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The lactulose hydrogen breath test as a measure of orocaecal transit time
J M Jorge1, S D Wexner, E D Ehrenpreis
1Department of Colorectal Surgery, Cleveland Clinic Florida, Ft. Lauderdale, Florida.
Objective:
To establish normal values and assess the reproducibility of the lactulose hydrogen breath test in measuring orocaecal transit time in control subjects, and to report results in a group of patients with chronic constipation as a result of colonic inertia.
Design:
Open study.
Setting:
Academic clinic.
Subjects:
42 Control subjects (29 women and 13 men) in 25 of whom the test was repeated within 2-4 weeks, and 19 patients.
Interventions:
Lactulose hydrogen breath test.
Main Outcome Measures:
Sustained increase in hydrogen production of 3 ppm or more.
Results:
Coefficient of variation within subjects was 8% compared with 38% between subjects; 3 of the control subjects (7%) and 3 of the patients (16%) did not ferment lactulose, the the incidence was similar in men (1/13, 8%) and women (2/29, 7%). Mean (SD) orocaecal transit time was significantly shorter among the 29 women (60 (27) minutes) than among the 11 men (89 (24) minutes) (p < 0.005). There were no significant differences between men in the control group and those with constipation.
Conclusions:
The lactulose hydrogen breath test is valuable to assess orocaecal transit time. It is simple, non-invasive, and reproducible, and may be of value in differentiating between generalised hypomotility and colonic inertia.