Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2023; 15(6): 1138-1148
Published online Jun 27, 2023. doi: 10.4240/wjgs.v15.i6.1138
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
Core Tip

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.