Lactose breath test (LBT) is considered the gold standard for the diagnosis of lactose malabsorption. The test is considered positive for a peak of hydrogen (H2) ≥ 20 parts per million (ppm) above the baseline. Some ...Lactose breath test (LBT) is considered the gold standard for the diagnosis of lactose malabsorption. The test is considered positive for a peak of hydrogen (H2) ≥ 20 parts per million (ppm) above the baseline. Some patients (pts) showed a rapid peak between 30 and 90 minutes after lactose ingestion. The aim of this study was to evaluate the predictive value of an early peak during a LBT and an accelerated oro-cecal transit time (OCTT). We retrospectively analyzed all pts who referred to our Gastroenterology unit for Irritable Bowel Syndrome, from January to September 2012, who performed LBT, glucose and lactulose breath test. We consider a positive LBT for a peak of H2 > 20 ppm, a positive GHBT for a peak >12 ppm and we considered a normal OCCT a peak of H2 ≥ 10 ppm between 75 ± 105 min after lactulose load. The correlation between LBT and OCTT was evaluated by Pearson score. 93 pts (65 F/28 M mean age 47 ± 6 years) with a positive LBT, without small intestinal bacterial overgrowth were analyzed: 46 pts (32 F/14 M;mean age 48 ± 6 years) with an early peak (2 (≥20 ppm) were enrolled as case, and 47 pts matched for sex and age with a peak of H2 after 90 min were enrolled as controls. 72% (33/46) of the group with an early peak showed an accelerated, 17% (8/46) a normal and 11% (5/46) a delayed OCTT. Meanwhile, in control group 40.4% (19/47) showed a normal, 57.5% (27/47) a delayed and just 1 pts an accelerated OCTT. The specificity and sensibility of LBT for an accelerated OCTT were 97.9% and 71.7% respectively. The positive predictive value of LBT for an accelerated OCTT is 97.1%;the negative predictive value is 78%. There is a significant correlation between LBT and OCTT (p The presence of an early peak of H2 between 30 and 90 min after the ingestion of 25 gr of lactose could predict the presence of an accelerated OCTT in 97% of pts. If confirmed by further study, in this subset of pts, lactulose breath test for evaluating OCTT could be avoided.展开更多
Currently, alcoholic liver disease (ALD) is one of the most prevalent chronic liver diseases worldwide, representing one of the main etiologies of cirrhosis and hepatocellular carcinoma (HCC). Although we do not know ...Currently, alcoholic liver disease (ALD) is one of the most prevalent chronic liver diseases worldwide, representing one of the main etiologies of cirrhosis and hepatocellular carcinoma (HCC). Although we do not know the exact mechanisms by which only a selected group of patients with ALD progress to the final stage of HCC, the role of the gut microbiota within the progression to HCC has been intensively studied in recent years. To date, we know that alcohol-induced gut dysbiosis is an important feature of ALD with important repercussions on the severity of this disease. In essence, an increased metabolism of ethanol in the gut induced by an excessive alcohol consumption promotes gut dysfunction and bacterial overgrowth, setting a leaky gut. This causes the translocation of bacteria, endotoxins, and ethanol metabolites across the enterohepatic circulation reaching the liver, where the recognition of the pathogen-associated molecular patterns via specific Toll-like receptors of liver cells will induce the activation of the nuclear factor kappa-B pathway, which releases pro-inflammatory cytokines and chemokines. In addition, the mitogenic activity of hepatocytes will be promoted and cellular apoptosis will be inhibited, resulting in the development of HCC. In this context, it is not surprising that microbiota-regulating drugs have proven effectiveness in prolonging the overall survival of patients with HCC, making attractive the implementation of these drugs as co-adjuvant for HCC treatment.展开更多
The gut microbiota(GM)is an integrated ecosystem of tens of trillions of microorganisms,as actinomyces,archaea,protozoa,and last but not least viruses,including one thousand different species of known bacteria with an...The gut microbiota(GM)is an integrated ecosystem of tens of trillions of microorganisms,as actinomyces,archaea,protozoa,and last but not least viruses,including one thousand different species of known bacteria with an overall count of more than three million genes,150 times more than the human genome.GM presents immune-modulating,absorptive and metabolic functions(1).展开更多
