Does a glucose-based hydrogen and methane breath test detect bacterial overgrowth in the jejunum?

BACKGROUND: Direct diagnosis of small intestinal bacterial overgrowth (SIBO) requires the collection and culture of fluid from the jejunal lumen, with a finding of over 105 viable bacteria per mL. More often, SIBO is diagnosed indirectly, using a non-invasive test of the exhaled hydrogen and methane generated by microbial fermentation when ingested glucose reaches the jejunum. Our objective was to determine how well this breath test detects chronic overgrowth of jejunal bacteria that is unrelated to gastrointestinal surgery. METHODS: Eighteen patients reporting symptoms consistent with SIBO received a glucose breath test. On a later day, the jejunal lumen was sampled via aspiration during enteroscopy. Jejunal aspirates were cultured on aerobic and anaerobic media. DNA was extracted from the same samples and analyzed by quantitative pan-bacterial PCR amplification of 16S ribosomal rRNA genes, which provided a culture-independent bacterial cell count. KEY RESULTS: Combined bacterial colony counts ranged from 5.7 x 103 to 7.9 x 106 CFU/mL. DNA-based yields ranged from 1.5 x 105 to 3.1 x 107 bacterial genomes per mL. Microbial viability ranged from 0.3% to near 100%. We found no significant correlation of glucose breath test results with either the number of bacterial colonies or with the DNA-based bacterial cell counts. Instead, higher signals in the hydrogen-methane breath test were significantly correlated with a lower viability of jejunal bacteria, at a P-value of .014. CONCLUSIONS & INFERENCES: The glucose-based hydrogen and methane breath test is not sensitive to the overgrowth of jejunal bacteria. However, a positive breath test may indicate altered jejunal function and microbial dysbiosis.

Evidence for glutamate receptor mediated transmission at mechanoreceptors in the skin.

The functional role of Merkel cells in the mechanosensitivity of the slowly adapting type I responses has been a controversial issue for many years. Here we show, for the first time, that glutamate receptor-mediated transmission is largely responsible for the static component of the slowly adapting type I response. An isolated sinus hair preparation was used to study the two types (I and II) of slowly adapting units. A broad spectrum ionotropic glutamate receptor antagonist kynurenate (1-10 mM) caused reliable and dose-dependent reductions in the static component of type I unit responses to mechanical stimulation. In addition, an amino acid transmitter candidate aspartate applied to the preparation selectively increased responses in type I units but not responses in type II units. This evidence establishes that the Merkel cell is a mechano-electric transducer, and challenges prevailing views that the Merkel cell acts merely as a support or target cell in the epidermis.