Diagnosis of bacterial overgrowth of the small intestine. Comparison of the 14C-D-xylose breath test and jejunal cultures in 60 patients.

Sixty consecutive patients suspected of having bacterial overgrowth of the small intestine (BOG) had aerobic and anaerobic bacterial cultures made of fasting upper jejunal fluid and also a 14C-D-xylose breath test (XBT). Culture-proven BOG was present in 23 patients. In another 15 patients the presence of BOG was ruled out (diagnoses: irritable bowel syndrome, 8; chronic diarrhoea, 6; and lactose malabsorption, 1). These patients were used as controls. The other 22 of the 60 patients could not be placed in either group owing to the presence of factors known to predispose for BOG; none of them had abnormal jejunal cultures, but several had strong clinical suspicion of BOG. An abnormal XBT, defined as values exceeding upper 90% confidence limits (upper range) of the 15 patient control values within a 4-h period, was observed with the following frequencies in the 23 patients with BOG: after 60 min, 35%; after 120 min, 44%; after 180 min, 61%; and after 240 min, 65%. An abnormal XBT was observed in 41% of the 22 patients with normal jejunal cultures but with predisposition for, and clinical suspicion of, BOG. It is concluded that, compared with a relevant control material, the XBT tends to be rather insensitive and that a negative outcome of jejunal cultures is inadequate to exclude the presence of BOG.