Published online Jun 27, 2023. doi: 10.4240/wjgs.v15.i6.1138
Peer-review started: February 19, 2023
First decision: March 24, 2023
Revised: April 5, 2023
Accepted: April 18, 2023
Article in press: April 18, 2023
Published online: June 27, 2023
Processing time: 115 Days and 18.8 Hours
While colorectal polyps are not cancerous, some types of polyps, known as adenomas, can develop into colorectal cancer over time. Polyps can often be found and removed by colonoscopy; however, this is an invasive and expensive test. Thus, there is a need for new methods of screening patients at high risk of developing polyps.
To identify a potential association between colorectal polyps and small intestine bacteria overgrowth (SIBO) or other relevant factors in a patient cohort with lactulose breath test (LBT) results.
A total of 382 patients who had received an LBT were classified into polyp and non-polyp groups that were confirmed by colonoscopy and pathology. SIBO was diagnosed by measuring LBT-derived hydrogen (H) and methane (M) levels according to 2017 North American Consensus recommendations. Logistic regression was used to assess the ability of LBT to predict colorectal polyps. Intestinal barrier function damage (IBFD) was determined by blood assays.
H and M levels revealed that the prevalence of SIBO was significantly higher in the polyp group than in the non-polyp group (41% vs 23%, P < 0.01; 71% vs 59%, P < 0.05, respectively). Within 90 min of lactulose ingestion, the peak H values in the adenomatous and inflammatory/hyperplastic polyp patients were significantly higher than those in the non-polyp group (P < 0.01, and P = 0.03, respectively). In 227 patients with SIBO defined by combining H and M values, the rate of IBFD determined by blood lipopolysaccharide levels was significantly higher among patients with polyps than those without (15% vs 5%, P < 0.05). In regression analysis with age and gender adjustment, colorectal polyps were most accurately predicted with models using M peak values or combined H and M values limited by North American Consensus recommendations for SIBO. These models had a sensitivity of ≥ 0.67, a specificity of ≥ 0.64, and an accuracy of ≥ 0.66.
The current study made key associations among colorectal polyps, SIBO, and IBFD and demonstrated that LBT has moderate potential as an alternative noninvasive screening tool for colorectal polyps.
Core Tip: As the lactulose breath test (LBT) is an indirect method of measuring bacteria in the digestive tract, it is primarily used to support small intestine bacteria overgrowth (SIBO) diagnosis but is implemented as a new method for screening colorectal polyps in this study. A total of 382 patients with LBT results were classified into polyp and non-polyp groups that were confirmed by colonoscopy and pathology. First, it applied the LBT for assessment of its utility as a noninvasive screening tool for colorectal polyps as well as for diagnosis of SIBO. Second, the results revealed certain key associations among colorectal polyps, SIBO and Intestinal barrier function damage (IBFD), such as SIBO was more prevalent in patients with colorectal polyp than those without polyp and IBFD was more susceptible in patients with colorectal polyp than those without polyp only when SIBO was evident. Third, in regression analysis with age and gender adjustment, colorectal polyp was best predicted by models using plain methane peak values or combined hydrogen and methane values limited by the North American Consensus for SIBO. One of the most important result was moderate potential of LBT as an alternative noninvasive screening tool for colorectal polyps.