Reduced accuracy of 14C-D-xylose breath test for detecting bacterial overgrowth in gastrointestinal motility disorders

The accuracy of the 14C-D-xylose breath test in the diagnosis of small-bowel bacterial overgrowth was prospectively evaluated in 10 patients with motility disorders: 6 myopathic, 3 neuropathic, and 1 mechanical obstruction. 6 of 10 patients had small-bowel bacterial overgrowth on culture of small-bowel aspirate. Increased breath 14CO2 levels were documented in 3 of 6 patients with positive cultures and in 2 of 4 with negative cultures. 2 patients with positive results by both methods and 1 of 2 with positive breath 14CO2 but negative cultures had previously undergone gastric surgery. 3 patients with myopathic dysmotility had positive cultures but negative breath tests. Cultures of duodenal aspirates and the D-xylose test had sensitivities of 80% and 40%, respectively, for the finding of hypoalbuminemia. Compared with cultures, the sensitivity and specificity of the breath test were 60% and 40%, respectively. Impaired delivery of 14C-D-xylose for bacterial metabolism may result from postprandial antral hypomotility or low amplitude small-bowel motility, contributing to the false-negative breath tests. Thus, cultures is the optimal method to detect small-bowel bacterial overgrowth in patients with motility disorders. 25 refs., 1 fig., 4 tabs