Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
To the Editor: On reading Dr Lin’s discussion
of the hypothesis of small intestinal bacterial overgrowth (SIBO) as a framework
for understanding irritable bowel syndrome (IBS),1 I
have concerns that the only data put forward are at best indirect, and that
alternate conclusions could be drawn from the given findings.
Our report of whole-body calorimeter measurement of 24-hour excretion
of hydrogen and methane2 (reference 19 in the
article) is referred to incorrectly. Higher hydrogen volumes and 4-fold greater
maximal rates of excretion were observed in patients compared with controls,
all of whom were eating the same “standard Western diet,” not
following lactulose ingestion as was stated. Patients and controls were provided
identical food for 14 days prior to measurement, with 3-day rotation of fixed
diet. The second reported study from the same group3 (reference
21 in the article) used the same methodology, which is also misstated. Whole-body
excretion of hydrogen and methane after lactulose has, to my knowledge, not
been studied in IBS patients but would require a prolonged period of measurement,
perhaps 18 hours.4
King T. Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome. JAMA. 2004;292(18):2213–2214. doi:10.1001/jama.292.18.2213-a
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