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Lactulose challenge test may help determine IBS severity
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Visceral sensitivity and severity of irritable bowel syndrome may be determined with the use of a nutrient and lactulose challenge test. The results of the test may also help characterize patients with IBS and help determine the efficacy of treatments.
In a prospective study, researchers examined 100 patients aged 18 to 65 years with IBS who were seen at Sahlgrenska Hospital, University of Gothenburg, Sweden, a secondary/tertiary care outpatient clinic. IBS diagnosis was based on the Rome III criteria, classification into subtypes was based on the Bristol Stool Form scale and IBS severity was assessed using patient questionnaires. The researchers also assessed visceral sensitivity, oro-anal transit time, and fecal microbiota composition prior to the challenge. For the nutrient and lactulose challenge, all patients fasted overnight and were then given a liquid breakfast of 400 mL of Nutridrink (Danone Nutricia), which had 25 g of lactulose.
Both before and during a 4-hour period following the liquid breakfast, patients were examined for the intensity of eight GI symptoms, the level of digestive comfort and the amount of exhaled H2 and CH4 in breath. They were then divided into two groups: 39 patients with high-intensity GI symptoms and 61 patients with low-intensity GI symptoms.
Researchers found that patients in the high-intensity GI symptoms group had more severe IBS (P < .0001), compared to those in the low-intensity group; they also had higher somatization (P < .01), lower quality of life (P < .05-.01) and significantly higher rectal sensitivity to random phasic distensions (P < .05-.001). With fecal microbiota composition, exhaled gas in breath, or oro-anal transit time, no significant difference was found between the high-intensity and the low-intensity groups.
“To conclude, we confirm in this study the potential of a combined nutrient and lactulose challenge as a simple and noninvasive test to investigate symptom severity and visceral sensitivity in IBS patients,” the researchers wrote. “This test constitutes a more physiological technique than the rectal barostat procedure to assess the presence and severity of visceral hypersensitivity in IBS patients. The combined nutrient and lactulose challenge test could be used to evaluate the effect of future interventions aiming to alleviate visceral hypersensitivity and postprandial symptoms in IBS patients.”
Disclosures: Le Nevé reports employment with Danone Research. Please see the full study for a list of all other authors’ relevant financial disclosures.
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