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Are IBS symptoms important?
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Breath Testing and FODMAPs Jim Brooker Gastroenterologist Waikato - - PowerPoint PPT Presentation
Breath Testing and FODMAPs Jim Brooker Gastroenterologist Waikato - - PowerPoint PPT Presentation
Breath Testing and FODMAPs Jim Brooker Gastroenterologist Waikato DHB and Tawa Street Clinic Are IBS symptoms important?
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Case History
34 year old professional female Crohn’s for 10 years Fistulating and small bowel disease Cutaneous complications Stable on anti-TNF therapy But still bloating and diarrhoea Incontinence of gas via ano-vaginal fistula
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Breath tests: negative for fructose and lactose But…..symptoms during both tests Therefore commenced FODMAP diet After 6months describes “night and day” effect
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What are FODMAPs? What are FODMAPs?
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What are FODMAPs? What are FODMAPs?
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What are FODMAPs? What are FODMAPs?
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What are FODMAPs? What are FODMAPs?
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What are FODMAPs? What are FODMAPs?
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- FODMAPs
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IBS Pathophysiology
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Low FODMAP diet efficacy
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Breath testing Dietician NPA 60min Individualised diet plan based on food record and breath test results Advice on cooking without onions and garlic 6 weeks FU, 30min, controlled reintroduction
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Mean FU 15.7 months (+/-9)
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Adherence to Diet
Ongoing adherence 75.6% At all times 12.2% Some exceptions 35.6% Except when eating out 14.4% At least 50% adherence 14.4% Initial 3months only 14.4% Non-adherent 24.4% Never followed the diet 4.4%
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What is a H2 breath test?
- 24 hours of low fermentable diet
- Lactulose test (positive control)
? H2 / CH4 producer ? Small intestinal bacterial overgrowth Oro caecal transit time
- Fructose (35g) challenge
- Lactose challenge
- Also look for symptoms
- Sequential breath tests Q15min until +/-
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Lactulose
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Lactulose
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Small Intestinal Bacterial Overgrowth
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Breath tests: Lactulose screen
Normal rise Early rise - SIBO
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Example of abnormal BT Lactose/Fructose malabsorption
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Example of normal BT Lactose/Fructose
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Symptoms
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Symptoms
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Breath Test Process
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Pre-test
4 weeks after colonoscopy or antibiotics 2 weeks off probiotics 1 day off motility agents, laxatives, antidiarrhoeals
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Individualised diet based on breath test result Maintain a well balanced diet
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Summary
IBS a significant problem Other causes of symptoms may need to be excluded Dietary triggers a major factor Good evidence for efficacy of FODMAP diet Breath testing can help individualise diet Dietician invaluable
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