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In Reply: I am grateful to Dr King for his clarifications regarding my recent review on IBS. I agree that the lactulose breath test provides an indirect demonstration of SIBO and that measurement of breath hydrogen alone is inadequate. Currently, direct confirmation of SIBO is severely limited by difficult access to the full length of the small intestine and inadequate culturing and identification methods for the vast majority of the more than 500 species of bacteria in the gut.

The possibility that SIBO may be a unifying explanation for IBS is based on integrating the multiplicity of findings noted in the review. While an alternate conclusion could be drawn for a single piece of evidence such as an abnormal breath hydrogen profile, SIBO uniquely provides a framework that accounts for all of the findings. King and his colleagues observed that the maximal rates of gas excretion in IBS patients on . . . [Full Text of this Article]

Henry C. Lin, MD
Henry.c.lin@usc.edu
Division of Gastrointestinal and Liver Diseases
Department of Medicine
Keck School of Medicine
University of Southern California
Los Angeles