Breath Test for Bacterial Overgrowth.pdfVIP

Improvement in Speci? city of [ 14 C]d-Xylose Breath Test for Bacterial Overgrowth STEPHEN J. LEWIS, MRCP, GERRY YOUNG, PhD, MICHAEL MANN, MMed (Nuclear Med), SHARON FRANCO, MMed (Chem Path), and STEPHEN J.D. O’KEEFE, FRCP The aim of the study was to determine whether the speci? city of the [ 14 C]d-xylose breath test could be improved, by excluding false-positive tests due to premature colonic metabolism of the [ 14 C]d-xylose caused by rapid colonic transit. Forty-seven patients with suspected small bowel bacterial overgrowth were investigated by (1) aspiration and culture of duodenal ˉ uid and (2) a [ 14 C]d-xylose breath test. Those with either a positive duodenal culture or breath test had a repeat [ 14 C]d-xylose breath test given with one of three transit markers (barium, Gastrogra? n or 99m Tc-labeled tin colloid) to determine if the site of metabolism was in the small bowel or colon. Fourteen patients had positive duodenal cultures, four of whom had a negative [ 14 C]d-xylose breath test, 15 patients had a positive [ 14 C]d-xylose breath test, three of which were due to colonic metabolism of the xylose. Where transit markers were used, 14 C was detectable in the breath and serum before barium had entered the small bowel, thus the barium did not comigrate with the xylose. Gastrogra? n accelerated small bowel transit, leading to malabsorption of the xylose in the small intestine and subsequent colonic metab- olism of the xylose. 99m Tc-labeled tin colloid had no obvious disadvantag es and appeared to be the marker of choice. The use of a transit marker increased the speci? city of the [ 14 C]d-xylose breath test from 85% to 94%. The speci? city of the [ 14 C]d-xylose breath test for the detection of small bowel bacterial overgrowth is improved to greater than 90% by the use of an appropriat e transit marker. KEY WORDS: bacterial overgrowth; breath test; malabsorption. In normal subjects, the stomach and proximal small bowel have a sparse population of bacteri