Ileocecal valve dysfunction in small intestinal bacterial overgrowth: A pilot study

Figure 1 Schematic of the terminal ileum, ileocecal valve and colon. It shows the colonoscope and manometry catheter passing through the biopsy channel of the colonoscope. The 4 channel manometry catheter is placed across the ileocecal valve so that at least 1 channel is in the cecum and 1 channel in the Ileum.

Figure 2 Representative trace of a simultaneous 4 channel manometry and video endoscopy. A: The response of the ileocecal valve during cecal distention by air insufflation in a subject with a normal lactulose breath test. Note the increase in pressure within the ileocecal valve greater than in the cecum and ileum during distension of the cecum; B: The response of the ileocecal valve during cecal distention by air insufflation in a subject with positive lactulose breath test. Note the similar pressures within all the manometry ports (a common cavity effect). ICV: Ileocecal valve.

Figure 3 Average pressure changes (baseline, peak and post) in the colon, ileocecal valve and terminal ileum during and after air insufflation. A: The average response of the ileocecal valve during cecal distention by air insufflation in subjects with normal lactulose breath tests; B: The average response of the ileocecal valve during cecal distention by air insufflation in subjects with positive lactulose breath tests. ICV: Ileocecal valve; SIBO: Small intestinal bacterial overgrowth.

Figure 4 Average lactulose breath test results. A: Normal lactulose breath tests; B: Positive lactulose breath tests. ICV: Ileocecal valve; SIBO: Small intestinal bacterial overgrowth.

Figure 5 Average percent change of the area under the pressure curve during air insufflation into the cecum, in normal subjects (normal lactulose breath tests) and in subjects with small bowel bacterial over growth (positive lactulose breath tests), with respect to the cecum. ICV: Ileocecal valve; SIBO: Small intestinal bacterial overgrowth.