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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Ability of lactulose breath test results to accurately identify colorectal polyps through the measurement of small intestine bacterial overgrowth
Lan Li, Xue-Yuan Zhang, Jin-Sheng Yu, Hui-Min Zhou, Yan Qin, Wen-Rui Xie, Wen-Jing Ding, Xing-Xiang He
Lan Li, Xue-Yuan Zhang, Hui-Min Zhou, Yan Qin, Wen-Rui Xie, Xing-Xiang He, Department of Gastroenterology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510080, Guangdong Province, China
Lan Li, Hui-Min Zhou, Yan Qin, Wen-Rui Xie, Xing-Xiang He, Washing Microbiota Transplantation, Engineering Techniques of Microbiota-Targeted Therapies of Guangdong Province, Guangzhou 510080, Guangdong Province, China
Xue-Yuan Zhang, Department of Gastroenterology, People's Hospital of Nanxiong County, Nanxiong 512400, Guangdong Province, China
Jin-Sheng Yu, Department of Genetics, Washington University School of Medicine, Saint Louis, MO 63110, United States
Wen-Jing Ding, North America Medical Education Foundation, California, CA 91710, United States
Author contributions: Lan Li and Zhang XY have contributed equally to this work. Lan Li participated the study design and wrote the manuscript draft; Zhang XY conducted clinical data collections and participated the writing of the draft; Zhou HM and Qin Y performed lactulose breath test tests; Xie WR participated statistical analysis of the data; Ding WJ interpreted the lactulose breath test results; Yu JS participated the study design, performed the statistical analysis of the data, and edited the final version of the manuscript; He XX conceived the study concept and design, supervised all the work, provided the study funding, and reviewed the final version of the manuscript. All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.
Supported by the Key-Area Research and Development Program of Guangdong Province, No. 2022B1111070006; the Guangdong Innovation Research Team for Higher Education, No. 2021KCXTD025.
Institutional review board statement: The study protocol was approved by the institutional review board and the Ethics Committee of the First Affiliated Hospital of Guangdong Pharmaceutical University, No. 2019045.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare. There are no ethical or legal conflicts involved in the article.
Data sharing statement: Statistical code, and dataset available from the corresponding author at hexingxiang@gdpu.edu.cn. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Xing-Xiang He, MD, PhD, Chief Doctor, Professor, Department of Gastroenterology, The First Affiliated Hospital of Guangdong Pharmaceutical University, No. 19 Nonglinxia Road, Guangzhou 510080, Guangdong Province, China. hexingxiang@gdpu.edu.cn
Received: February 19, 2023
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
ARTICLE HIGHLIGHTS
Research background
Polyps can often be found and removed by colonoscopy; however, this is an invasive and expensive test. Due to its safety, accessibility, and affordability, the lactulose breath test (LBT) is widely used as a noninvasive method of diagnosing small intestine bacterial overgrowth (SIBO). SIBO suggests dysbiosis of the intestinal flora, which is associated with the pathogenesis of adenomatous polyps and colorectal cancer.
Research motivation
New methods that can identify precancerous colorectal lesions can play an important role in early-stage colorectal cancer treatment and prevention.
Research objectives
To identify a potential association between colorectal polyps and SIBO or other relevant factors in a patient cohort with LBT results.
Research methods
This retrospective analysis of data from a total of 382 patients who had received an LBT were collected. 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.
Research results
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%; 71% vs 59%, 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. 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.
Research conclusions
The current study made key associations among colorectal polyps and SIBO and demonstrated that LBT has moderate potential as an alternative noninvasive screening tool for colorectal polyps.
Research perspectives
Due to its safety, accessibility, and affordability, the LBT has the potential to become one of the routine non-invasive screening methods for polyps and precancerous lesions. Furthermore, non-invasive tests such as fecal occult blood testing and LBT will help to improve the detection rate of precancerous lesions during colonoscopy screening.
