBO. We are recruiting subjects with IBS, normal subjects and controls. For more information on how to participate in these studies, please contact our research office at (310) 423-3792. Again a motility issue?Probably not a coincidence.
Ok we have had some discussions about motility and IBS in the past and I noticed that you tried to suggest to flux too that IBS was primarily a motility disorder and he disagreed with you. Here is what I think. It comes mainly from reading Quigley's article in Gastroenterology Clinics of North America who kind of wrote an editorial on the subject. Motility is a very difficult subject to study as symptoms of IBS'ers vary over time and hence it is necessary to do studies when their symptoms ar their peak and these peaks may not happen during the time of the study. Further these symptoms and any perceived abnormality in motility may be affected by external factors like stress, psychopathology, food. It could be an effect of diarrhea in some subgroup rather than leading to constipation or diarrhea. So it is makes it very difficult to interpret abnormal findings as playing a part in the pathogenesis of IBS. There have been studies of clusters seen in the small intestine of IBS'ers but they are a feature of several motor disorders so can't say it is specific to IBS. Also there have been inconsitent findings of clusters when all the studies are reviewed. And for reasons cited above as to the effect of extrinsic factors, one can't say that electromyographic and manometric abnormalities there is a basic abnormality in the motility. Then there is transit. While gas transit has been shown to be impaired by Serra et al there is accelerated transit of mixed solid-liquid meal in bloated patients. As you can see it is confounding. Gastric emptying studies show an overlap of the abnormalities between IBS'ers and thoose with functional dyspepsia. So once again it cannot be said it is specific to IBS. As for Pimentel, he has shown lower frequency of MMC's in those with an abnormal lactulose breath test.But as you know whether IBS'ers actually have SIBO or not has not been demonstrated with jejunal cultures. So more tests are necessary. And lastly some people with severe IBS have actually been shown to have chronic idiopathic intestinal pseudo-obstruction. In short it is possible that dysmotility plays a part in a minority of IBS'ers and also that it may play a part in symptom generation as has been shown by the efficacy of antispasmodics. However antispasmodics help only temporarily. So it can be argued that dysmotilty does not play a major role in the pathogenesis of IBS.
But Flux also say that there is gas and after comes the motility.That's interesting and by telling that,Flux contradict himself because he claims the "multifactor" thing.And it could be more the motility and then the gas.
Someday Flux will learn that motility is involved.
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