SMALL INTESTINAL BACTERIAL OVERGROWTH AND INTESTINAL METHANOGEN OVERGROWTH IN A DOG WITH PARVOVIRAL GASTROENTERITIS: MEASUREMENT BY BREATH TESTING USING A LACTULOSE PROBE
Year 2024,
Volume: 5 Issue: 2, 89 - 94
Kerem Ural
,
Hasan Erdoğan
,
Mehmet Gültekin
,
Serdar Paşa
,
Songül Erdoğan
,
Cansu Balıkçı
,
İlayda Tendar
Abstract
The aim of this case report is to detect small intestinal bacterial overgrowth (SIBO) and intestinal methanogen overgrowth (IMO) in a dog infected with Canine Parvovirus (CPV) using lactulose breath test and to evaluate the effects of CPV on intestinal permeability changes with this method. H2 and CH4 breath test analyses were performed to determine the presence of SIBO and/or IMO in the dog confirmed as CPV positive with antigen rapid test kit. Within this scope, four breath samples were collected from the patient at half-hour intervals using a pediatric masked gas collector apparatus. The collected samples were analyzed sequentially. H2 value was determined as 55 ppm in the first breath sample (#0). H2 value increased significantly to 168 ppm at 60th minute (#2). CH4 value was initially 19 ppm and reached 31 ppm at 60th minute. In addition, a second H2 peak of 132 ppm and a CH4 peak of 28 ppm were detected at 90 minutes. These findings indicated that SIBO and IMO were positive in the breath test. This case report emphasizes the importance of detecting and managing SIBO and IMO in dogs infected with CPV. The lactulose breath test is considered a promising tool in veterinary medicine for the diagnosis of intestinal permeability changes, leaky gut, and possible SIBO and IMO in dogs infected with CPV. Although further studies are needed, it was concluded that the detection of SIBO with this method may be critical for the prognosis and management of the infection.
References
- 1. Mylonakis ME, Kalli I, Rallis TS. Canine parvoviral enteritis: an update on the clinical diagnosis, treatment, and prevention. Veterinary Medicine: Research and Reports 2016; 91-100.
- 2. Pollock RV. Experimental canine parvovirus infection in dogs. Cornell Veterinarian 1982; 72(2): 103-119.
3. Goddard A, Leisewitz AL. Canine parvovirus. Veterinary Clinics of North America: Small Animal Practice 2010; 40(6): 1041-1053.
- 4. Nandi S, Kumar M. Canine parvovirus: current perspective. Indian Journal of Virology 2010; 21: 31-44.
- 5. Di Vincenzo F, Del Gaudio A, Petito V, Lopetuso LR, Scaldaferri F. Gut microbiota, intestinal permeability, and systemic inflammation: a narrative review. Internal and Emergency Medicine 2024; 19(2): 275-293.
- 6. Inczefi O, Bacsur P, Resál T, Keresztes C, Molnár T. The Influence of Nutrition on Intestinal Permeability and the Microbiome in Health and Disease. Frontiers in Nutrition 2022; 9.
- 7. Allam-Ndoul B, Castonguay-Paradis S, Veilleux A. Gut microbiota and intestinal trans-epithelial permeability. International Journal of Molecular Sciences 2020; 21(17): 6402.
- 8. Sartor RB. Microbial influences in inflammatory bowel diseases. Gastroenterology 2008; 134: 577-594.
- 9. Rezaie A, Pimentel M, Rao SS. How to test and treat small intestinal bacterial overgrowth: an evidence-based approach. Current Gastroenterology Reports 2016; 18: 1-11.
- 10. Gasbarrini A, Corazza GR, Gasbarrini G, Montalto M, Di Stefano M, et al. Methodology and Indications of H2-Breath Testing in Gastrointestinal Diseases: the Rome Consensus Conference. Alimentary Pharmacology & Therapeutics 2009; 29: 1-8.
- 11. Simrén M, Stotzer PO. Use and abuse of hydrogen breath tests. Gut 2006; 55(3): 297-303.
- 12. Ghoshal UC. How to interpret hydrogen breath tests. Journal of Neurogastroenterology and Motility 2011; 17(3): 312-317.
- 13. Lin HC. Small intestinal bacterial overgrowth: A framework for understanding irritable bowel syndrome. JAMA 2004; 292(7): 852-858.
- 14. Yamini D, Pimentel M. Irritable bowel syndrome and small intestinal bacterial overgrowth. Journal of Clinical Gastroenterology 2010; 44(10): 672-675.
