BREATH HYDROGEN RESPONSES MEASURED BY A NOVEL PORTABLE HYDROGEN BREATH ANALYZER AND SMART PHONE APP USED AT HOME CAN DISTINGUISH NORMAL SUBJECTS FROM PATIENTS WITH SUSPECTED SIBO
DDW ePoster Library. Pasricha P. 05/22/21; 320187; Sa384
Pankaj Pasricha
Pankaj Pasricha
Contributions
Abstract
Engage with the presenter here during ePoster Session: Diarrheal Disorders: Bacterial Overgrowth - Drug Induced and Other Enterocolitides (Microscopic, Enteropathy, Check Point Inhibitors, etc.)
On Saturday, May 22, 2021 12:15 - 1 p.m. EDT

Number: Sa384
BREATH HYDROGEN RESPONSES MEASURED BY A NOVEL PORTABLE HYDROGEN BREATH ANALYZER AND SMART PHONE APP USED AT HOME CAN DISTINGUISH NORMAL SUBJECTS FROM PATIENTS WITH SUSPECTED SIBO

Society: AGA
Track: Functional GI and Motility Disorders
Category: Neurogastroenterology & Motility

Author(s): Guillermo A. Barahona1, Luisa G. Villatoro1, Megan Mcknight1, Robert Burns1, Claire Shortt2, Niall Mcgovern2, Pankaj J. Pasricha11 Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States; 2 FoodMarble, Dublin, Ireland

INTRODUCTION:
Small intestinal bacterial overgrowth (SIBO) is a population-wide disorder characterized by excessive bacteria present in the small intestine. Lactulose-hydrogen (H2) breath testing (LHBT) is widely used to make a diagnosis of SIBO but is accuracy is sub-optimal. Moreover, a single test with an artificial substrate may not reflect the real-world symptom experience of a patient at home on their regular diet. To address these issues, we tested a novel hand-held breath analyser (AIRE®, FoodMarble, Dublin, Ireland) linked to a smartphone app for rapid, convenient and frequent H2 and simultaneous symptom monitoring at home. The aims of this study were (1) to compare the performance of lactulose-provoked breath using AIRE versus a mail-in, at-home LHBT kit (QuinTron BreathTracker SC) using concordance analysis (2) to evaluate the post-prandial breath H2 and symptom responses in patients with SIBO in their daily routine and discern patterns that distinguished them from normal subjects and (2) METHODS:
12 patients suspected of SIBO (https://clinicaltrials.gov/ct2/show/NCT04309396) and 14 healthy subjects, recorded baseline and post-prandial breath H2 and symptoms (bloating, abdominal pain) in response to their morning and evening meal for 1-week using AIRE. Symptoms were recorded using a 0-5 scale and were self-assessed immediately after each breath test.
RESULTS:
There was 100% diagnostic agreement between AIRE and the results from the LHBT kit in the 9 patients to date who completed this part of the protocol. In both normal subjects and patients with suspected with SIBO, breath H2 was lower (and decreased) after the morning meal and was higher (and increased) after the evening meals (Fig 1). Symptom levels followed a similar trend (Fig 2). However, breath H2 and symptoms were significantly greater for the suspected SIBO patients. This study is ongoing and we expect to recruit sufficient patients to be able to establish diagnostic cut-offs for SIBO based on these patterns.
CONCLUSIONS:
The AIRE test performs as well as the standard LHBT for a binary (yes/no) diagnosis of SIBO by established criteria. More importantly, real-world breath and symptom data shows promise in differentiating SIBO patients from healthy subjects. The use of solid food instead of artificial, liquid substrates better reflects the actual digestive process. Additionally, tracking the response to multiple meals over several days, provides more certainty rather than a single snapshot test. Remote monitoring technologies may facilitate the collection of this richer, longitudinal data set, to support a more accurate diagnosis of SIBO and other common gastrointestinal disorders.
Engage with the presenter here during ePoster Session: Diarrheal Disorders: Bacterial Overgrowth - Drug Induced and Other Enterocolitides (Microscopic, Enteropathy, Check Point Inhibitors, etc.)
On Saturday, May 22, 2021 12:15 - 1 p.m. EDT

Number: Sa384
BREATH HYDROGEN RESPONSES MEASURED BY A NOVEL PORTABLE HYDROGEN BREATH ANALYZER AND SMART PHONE APP USED AT HOME CAN DISTINGUISH NORMAL SUBJECTS FROM PATIENTS WITH SUSPECTED SIBO

Society: AGA
Track: Functional GI and Motility Disorders
Category: Neurogastroenterology & Motility

Author(s): Guillermo A. Barahona1, Luisa G. Villatoro1, Megan Mcknight1, Robert Burns1, Claire Shortt2, Niall Mcgovern2, Pankaj J. Pasricha11 Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States; 2 FoodMarble, Dublin, Ireland

INTRODUCTION:
Small intestinal bacterial overgrowth (SIBO) is a population-wide disorder characterized by excessive bacteria present in the small intestine. Lactulose-hydrogen (H2) breath testing (LHBT) is widely used to make a diagnosis of SIBO but is accuracy is sub-optimal. Moreover, a single test with an artificial substrate may not reflect the real-world symptom experience of a patient at home on their regular diet. To address these issues, we tested a novel hand-held breath analyser (AIRE®, FoodMarble, Dublin, Ireland) linked to a smartphone app for rapid, convenient and frequent H2 and simultaneous symptom monitoring at home. The aims of this study were (1) to compare the performance of lactulose-provoked breath using AIRE versus a mail-in, at-home LHBT kit (QuinTron BreathTracker SC) using concordance analysis (2) to evaluate the post-prandial breath H2 and symptom responses in patients with SIBO in their daily routine and discern patterns that distinguished them from normal subjects and (2) METHODS:
12 patients suspected of SIBO (https://clinicaltrials.gov/ct2/show/NCT04309396) and 14 healthy subjects, recorded baseline and post-prandial breath H2 and symptoms (bloating, abdominal pain) in response to their morning and evening meal for 1-week using AIRE. Symptoms were recorded using a 0-5 scale and were self-assessed immediately after each breath test.
RESULTS:
There was 100% diagnostic agreement between AIRE and the results from the LHBT kit in the 9 patients to date who completed this part of the protocol. In both normal subjects and patients with suspected with SIBO, breath H2 was lower (and decreased) after the morning meal and was higher (and increased) after the evening meals (Fig 1). Symptom levels followed a similar trend (Fig 2). However, breath H2 and symptoms were significantly greater for the suspected SIBO patients. This study is ongoing and we expect to recruit sufficient patients to be able to establish diagnostic cut-offs for SIBO based on these patterns.
CONCLUSIONS:
The AIRE test performs as well as the standard LHBT for a binary (yes/no) diagnosis of SIBO by established criteria. More importantly, real-world breath and symptom data shows promise in differentiating SIBO patients from healthy subjects. The use of solid food instead of artificial, liquid substrates better reflects the actual digestive process. Additionally, tracking the response to multiple meals over several days, provides more certainty rather than a single snapshot test. Remote monitoring technologies may facilitate the collection of this richer, longitudinal data set, to support a more accurate diagnosis of SIBO and other common gastrointestinal disorders.

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