Letter to the Editor
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 16, 2022; 10(26): 9536-9538
Published online Sep 16, 2022. doi: 10.12998/wjcc.v10.i26.9536
Glucose substrate in the hydrogen breath test for gut microbiota determination: A recommended noninvasive test
Qi-Qi Xie, Jia-Feng Wang, Yang-Fen Zhang, Dong-Hui Xu, Bo Zhou, Ting-Hui Li, Zhi-Peng Li
Qi-Qi Xie, Yang-Fen Zhang, Dong-Hui Xu, Bo Zhou, Ting-Hui Li, Zhi-Peng Li, School of Medicine, Taizhou University, Taizhou 318000, Zhejiang Province, China
Jia-Feng Wang, Town Hospital of Gaodu, Mengyin County, Linyi 276200, Shandong Province, China
Author contributions: Xie QQ Write the original draft; Wang JF was responsible for methodology and software; Zhang YF, Xu DH, Zhou B and Li TH analyzed data and wrote the original draft; Li ZP participated in conceptualization, writing, reviewing and editing; all authors participated in drafting the manuscript and all have read, contributed to, and approved the final version of the manuscript.
Conflict-of-interest statement: The authors have nothing to disclose.
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: Zhi-Peng Li, PhD, Surgeon, School of Medicine, Taizhou University, No. 1139 Shifu Avenue, Jiaojiang District, Taizhou 318000, Zhejiang Province, China. lzpzhonghong@126.com
Received: March 31, 2022
Peer-review started: March 31, 2022
First decision: May 29, 2022
Revised: June 6, 2022
Accepted: August 6, 2022
Article in press: August 6, 2022
Published online: September 16, 2022

Intestinal dysbiosis and small intestinal bacterial overgrowth (SIBO) are common in patients with liver cirrhosis. Existing studies have not explored the association between gut dysbiosis and SIBO. We propose some suggestions for the authors’ experimental methods and concepts, and we hope these suggestions can be adopted. The hydrogen breath test is worthy of recommendation due to its high accuracy and convenient operation. We suggest changing the substrate of the hydrogen breath test from lactulose to glucose to improve the accuracy of each parameter. SIBO is a small subset of gut dysbiosis, and we propose clarifying the concept of both. SIBO may be caused by liver cirrhosis or one of the pathogeneses of gastrointestinal diseases. Therefore, interference from other gastrointestinal diseases should be excluded from this study.

Keywords: Glucose, Hydrogen breath test, Lactulose, Liver cirrhosis, Small intestinal bacterial overgrowth

Core Tip: The sensitivity of the hydrogen breath test is higher with glucose than lactulose as the substrate. We recommend using the hydrogen breath test in this experiment for measuring intestinal flora but replacing the test substrate with glucose. We recommend that the authors clarify the relation and concept of small intestinal bacterial overgrowth (SIBO) and gut dysbiosis. When exploring the relationship between gut dysbiosis and SIBO in cirrhosis, the etiology of SIBO should be considered. After estimating the sample size, we determined that the sample size included in the experiment was small and should be expanded.