PUBLISHED: 4:34 PM on Wednesday, September 26, 2007
Breath test might be key to IBS diagnosis
TOPEKA, Kan. - Lori Garcia was used to mild stomach discomfort.

Typically, the symptoms would show up for a few days and then go away.

But about three months ago, they stayed. A sharp stomachache and diarrhea left her feeling bad enough that co-workers could tell when she was hurting.

Garcia said she had self-diagnosed irritable-bowel syndrome but never had gotten a confirmation from the doctor. Now, with symptoms occurring all the time, she knew something would have to be done.

The result was a series of tests that showed nothing. She had a colonoscopy and an Esophagogastroduodenoscopy (EGDE), both different procedures that involved looking at her colon, esophagus and stomach with a scope to determine if there were any problems.

Then came a relatively new test that Garcia called the "least invasive" of anything that had been done previously. The lactulose breath test is overseen by Dr. Shekhar Challa, a Topeka gastroenterologist.

The test, manufactured by Quinitron, is called the small intestinal bacterial overgrowth breath test.

"IBS is a diagnosis of exclusion," Challa said, explaining that patients with symptoms like Garcia's, including stomach pain, bloating and diarrhea, should be checked for more serious disorders like colon cancer or inflammatory bowel disease.

In the past, a diagnosis of IBS meant a lifetime of treating the symptoms, he said. In fact, many in the medical profession thought the intestinal symptoms were caused by stress and were more psychological than physiological.

"It's really frustrating," Garcia said. "I was thinking maybe it's in my head. I was relieved (after the breath test). I'm not crazy; this isn't in my head."

"It's not in your head; it's a gut problem," Challa said.

Landmark studies by Dr. Mark Pimentel, of the Cedars-Sinai Medical Center, Los Angeles, and then by others in the field determined some IBS may be caused by bacterial overgrowth in the small intestine.

There still is some disagreement in the profession on whether the SIBO actually causes IBS.

Challa said current studies indicate that anywhere from 40 percent to 80 percent of people with IBS-type symptoms show an overgrowth of bacteria in the small intestine.

The breath test involves drinking a lactulose syrup solution and then puffing into a tube every 15 to 20 minutes for three hours.

As the bacteria in the small intestine eat and digest the lactulose, hydrogen and methane gases are produced and can be measured by the breath test, Challa said.

If the measurements indicate that the bacteria are present, an antibiotic is prescribed.

Sometimes, Challa said, several rounds are necessary before patients notice a decrease in symptoms. The antibiotic is taken anywhere from one to 23 weeks depending on the levels of bacteria indicated in the breath tests.

Garcia has been taking an antibiotic for a couple of weeks and said her symptoms are still with her.

She will be retaking the breath test this week to determine the levels of bacteria and will continue on medication.