- 15. Jacobs C, Coss Adame E, Attaluri A, Valestin J, Rao SS. Dysmotility and proton pump inhibitor use are independent risk factors for small intestinal bacterial and/or fungal overgrowth. Alimentary Pharmacology & Therapeutics 2013; 37(11): 1103-1111.
- 16. Pyleris E, Giamarellos-Bourboulis EJ, Tzivras D, Koussoulas V, Barbatzas C, et al. The prevalence of overgrowth by aerobic bacteria in the small intestine by small bowel culture: relationship with irritable bowel syndrome. Digestive Diseases and Sciences 2012; 57: 1321-1329.
- 17. Sundin OH, Ladd AH, Zeng M, Diaz-Arévalo D, Morales E, et al. The Human Jejunal Microbiome has a Distinctive Bacterial Flora, With Streptococcus tigurinus as its Signature Species, and an Increased Fraction of Gram-Negative Phyla in Patients With Small Intestinal Bacterial Overgrowth. Gastroenterology 2016; 150(4): S689.
- 18. Pimentel M, Saad RJ, Long MD, Rao SS. ACG clinical guideline: small intestinal bacterial overgrowth. American Journal of Gastroenterology 2020; 115(2): 165-178.
- 19. Saad RJ, Chey WD. Breath testing for small intestinal bacterial overgrowth: maximizing test accuracy. Clinical Gastroenterology and Hepatology 2014; 12(12): 1964-1972.
- 20. Levitt MD. Volume and composition of human intestinal gas determined by means of an intestinal washout technic. New England Journal of Medicine 1971; 284(25): 1394-1398.
- 21. Rezaie A, Buresi M, Lembo A, Lin H, McCallum R, Rao S, et al. Hydrogen and methane-based breath testing in gastrointestinal disorders: the North American consensus. American Journal of Gastroenterology 2017; 112(5): 775-784.
- 22. Papasouliotis K, Muir P, Gruffydd-Jones TJ, Cripps PJ, Blaxter AC. The effect of short-term dietary fibre administration on oro-caecal transit time in dogs. Diabetologia 1993; 36: 207-211.
- 23. Spohr A, Guilford WG, Haslett SJ, Vibe-Petersen G. Use of breath hydrogen testing to detect experimentally induced disaccharide malabsorption in healthy adult dogs. American Journal of Veterinary Research 1999; 60(7): 836-840.
- 24. Washabau RJ, Strombeck DR, Buffington CA, Harrold D. Evaluation of intestinal carbohydrate malabsorption in the dog by pulmonary hydrogen gas excretion. American Journal of Veterinary Research 1986; 47(6): 1402-1406.
- 25. Muir P, Papassouliotis K, Gruffydd-Jones TJ, Cripps PJ, Harbour DA. Evaluation of carbohydrate malassimilation and intestinal transit time in cats by measurement of breath hydrogen excretion. American Journal of Veterinary Research 1991; 52(7): 1104-1109.
- 26. Hammer HF, Fox MR, Keller J, Salvatore S, Basilisco G, et al. European guideline on indications, performance, and clinical impact of hydrogen and methane breath tests in adult and pediatric patients. United European Gastroenterology Journal 2022; 10(1): 15-40.
- 27. Hammer HF. Colonic hydrogen absorption: quantification of its effect on hydrogen accumulation caused by bacterial fermentation of carbohydrates. Gut 1993; 34(6): 818-822.
- 28. Ghoshal UC, Shukla R, Ghoshal U. Small intestinal bacterial overgrowth and irritable bowel syndrome: a bridge between functional organic dichotomy. Gut and Liver 2017; 11(2): 196-208.
- 29. Yu D, Cheeseman F, Vanner S. Combined oro-caecal scintigraphy and lactulose hydrogen breath testing demonstrate that breath testing detects oro-caecal transit, not small intestinal bacterial overgrowth in patients with IBS. Gut 2011; 60(3): 334-340.
- 30. Bratten JR, Spanier J, Jones MP. Lactulose breath testing does not discriminate patients with irritable bowel syndrome from healthy controls. American Journal of Gastroenterology 2008; 103(4): 958-963.
- 31. Miller MA, Parkman HP, Urbain JLC, Brown KL, Donahue DJ, et al. Comparison of scintigraphy and lactulose breath hydrogen test for assessment of orocecal transit (lactulose accelerates small bowel transit). Digestive Diseases and Sciences 1997; 42: 10-18.
