Issue Highlights

Abstract

Small bowel bacterial overgrowth (SBBO) has traditionally been challenging to diagnose. A widely used option is breath testing, which detects the production of hydrogen and/or methane that results from the digestion of a swallowed carbohydrate load by excessive bacteria in the small bowel. However, breath testing is often unable to distinguish small bowel from colonic metabolism of substrates and can be affected by conditions that accelerate small bowel transit. In this issue of Clinical Gastroenterology and Hepatology, Lin and Massey reviewed data from glucose breath tests performed with concurrent scintigraphy on 139 patients with suspected SBBO at the Medical College of Wisconsin from January 2003 through July 2013. Scintigraphy was used to determine whether an increasing curve of hydrogen or methane (by >15 ppm above baseline within 90 minutes) on breath testing occurred before or after arrival of the glucose bolus to the cecum. Forty-six of the patients had abnormal breath tests results, of which nearly half (48%) were deemed false-positive due to colon fermentation, based on scintigraphy. The rate of false-positive findings was higher (65%) in the subset of patients with prior upper gastrointestinal surgery. Oro-cecal transit time was significantly shorter in patients with false-positive breath test results, compared to those with positive breath tests and SBBO, and those with negative breath tests. These data suggest that breath testing alone is insufficiently specific for SBBO, and that patients with abnormal breath testing, especially those with prior upper gastrointestinal surgery, could be considered for confirmatory scintigraphy to distinguish SBBO from colonic fermentation. This article is highlighted by an editorial by Joseph H. Sellin (page 209). See page 203. The treatment of alcohol use disorder in patients with chronic liver disease is problematic. Pharmacologic options are limited, while psychosocial interventions have shown value in treating alcohol use disorder in patients without liver disease. The effect of such interventions specifically on patients with chronic liver disease is unclear. In this issue of Clinical Gastroenterology and Hepatology, Khan et al performed a systematic review of studies assessing the efficacy of psychosocial interventions to induce or maintain alcohol abstinence in patients with chronic liver disease and alcohol use disorder. The investigators identified 13 studies published between 1983 and 2014 (5 of which were randomized controlled trials), comprising 1945 patients. Interventions included motivational enhancement therapy, cognitive behavioral therapy (CBT), motivational interviewing, supportive therapy and psychoeducation either alone or in combination in the intervention group, and general health education or usual treatment in the control group. Integrated combination psychotherapy with CBT, motivational enhancement therapy, and comprehensive medical care delivered over 2 years, was the only intervention that produced a significant increase in induction of abstinence (74% increase in intervention group vs 48% increase in control group; P = .02), reported in a randomized controlled trial. Most other interventions did not impact induction of abstinence in patients with chronic liver disease. For the outcome of maintenance of alcohol abstinence, no psychosocial intervention was successful in the long term. However, an integrated therapy combining medical care with CBT showed promise, as it reduced the rate of recidivism (32.7% in integrated CBT group vs 75% in control group, P = .03). See page 191. Efficacy of Psychosocial Interventions in Inducing and Maintaining Alcohol Abstinence in Patients With Chronic Liver Disease: A Systematic ReviewClinical Gastroenterology and HepatologyVol. 14Issue 2PreviewWe conducted a systematic review of efficacy of psychosocial interventions in inducing or maintaining alcohol abstinence in patients with chronic liver disease (CLD) and alcohol use disorder (AUD). Full-Text PDF Scintigraphy Demonstrates High Rate of False-positive Results From Glucose Breath Tests for Small Bowel Bacterial OvergrowthClinical Gastroenterology and HepatologyVol. 14Issue 2PreviewBreath tests for hydrogen and/or methane are used to detect small bowel bacterial overgrowth (SBBO), but false-positive results can arise from clinical conditions that accelerate small bowel transit and deliver unabsorbed glucose to the colon. We investigated the prevalence of false-positive results from glucose breath tests by also evaluating patients with scintigraphy. Full-Text PDF