乳果糖氢甲烷呼气试验阳性患儿临床特征及内镜和病理表现分析

doi:10.12372/jcp.2025.25e0105

Abstract

Abstract:

Objective To summarize the application of the lactulose hydrogen-methane breath test (LHMBT) in children with gastrointestinal discomfort, and to analyze the clinical and endoscopic features of children with positive LHMBT. Methods A retrospective analysis was conducted on the clinical data of children hospitalized due to gastrointestinal discomfort in the Department of Gastroenterology of Shanghai Children's Hospital from August 2021 to October 2022. According to the LHMBT results, the children were classified into the LHMBT positive group and the LHMBT negative group, and the clinical characteristics of the two groups were compared. Among them, 63 children underwent gastrointestinal endoscopy, and their endoscopic and histopathological characteristics were analyzed. Results A total of 124 children with gastrointestinal discomfort were included, including 62 boys and 62 girls, with a median age of 10.0 (7.5-12.7) years. LHMBT was positive in 85 (68.5%) children. Among them, the positive rate of SIBO was 24.2% (30/124), the positive rate of IMO was 63.7% (79/124), and the co-positive rate of SIBO and IMO was 19.4% (24/124). The age distribution between the LHMBT positive and negative groups was statistically significant (P<0.05). The proportion of those aged 12-18 years in the LHMBT positive group was relatively low. Among the gastrointestinal discomfort symptoms of the children, abdominal pain was the most common (67.7%, 84/124), followed by abdominal distension (25.0%, 31/124) and constipation (18.5%, 23/124). Compared with the LHMBT-negative group, the proportion of children with diarrhea in the LHMBT-positive group was lower, and the difference was statistically significant (P<0.05). Among the 63 children who underwent gastrointestinal endoscopy, villous blunting and crypt loss in the terminal ileum were more frequently observed in the LHMBT positive group (n=47) than that in the LHMBT negative group (n=16), and the difference was statistically significant (P<0.05). Conclusions The positive rate of LHMBT in children with gastrointestinal discomfort is high, and the incidence of IMO is higher than that of SIBO. LHMBT positivity might correlates with villous blunting and crypt loss in the terminal ileum.

Key words: lactulose hydrogen-methane breath test, small intestinal bacterial overgrowth, methanogenic bacterial overgrowth, gastrointestinal discomfort, child

CLC Number:

WANG Ruixue, WANG Runjie, LI Xiaolu, ZHANG Ting, XIAO Yongmei. Analysis of clinical characteristics, endoscopic and pathological manifestations of children with positive lactulose hydrogen-methane breath test[J].Journal of Clinical Pediatrics, 2025, 43(6): 418-425.

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References 34

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项目	LHMBT阴性组(n=39)	LHMBT阳性组(n=85)	统计量	P
男性[n(%)]	19(48.7)	43(50.6)	χ²=0.04	0.847
年龄[M(P₂₅~P₇₅)]/岁	11.1(7.7~13.5)	9.6(7.2~12.0)	Z=1.89	0.059
年龄分组[n(%)]			－	0.023¹⁾
>3~6岁	2(5.1)	13(15.3)
>6~12岁	18(46.2)	51(60.0)
>12~18岁	19(48.7)	21(24.7)
年龄别身高[M(P₂₅~P₇₅)]	0.84(－0.17~1.29)	0.61(－0.09~1.23)	Z=0.07	0.942
年龄别体重[M(P₂₅~P₇₅)]	0.02(－0.84~0.90)	0.06(－0.88~0.79)	Z=0.10	0.919
身高别体重[M(P₂₅~P₇₅)]	－0.55(－1.43~0.67)	－0.39(－1.69~0.55)	Z=0.25	0.804
25羟维生素D[n(%)]			χ²=0.53	0.764
正常	8(20.5)	13(15.5)
不足/缺乏	19(48.7)	43(51.2)
未检测	12(30.8)	29(34.1)
有过敏史[n(%)]	19(48.7)	43(50.6)	χ²=0.04	0.847
消化道症状[n(%)]
食欲减退	1(2.6)	5(5.9)	－	0.664¹⁾
腹痛	30(76.9)	54(63.5)	χ²=2.20	0.138
腹泻	11(28.2)	8(9.4)	χ²=7.28	0.007
腹胀	6(15.4)	25(29.4)	χ²=2.81	0.094
便秘	4(10.3)	19(22.4)	χ²=2.59	0.108
恶心呕吐	6(15.4)	12(14.1)	χ²=0.04	0.852
胃肠镜检查[n(%)]	16(41.0)	47(55.3)	χ²=2.18	0.140
胃镜[n(%)]	24(61.5)	69(81.2)	χ²=5.50	0.019
肠镜[n(%)]	18(46.2)	53(62.4)	χ²=2.87	0.090

项目	LHMBT阴性组(n=16)	LHMBT阳性组(n=47)	统计量	P
十二指肠
内镜表现[n(%)]			－	0.130¹⁾
正常	7(43.8)	23(48.9)
炎症	9(56.2)	16(34.0)
浅溃疡	0(0)	8(17.0)
黏膜组织病理学特点
绒毛短平[n(%)]	4(25.0)	17(36.2)	χ²=0.67	0.413
隐窝减少[n(%)]	4(25.0)	13(27.7)	－	1.000¹⁾
黏膜急性活动性炎症[n(%)]	0(0)	5(10.6)	－	0.315¹⁾
嗜酸性粒细胞计数[M(P₂₅~P₇₅)]/HPF	6.5(4.0~11.5)	8.0(5.0~10.0)	Z=0.46	0.643
少量淋巴细胞、浆细胞浸润[n(%)]	16(100)	47(100)	－	－
淋巴组织增生[n(%)]	2(12.5)	4(8.5)	－	0.639¹⁾
淋巴滤泡形成[n(%)]	0(0)	0(0)	－	－
回肠末端
内镜表现[n(%)]			－	0.133¹⁾
正常	10(62.5)	16(34.0)
炎症	6(37.5)	29(61.7)
浅溃疡	0(0)	2(4.3)
黏膜组织病理学特点
绒毛短平[n(%)]	5(31.3)	29(61.7)	χ²=4.46	0.035
隐窝减少[n(%)]	7(43.8)	34(72.3)	χ²=4.29	0.038
黏膜急性活动性炎症[n(%)]	7(43.8)	12(25.5)	－	0.212¹⁾
嗜酸性粒细胞计数[M(P₂₅~P₇₅)]/HPF	10.0(8.0~15.0)	9.00(6.0~15.0)	Z=0.50	0.616
少量淋巴细胞、浆细胞浸润[n(%)]	16(100.0)	47(100.0)	－	－
淋巴组织增生[n(%)]	16(100.0)	43(91.5)	－	0.564¹⁾
淋巴滤泡形成[n(%)]	13(81.0)	30(63.8)	χ²=1.67	0.232

Analysis of clinical characteristics, endoscopic and pathological manifestations of children with positive lactulose hydrogen-methane breath test

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