- 32. Riordan SM, McIver CJ, Walker BM, Duncombe VM, Bolin TD, et al. The lactulose breath hydrogen test and small intestinal bacterial overgrowth. American Journal of Gastroenterology 1996; 91(9): 1795-1803.
- 33. Pimentel M, Chow EJ, Lin HC. Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. The American Journal of Gastroenterology 2000; 95(12): 3503-3506.
- 34. Pimentel M, Chow EJ, Lin HC. Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome: a double-blind, randomized, placebo-controlled study. The American Journal of Gastroenterology 2003; 98(2): 412-419.
- 35. Ghoshal UC, Ghoshal U, Das K, Misra A. Utility of hydrogen breath tests in diagnosis of small intestinal bacterial overgrowth in malabsorption syndrome, and its relationship with oro-cecal transit time. Indian Journal of Gastroenterology 2006; 25(1): 6-10.
- 36. Kumar S, Misra A, Ghoshal UC. Patients with irritable bowel syndrome exhale more hydrogen than healthy subjects in fasting state. Journal of Neurogastroenterology and Motility 2010; 16(3): 299-305.
- 37. Mastropaolo G, Rees WD. Evaluation of the hydrogen breath test in man: definition and elimination of the early hydrogen peak. Gut 1987; 28(6): 721-725.
- 38. Low K, Hwang L, Hua J, Zhu A, Morales W, et al. A combination of rifaximin and neomycin is most effective in treating irritable bowel syndrome patients with methane on lactulose breath test. Journal of Clinical Gastroenterology 2010; 44(8): 547-550.
- 39. Takakura W, Pimentel M, Rao S, Villanueva-Millan MJ, Chang C, et al. A single fasting exhaled methane level correlates with fecal methanogen load, clinical symptoms and accurately detects intestinal methanogen overgrowth. The American Journal of Gastroenterology 2022; 117(3): 470-477.
PARVOVİRAL GASTROENTERİTİSLİ BİR KÖPEKTE İNCE BAĞIRSAKTA AŞIRI BAKTERİYEL KOLONİZASYON VE İNTESTİNEL METANOJEN AŞIRI ÇOĞALMA: LAKTULOZ PROBU KULLANILARAK NEFES TESTİ İLE ÖLÇÜM
Year 2024,
Volume: 5 Issue: 2, 89 - 94
Kerem Ural
,
Hasan Erdoğan
,
Mehmet Gültekin
,
Serdar Paşa
,
Songül Erdoğan
,
Cansu Balıkçı
,
İlayda Tendar
Abstract
Bu vaka raporunun amacı, Kanin Parvovirus (CPV) ile enfekte bir köpekte, laktuloz nefes testi kullanılarak ince bağırsaklarda aşırı bakteriyel çoğalma (SIBO) ile intestinel metanojen aşırı çoğalmanın (IMO) tespit edilmesi ve bu yöntemle CPV'nin intestinal permeabilite değişimlerine olan etkilerinin değerlendirilmesidir. Antijen hızlı test kiti ile CPV pozitif olarak doğrulanan köpekte SIBO ve/veya IMO mevcudiyetini belirlemek amacıyla H2 ve CH4 nefes testi analizleri gerçekleştirildi. Bu kapsamda, hastadan yarım saatlik aralıklarla dört adet nefes numunesi pediyatrik maskeli gaz toplayıcı aparat kullanılarak toplandı. Toplanan numuneler ardışık olarak analiz edildi. İlk nefes numunesinde (#0) H2 değeri 55 ppm olarak tespit edildi. 60. dakikada (#2) H2 değeri 168 ppm'e yükselerek belirgin bir artış gösterdi. CH4 değeri ise başlangıçta 19 ppm iken, 60. dakikada 31 ppm'e ulaştı. Ayrıca, 90. dakikada ikinci bir H2 zirvesi 132 ppm ve CH4 zirvesi 28 ppm olarak tespit edildi. Bu bulgular, nefes testinde SIBO'nun ve IMO’nun pozitif olduğunu gösterdi. Bu vaka raporu, CPV ile enfekte köpeklerde SIBO ve IMO 'nun tespiti ve yönetiminin önemini vurgulamaktadır. Laktuloz nefes testi, veteriner hekimlikte CPV ile enfekte köpeklerde intestinal permeabilite değişikliklerinin, geçirgen bağırsağın, muhtemel SİBO ile IMO’nun tanısında umut vadeden bir araç olarak görülmektedir. Daha ileri çalışmalara ihtiyaç duyulmakla birlikte, bu yöntemle SIBO'nun tespiti, enfeksiyonun prognozu ve yönetimi açısından kritik öneme sahip olabileceği sonucuna ulaşıldı.
