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Effect of Bifidobacterium infantis 35624 (Align) on the Lactulose Breath Test for Small Intestinal Bacterial Overgrowth

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Abstract

Background

Small intestinal bacterial overgrowth (SIBO) may cause symptoms in patients with abdominal bloating, distension, and gas. SIBO can be assessed using the lactulose breath test (LBT). A commonly used probiotic supplement is Align containing Bifidobacterium infantis 35624. The aim of this study was to determine the effect of B. infantis 35624 on hydrogen and methane excretion during LBT.

Methods

Healthy subjects underwent LBT before and after 2 weeks of daily Align administration. Hydrogen and methane concentrations were measured for each breath sample. Results are expressed as mean ± SE and analyzed using repeated measures ANCOVA. A breath test was considered positive if hydrogen and/or methane increased > 20 ppm above baseline by 90 min of the test or if a dual hydrogen peak was present.

Results

Nineteen healthy subjects were studied. Hydrogen levels were similar pre- and post-probiotic across the 3-h study (p = 0.768). In contrast, methane levels were significantly higher with probiotic administration (p = 0.012). A rise in methane > 20 ppm was seen in three subjects pre-probiotic but six post-probiotic. Of the 19 subjects, an “abnormal” LBT pre-probiotic was present in ten subjects and during the probiotic, 13 were abnormal.

Conclusions

This study found that 2 weeks of B. infantis 35624 (Align) supplementation affects LBT assessment for SIBO by significantly increasing methane, but not hydrogen, excretion after lactulose administration. Methane levels reached values that would be considered positive for SIBO patients. This study suggests that patients undergoing LBT should discontinue probiotics prior to the test as these supplements may alter the test results.

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Authors and Affiliations

  1. Gastroenterology Section, Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA

    Krishma Kumar, Mohammed Saadi, Frederick V. Ramsey, Ron Schey & Henry P. Parkman

  2. Gastroenterology Section, Temple University School of Medicine, 3401 North Broad Street, Philadelphia, PA, 19140, USA

    Henry P. Parkman

Authors
  1. Krishma Kumar
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  2. Mohammed Saadi
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  3. Frederick V. Ramsey
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  4. Ron Schey
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  5. Henry P. Parkman
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Contributions

Krishma Kumar, BS was involved in study concept and design, data entry, analysis and interpretation of data, statistical analysis, and drafting of manuscript. Mohammed Saadi, MD was involved in study set-up and review of manuscript. Frederick V. Ramsey, PhD was involved in analysis of data and review of manuscript. Ron Schey, MD was involved in study concept and design, interpretation of data, review of manuscript. Henry P. Parkman, MD was involved in study concept and design, analysis and interpretation of data, critical revision of the manuscript for important intellectual content, and study supervision.

Corresponding author

Correspondence to Henry P. Parkman.

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The authors declare that they have no competing interests.

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Kumar, K., Saadi, M., Ramsey, F.V. et al. Effect of Bifidobacterium infantis 35624 (Align) on the Lactulose Breath Test for Small Intestinal Bacterial Overgrowth. Dig Dis Sci 63, 989–995 (2018). https://doi.org/10.1007/s10620-018-4945-3

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  • DOI: https://doi.org/10.1007/s10620-018-4945-3

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