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? � ������������� � ����������������������������� � ���������������������������� � ��������������������������������������� � ��� � � � � ����������� � ��� � � � � ������������� � ���!��"�#��$�����%!������������������

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

� Breath tests: negative for fructose and lactose � But…..symptoms during both tests � Therefore commenced FODMAP diet � After 6months describes “night and day” effect

What are FODMAPs? What are FODMAPs? ����������� ���������� � ���������������� ��������������� � ������������� ������������ � ��������������� �������������� � ���� ��� � ������ ������ � �

What are FODMAPs? What are FODMAPs? � ��������������� ������������������� � ��������������� � � � � � � � �

What are FODMAPs? What are FODMAPs? � � � ������������ ������� � ������������ � � � � � �

What are FODMAPs? What are FODMAPs? � � � � � �������������� ��������� � �������������� ���������������������� � � � �

What are FODMAPs? What are FODMAPs? � � � � � � � ��� � ��� �������� � � ������ ������

!���� ��������&�� FODMAPs *�������������������� ��� ����� '������� ���� (����"��� )���

IBS Pathophysiology &'�����( &)�������( "����� ����� ��������� # ������� %�� �� ���������!��� $�������� "�����

Low FODMAP diet efficacy

� 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

Mean FU 15.7 months (+/-9)

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%

What is a H 2 breath test? � 24 hours of low fermentable diet � Lactulose test (positive control) � ? H 2 / CH 4 producer � ? Small intestinal bacterial overgrowth � Oro caecal transit time � Fructose (35g) challenge � Lactose challenge � Also look for symptoms � Sequential breath tests Q15min until +/-

!���� ��������&�� Lactulose � * � * � * � * � * � *

!���� Small Intestinal Bacterial Overgrowth ��������&�� � * � * � * Lactulose � * � * � * +����������������������������

Breath tests: Lactulose screen Normal rise Early rise - SIBO

Example of abnormal BT Lactose/Fructose malabsorption

Example of normal BT Lactose/Fructose

Symptoms

Symptoms

Breath Test Process

Pre-test 4 weeks after colonoscopy or antibiotics 2 weeks off probiotics 1 day off motility agents, laxatives, antidiarrhoeals

� Individualised diet based on breath test result � Maintain a well balanced diet

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