References
- 1. Mylonakis ME, Kalli I, Rallis TS. Canine parvoviral enteritis: an update on the clinical diagnosis, treatment, and prevention. Veterinary Medicine: Research and Reports 2016; 91-100.
- 2. Pollock RV. Experimental canine parvovirus infection in dogs. Cornell Veterinarian 1982; 72(2): 103-119.
3. Goddard A, Leisewitz AL. Canine parvovirus. Veterinary Clinics of North America: Small Animal Practice 2010; 40(6): 1041-1053.
- 4. Nandi S, Kumar M. Canine parvovirus: current perspective. Indian Journal of Virology 2010; 21: 31-44.
- 5. Di Vincenzo F, Del Gaudio A, Petito V, Lopetuso LR, Scaldaferri F. Gut microbiota, intestinal permeability, and systemic inflammation: a narrative review. Internal and Emergency Medicine 2024; 19(2): 275-293.
- 6. Inczefi O, Bacsur P, Resál T, Keresztes C, Molnár T. The Influence of Nutrition on Intestinal Permeability and the Microbiome in Health and Disease. Frontiers in Nutrition 2022; 9.
- 7. Allam-Ndoul B, Castonguay-Paradis S, Veilleux A. Gut microbiota and intestinal trans-epithelial permeability. International Journal of Molecular Sciences 2020; 21(17): 6402.
- 8. Sartor RB. Microbial influences in inflammatory bowel diseases. Gastroenterology 2008; 134: 577-594.
- 9. Rezaie A, Pimentel M, Rao SS. How to test and treat small intestinal bacterial overgrowth: an evidence-based approach. Current Gastroenterology Reports 2016; 18: 1-11.
- 10. Gasbarrini A, Corazza GR, Gasbarrini G, Montalto M, Di Stefano M, et al. Methodology and Indications of H2-Breath Testing in Gastrointestinal Diseases: the Rome Consensus Conference. Alimentary Pharmacology & Therapeutics 2009; 29: 1-8.
- 11. Simrén M, Stotzer PO. Use and abuse of hydrogen breath tests. Gut 2006; 55(3): 297-303.
- 12. Ghoshal UC. How to interpret hydrogen breath tests. Journal of Neurogastroenterology and Motility 2011; 17(3): 312-317.
- 13. Lin HC. Small intestinal bacterial overgrowth: A framework for understanding irritable bowel syndrome. JAMA 2004; 292(7): 852-858.
- 14. Yamini D, Pimentel M. Irritable bowel syndrome and small intestinal bacterial overgrowth. Journal of Clinical Gastroenterology 2010; 44(10): 672-675.
- 15. Jacobs C, Coss Adame E, Attaluri A, Valestin J, Rao SS. Dysmotility and proton pump inhibitor use are independent risk factors for small intestinal bacterial and/or fungal overgrowth. Alimentary Pharmacology & Therapeutics 2013; 37(11): 1103-1111.
- 16. Pyleris E, Giamarellos-Bourboulis EJ, Tzivras D, Koussoulas V, Barbatzas C, et al. The prevalence of overgrowth by aerobic bacteria in the small intestine by small bowel culture: relationship with irritable bowel syndrome. Digestive Diseases and Sciences 2012; 57: 1321-1329.
- 17. Sundin OH, Ladd AH, Zeng M, Diaz-Arévalo D, Morales E, et al. The Human Jejunal Microbiome has a Distinctive Bacterial Flora, With Streptococcus tigurinus as its Signature Species, and an Increased Fraction of Gram-Negative Phyla in Patients With Small Intestinal Bacterial Overgrowth. Gastroenterology 2016; 150(4): S689.
- 18. Pimentel M, Saad RJ, Long MD, Rao SS. ACG clinical guideline: small intestinal bacterial overgrowth. American Journal of Gastroenterology 2020; 115(2): 165-178.
- 19. Saad RJ, Chey WD. Breath testing for small intestinal bacterial overgrowth: maximizing test accuracy. Clinical Gastroenterology and Hepatology 2014; 12(12): 1964-1972.
- 20. Levitt MD. Volume and composition of human intestinal gas determined by means of an intestinal washout technic. New England Journal of Medicine 1971; 284(25): 1394-1398.
- 21. Rezaie A, Buresi M, Lembo A, Lin H, McCallum R, Rao S, et al. Hydrogen and methane-based breath testing in gastrointestinal disorders: the North American consensus. American Journal of Gastroenterology 2017; 112(5): 775-784.
