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Title: Lactulose breath test gas production in childhood IBS is associated with intestinal transit and bowel movement frequency

item CHUMPITAZI, BRUNO - Texas Children'S Hospital
item WEIDLER, ERICA - Children'S Nutrition Research Center (CNRC)
item SHULMAN, ROBERT - Children'S Nutrition Research Center (CNRC)

Submitted to: Journal of Pediatric Gastroenterology and Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/2/2016
Publication Date: 4/1/2017
Citation: Chumpitazi, B.P., Weidler, E.M., Shulman, R.J. 2017. Lactulose breath test gas production in childhood IBS is associated with intestinal transit and bowel movement frequency. Journal of Pediatric Gastroenterology and Nutrition. 64(4):541-545.

Interpretive Summary: Certain gases produced by bacteria are thought to possibly affect how food moves through our intestines, affect the digestion of food, and affect our stooling pattern. To learn whether one type of gas (methane) produced by bacteria can affect these processes in children, researchers at the Children's Nutrition Research Center in Houston, Texas measured the amount of methane produced. The greater the amount of methane produced, the slower food moved through the intestines and the less frequently the children stooled. These results suggest that by altering the types of bacteria in the intestine, we may be able to affect how long it takes for food to pass through our intestines and our stooling pattern.

Technical Abstract: In adults with irritable bowel syndrome (IBS), bacterial gas production (colonic fermentation) is related to both symptom generation and intestinal transit. Whether gas production affects symptom generation, psychosocial distress, or intestinal transit in childhood IBS is unknown. Children (ages 7-17 years) with pediatric Rome III IBS completed validated psychosocial questionnaires and a 2-week daily diary capturing pain and stooling characteristics. Stool form determined IBS subtype. Subjects then completed a 3-hour lactulose breath test for measurement of total breath hydrogen and methane production. Carmine red was used to determine whole intestinal transit time. A total of 87 children (mean age 13+/-2.6 [standard deviation] years) were enrolled, of whom 50 (57.5%) were girls. All children produced hydrogen and 51 (58.6%) produced methane. Hydrogen and methane production did not correlate with either abdominal pain frequency/severity or psychosocial distress. Hydrogen and methane production did not differ significantly by IBS subtype. Methane production correlated positively with whole intestinal transit time (r=0.31, P<0.005) and inversely with bowel movement frequency (r=-0.245, P<0.05). Methane production (threshold 3 ppm) as a marker for identifying IBS-C had a sensitivity of 60% and specificity of 42.9%. Lactulose breath test total methane production may serve as a biomarker of whole intestinal transit time and bowel movement frequency in children with IBS. In children with IBS, lactulose breath test hydrogen and methane production did not, however, correlate with abdominal pain, IBS subtype, or psychosocial distress.