In my practice, I deal with many patients whose lives are affected on a daily basis by symptoms of functional bowel disorders. They suffer from gas, bloating, and other bothersome symptoms that interfere with everyday life.
They often undergo procedures to rule out conditions such as peptic ulcer disease, colitis, and other conditions. Many of them are diagnosed with irritable bowel syndrome (IBS).
These patients are placed on severely restrictive diets by healthcare professionals or even well-intentioned, but misinformed friends and family. For example, the common practice of restricting dairy products in nonlactose intolerant patients can be unnecessarily restrictive. These additional -- and sometimes unwarranted -- restrictions can make adequate diet selection difficult.
In patients who do not have celiac disease, sensitivity to gluten may still exist. But ruling out other testable and common intolerances (such as lactose or fructose) and small intestinal bacterial overgrowth may be a good idea before long-term gluten restriction in these patients.
I have found that offering my patients hydrogen breath testing can be valuable in helping us diagnose on two fronts: overlooked intolerances to lactose or fructose, as well as small intestinal bacterial overgrowth.
There is a growing body of literature highlighting symptoms that may be attributable to poor absorption of short chain sugars. Fermentable oligo-, di-, and monosaccharides, and polyols (FODMAPs) may trigger gastrointestinal symptoms in IBS patients, and adherence to these diets has been associated with symptoms improvement.
Small intestinal bacterial overgrowth is a condition characterized by excessive growth of small intestinal bacteria and can be associated with inflammation and nutrient malabsorption. Patients may have symptoms such as bloating, dyspepsia, abdominal discomfort, and diarrhea, which may be mistakenly labeled as irritable bowel syndrome. This is important for treatment: bacterial overgrowth may respond to a short course of antibiotics rather than long-term management of uncomfortable symptoms.
Breath testing measures the hydrogen and methane gas produced by bacteria in the small intestine that has diffused into the blood and then lungs for expiration. During a breath test, patients are asked to give a baseline breath sample and then ingest a substance such as lactose, fructose, or lactulose. Subsequent breath samples are then taken to determine if these substances were adequately digested or if there may be an overgrowth of small intestinal bacteria.
We have found these tests to be quite useful in treating patients with gas and bloating and IBS. They allow us to place patients on accurate and specific diet plans. Our patients are very appreciative of being able to identify which foods cause their adverse symptoms, which subsequently leads to a more free diet.
We have found that many of our patients who had previously been told to restrict lactose and fructose may in fact not have issues with digesting these substances and can expand their already restricted diets. This extra piece of information can make a difference for patients and can be as simple as taking a breath.
Shawn Khodadadian, MD, is a gastroenterologist and director of clinical nutrition at Lenox Hill Hospital in New York City. He is a clinical instructor at NYU Langone Medical Center and owner of Manhattan Gastroenterology.