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Evacuation Dysfunction Does Not Impact Breath Test Results
Céline Soetaert1,2, Mohamad Itani1, George Triadafilopoulos1
1Division of Gastroenterology and Hepatology, Stanford University, Stanford, California, USA.
Background:
Evacuation dysfunction affects gastrointestinal motility, yet its effect on small bowel microbiota is unknown. We aimed to compare the glucose breath test (GBT) and lactulose breath test (LBT) outcomes in patients with or without evacuation dysfunction based on high-resolution anorectal manometry (HR-ARM) and balloon expulsion test (BET).
Methods:
We conducted a retrospective review of patients who received a HR-ARM and either a GBT or LBT from 2018 to 2024.
Key Results:
We studied 344 patients who underwent GBT and 144 who underwent LBT. Clinical characteristics between the two groups were comparable. Abnormal BET was observed in 53% of patients. Rates of abnormal breath tests were comparable among patients with or without abnormal BET. Patients with positive vs. negative breath tests had similar anorectal pressures, rectal sensory function, and BET results. There were significantly more negative breath tests in GBT (64%) versus LBT (35%), with higher rates of small intestinal bacterial overgrowth (SIBO) in LBT versus GBT (SIBO only: 20.1% vs. 7.6%; SIBO+IMO: 21.5% vs. 5.5%; p < 0.001).
Conclusions And Inferences:
The presence of evacuation dysfunction does not impact the results of the breath test. HR-ARM and BET demonstrate a high diagnostic yield in identifying the etiology of abdominal bloating in patients with chronic constipation or IBS without diarrhea, whereas hydrogen breath tests have a low diagnostic yield in this context. The specificity and sensitivity of LBT in this patient population remain less certain.
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