文摘Lactose breath test (LBT) is considered the gold standard for the diagnosis of lactose malabsorption. The test is considered positive for a peak of hydrogen (H2) ≥ 20 parts per million (ppm) above the baseline. Some patients (pts) showed a rapid peak between 30 and 90 minutes after lactose ingestion. The aim of this study was to evaluate the predictive value of an early peak during a LBT and an accelerated oro-cecal transit time (OCTT). We retrospectively analyzed all pts who referred to our Gastroenterology unit for Irritable Bowel Syndrome, from January to September 2012, who performed LBT, glucose and lactulose breath test. We consider a positive LBT for a peak of H2 > 20 ppm, a positive GHBT for a peak >12 ppm and we considered a normal OCCT a peak of H2 ≥ 10 ppm between 75 ± 105 min after lactulose load. The correlation between LBT and OCTT was evaluated by Pearson score. 93 pts (65 F/28 M mean age 47 ± 6 years) with a positive LBT, without small intestinal bacterial overgrowth were analyzed: 46 pts (32 F/14 M;mean age 48 ± 6 years) with an early peak (2 (≥20 ppm) were enrolled as case, and 47 pts matched for sex and age with a peak of H2 after 90 min were enrolled as controls. 72% (33/46) of the group with an early peak showed an accelerated, 17% (8/46) a normal and 11% (5/46) a delayed OCTT. Meanwhile, in control group 40.4% (19/47) showed a normal, 57.5% (27/47) a delayed and just 1 pts an accelerated OCTT. The specificity and sensibility of LBT for an accelerated OCTT were 97.9% and 71.7% respectively. The positive predictive value of LBT for an accelerated OCTT is 97.1%;the negative predictive value is 78%. There is a significant correlation between LBT and OCTT (p The presence of an early peak of H2 between 30 and 90 min after the ingestion of 25 gr of lactose could predict the presence of an accelerated OCTT in 97% of pts. If confirmed by further study, in this subset of pts, lactulose breath test for evaluating OCTT could be avoided.
基金This work was supported partially by Medica Sur Clinic&Foundation.This work was supported in part by a research grant R01 DK114516(to DQ-HW)from the National Institutes of Health(US Public Health Service)
文摘Currently, alcoholic liver disease (ALD) is one of the most prevalent chronic liver diseases worldwide, representing one of the main etiologies of cirrhosis and hepatocellular carcinoma (HCC). Although we do not know the exact mechanisms by which only a selected group of patients with ALD progress to the final stage of HCC, the role of the gut microbiota within the progression to HCC has been intensively studied in recent years. To date, we know that alcohol-induced gut dysbiosis is an important feature of ALD with important repercussions on the severity of this disease. In essence, an increased metabolism of ethanol in the gut induced by an excessive alcohol consumption promotes gut dysfunction and bacterial overgrowth, setting a leaky gut. This causes the translocation of bacteria, endotoxins, and ethanol metabolites across the enterohepatic circulation reaching the liver, where the recognition of the pathogen-associated molecular patterns via specific Toll-like receptors of liver cells will induce the activation of the nuclear factor kappa-B pathway, which releases pro-inflammatory cytokines and chemokines. In addition, the mitogenic activity of hepatocytes will be promoted and cellular apoptosis will be inhibited, resulting in the development of HCC. In this context, it is not surprising that microbiota-regulating drugs have proven effectiveness in prolonging the overall survival of patients with HCC, making attractive the implementation of these drugs as co-adjuvant for HCC treatment.
文摘The gut microbiota(GM)is an integrated ecosystem of tens of trillions of microorganisms,as actinomyces,archaea,protozoa,and last but not least viruses,including one thousand different species of known bacteria with an overall count of more than three million genes,150 times more than the human genome.GM presents immune-modulating,absorptive and metabolic functions(1).
