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A link between irritable bowel syndrome and fibromyalgia
      03/30/04 01:46 PM
HeatherAdministrator

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A link between irritable bowel syndrome and fibromyalgia

An abnormal lactulose breath test (LBT), indicative of small intestinal bacterial overgrowth, in fibromyalgia patients and in irritable bowel syndrome (IBS) patients may help to explain common features of the conditions, researchers report in the April issue of the Annals of the Rheumatic Diseases.

Dr. Mark Pimentel from Cedars-Sinai Medical Center, Los Angeles, California and colleagues note that nearly a third of fibromyalgia patients in some studies are also diagnosed with IBS, suggesting a causal link between the two disorders.

The researchers tested their hypothesis that the lactulose breath test would be abnormal in both IBS and fibromyalgia by performing the test in 42 fibromyalgia patients, 111 IBS patients, and 15 healthy controls.

All 42 patients with fibromyalgia had an abnormal LBT, compared with 93 (84%) of IBS patients and 3 (20%) of the controls.

Hydrogen production was significantly greater in fibromyalgia patients than in IBS patients or healthy controls. Moreover, the researchers note that in 41 fibromyalgia patients, there was a significant correlation between their visual analogue pain score and the peak hydrogen level and hydrogen area under the curve seen on the LBT.

"The additional finding in our study that the degree of pain in fibromyalgia seems to correlate with the degree of hydrogen suggests a possible link between the LBT findings and hyperalgesia," the investigators write.

"This study suggests that an abnormal LBT may be a common link between subjects with fibromyalgia and IBS," the authors conclude. "Further study is needed to determine if treatment and normalization of the breath test with antibiotic treatment can produce an improvement in fibromyalgia in addition to bowel complaints."

Ann Rheum Dis 2004;63:450-452.

http://www.medscape.com/viewarticle/472635



A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing

M Pimentel, D Wallace, D Hallegua, E Chow, Y Kong, S Park and H C Lin

GI Motility Program, Divisions of Gastroenterology and Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, CSMC Burns & Allen Research Institute, Los Angeles, California 90048, School of Medicine, University of California, Los Angeles, Los Angeles, California 90024, USA


Correspondence to:
Dr M Pimentel
Cedars-Sinai Medical Center, 8635 W 3rd St, Suite 770 W, Los Angeles, CA 90048, USA; mark.pimentel@cshs.org


ABSTRACT
Background: An association between irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO) has been found.

Objective: To compare the prevalence and test results for bacterial overgrowth between IBS and fibromyalgia.

Methods: Subjects with independent fibromyalgia and IBS were compared with controls in a double blind study. Participants completed a questionnaire, and a lactulose hydrogen breath test was used to determine the presence of SIBO. The prevalence of an abnormal breath test was compared between study participants. Hydrogen production on the breath test was compared between subjects with IBS and fibromyalgia. The somatic pain visual analogue score of subjects with fibromyalgia was compared with their degree of hydrogen production.

Results: 3/15 (20%) controls had an abnormal breath test compared with 93/111 (84%) subjects with IBS (p<0.01) and 42/42 (100%) with fibromyalgia (p<0.0001 v controls, p<0.05 v IBS). Subjects with fibromyalgia had higher hydrogen profiles (p<0.01), peak hydrogen (p<0.0001), and area under the curve (p<0.01) than subjects with IBS. This was not dependent on the higher prevalence of an abnormal breath test. The degree of somatic pain in fibromyalgia correlated significantly with the hydrogen level seen on the breath test (r = 0.42, p<0.01).

Conclusions: An abnormal lactulose breath test is more common in fibromyalgia than IBS. In contrast with IBS, the degree of abnormality on breath test is greater in subjects with fibromyalgia and correlates with somatic pain.

http://ard.bmjjournals.com/cgi/content/abstract/63/4/450

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