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Digestive Diseases and Sciences, Vol. 49, No. 1 (January 2004), pp. 7377 ( CMARK PIMENTEL, MD, FRCP(C), TESS CONSTANTINO, RN, YUTHANA KONG, MPH,MEERA BAJWA, MD, ABOLGHASEM REZAEI, MD, and SANDY PARK, BATreatment of small intestinal bacterial overgrowth is frustrated by the low efficacy of antibiotics.
Elemental diets have been shown to reduce enteric flora. In this study, we evaluate the ability
of an elemental diet to normalize the lactulose breath test (LBT) in IBS subjects with abnormal
breath test findings. Consecutive subjects with IBS and abnormal LBT suggesting the presence of
bacterial overgrowth underwent a 2-week exclusive elemental diet. The diet consisted of Vivonex Plus
(Novartis Nutrition Corp., Minneapolis, MN) in a quantity based on individual caloric requirement.
On day 15 (prior to solid food), subjects returned for a follow-up breath test and those with an
abnormal LBT were continued on the diet for an additional 7 days. The ability of an elemental diet to
normalize the LBT was determined for days 15 and 21. A chart review was then conducted to evaluate
any clinical benefit 1 month later. Of the 93 subjects available for analysis, 74 (80%) had a normal LBT
on day 15 of the elemental diet. When those who continued to day 21 were included, five additional
patients normalized the breath test (85%). On chart review, subjects who successfully normalized
their breath test had a 66.4 36.1% improvement in bowel symptoms, compared to 11.9 22.0%
in those who failed to normalize (P < 0.001). An elemental diet is highly effective in normalizing
an abnormal LBT in IBS subjects, with a concomitant improvement in clinical symptoms.KEY WORDS: bacterial overgrowth; enteral nutrition; elemental diet; irritable bowel syndrome.Bacterial overgrowth is a condition whereby the bacteria of the normally colonized colon are now also colonizing the relatively sterile small intestine. The resulting
displacement of bacteria into the small bowel produces a
constellation of symptoms including altered bowel habits,
abdominal pain, bloating, gas, and distention (1). Classically, bacterial overgrowth is observed in subjects with
altered bowel anatomy (28). However, recent data suggest that the majority of subjects with IBS may also have
an abnormal lactulose breath test (LBT) to suggest bac-Manuscript received June 21, 2003; accepted September 30, 2003.All from the GI Motility Program, Division of Gastroenterology,