- 22. Papasouliotis K, Muir P, Gruffydd-Jones TJ, Cripps PJ, Blaxter AC. The effect of short-term dietary fibre administration on oro-caecal transit time in dogs. Diabetologia 1993; 36: 207-211.
- 23. Spohr A, Guilford WG, Haslett SJ, Vibe-Petersen G. Use of breath hydrogen testing to detect experimentally induced disaccharide malabsorption in healthy adult dogs. American Journal of Veterinary Research 1999; 60(7): 836-840.
- 24. Washabau RJ, Strombeck DR, Buffington CA, Harrold D. Evaluation of intestinal carbohydrate malabsorption in the dog by pulmonary hydrogen gas excretion. American Journal of Veterinary Research 1986; 47(6): 1402-1406.
- 25. Muir P, Papassouliotis K, Gruffydd-Jones TJ, Cripps PJ, Harbour DA. Evaluation of carbohydrate malassimilation and intestinal transit time in cats by measurement of breath hydrogen excretion. American Journal of Veterinary Research 1991; 52(7): 1104-1109.
- 26. Hammer HF, Fox MR, Keller J, Salvatore S, Basilisco G, et al. European guideline on indications, performance, and clinical impact of hydrogen and methane breath tests in adult and pediatric patients. United European Gastroenterology Journal 2022; 10(1): 15-40.
- 27. Hammer HF. Colonic hydrogen absorption: quantification of its effect on hydrogen accumulation caused by bacterial fermentation of carbohydrates. Gut 1993; 34(6): 818-822.
- 28. Ghoshal UC, Shukla R, Ghoshal U. Small intestinal bacterial overgrowth and irritable bowel syndrome: a bridge between functional organic dichotomy. Gut and Liver 2017; 11(2): 196-208.
- 29. Yu D, Cheeseman F, Vanner S. Combined oro-caecal scintigraphy and lactulose hydrogen breath testing demonstrate that breath testing detects oro-caecal transit, not small intestinal bacterial overgrowth in patients with IBS. Gut 2011; 60(3): 334-340.
- 30. Bratten JR, Spanier J, Jones MP. Lactulose breath testing does not discriminate patients with irritable bowel syndrome from healthy controls. American Journal of Gastroenterology 2008; 103(4): 958-963.
- 31. Miller MA, Parkman HP, Urbain JLC, Brown KL, Donahue DJ, et al. Comparison of scintigraphy and lactulose breath hydrogen test for assessment of orocecal transit (lactulose accelerates small bowel transit). Digestive Diseases and Sciences 1997; 42: 10-18.
- 32. Riordan SM, McIver CJ, Walker BM, Duncombe VM, Bolin TD, et al. The lactulose breath hydrogen test and small intestinal bacterial overgrowth. American Journal of Gastroenterology 1996; 91(9): 1795-1803.
- 33. Pimentel M, Chow EJ, Lin HC. Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. The American Journal of Gastroenterology 2000; 95(12): 3503-3506.
- 34. Pimentel M, Chow EJ, Lin HC. Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome: a double-blind, randomized, placebo-controlled study. The American Journal of Gastroenterology 2003; 98(2): 412-419.
- 35. Ghoshal UC, Ghoshal U, Das K, Misra A. Utility of hydrogen breath tests in diagnosis of small intestinal bacterial overgrowth in malabsorption syndrome, and its relationship with oro-cecal transit time. Indian Journal of Gastroenterology 2006; 25(1): 6-10.
- 36. Kumar S, Misra A, Ghoshal UC. Patients with irritable bowel syndrome exhale more hydrogen than healthy subjects in fasting state. Journal of Neurogastroenterology and Motility 2010; 16(3): 299-305.
- 37. Mastropaolo G, Rees WD. Evaluation of the hydrogen breath test in man: definition and elimination of the early hydrogen peak. Gut 1987; 28(6): 721-725.
- 38. Low K, Hwang L, Hua J, Zhu A, Morales W, et al. A combination of rifaximin and neomycin is most effective in treating irritable bowel syndrome patients with methane on lactulose breath test. Journal of Clinical Gastroenterology 2010; 44(8): 547-550.
- 39. Takakura W, Pimentel M, Rao S, Villanueva-Millan MJ, Chang C, et al. A single fasting exhaled methane level correlates with fecal methanogen load, clinical symptoms and accurately detects intestinal methanogen overgrowth. The American Journal of Gastroenterology 2022; 117(3): 470-477.