Open AccessMicrobiota stability in healthy individuals after single-dose lactulose challenge—A randomized controlled study
Author(s) -
Sandra Y. Wotzka,
Markus Kreuzer,
Lisa Maier,
Mirjam Zünd,
Markus C. Schlumberger,
Bidong D. Nguyen,
Mark Fox,
Daniel Pohl,
Henriette Heinrich,
Gerhard Rogler,
Luc Biedermann,
Michael Scharl,
Shinichi Sunagawa,
WolfDietrich Hardt,
Benjamin Misselwitz
Publication year - 2018
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0206214
Subject(s) - lactulose , ingestion , feces , food science , microbiology and biotechnology , diarrhea , medicine , hepatic encephalopathy , biology , gastroenterology , cirrhosis
Background and aims Lactulose is a common food ingredient and widely used as a treatment for constipation or hepatic encephalopathy and a substrate for hydrogen breath tests. Lactulose is fermented by the colon microbiota resulting in the production of hydrogen (H 2 ). H 2 is a substrate for enteropathogens including Salmonella Typhimurium ( S . Typhimurium) and increased H 2 production upon lactulose ingestion might favor the growth of H 2 -consuming enteropathogens. We aimed to analyze effects of single-dose lactulose ingestion on the growth of intrinsic Escherichia coli ( E . coli ), which can be efficiently quantified by plating and which share most metabolic requirements with S . Typhimurium. Methods 32 healthy volunteers (18 females, 14 males) were recruited. Participants were randomized for single-dose ingestion of 50 g lactulose or 50 g sucrose (controls). After ingestion, H 2 in expiratory air and symptoms were recorded. Stool samples were acquired at days -1, 1 and 14. We analyzed 16S microbiota composition and abundance and characteristics of E . coli isolates. Results Lactulose ingestion resulted in diarrhea in 14/17 individuals. In 14/17 individuals, H 2 -levels in expiratory air increased by ≥20 ppm within 3 hours after lactulose challenge. H 2 -levels correlated with the number of defecations within 6 hours. E . coli was detectable in feces of all subjects (2 x 10 2 –10 9 CFU/g). However, the number of E . coli colony forming units (CFU) on selective media did not differ between any time point before or after challenge with sucrose or lactulose. The microbiota composition also remained stable upon lactulose exposure. Conclusion Ingestion of a single dose of 50 g lactulose does not significantly alter E . coli density in stool samples of healthy volunteers. 50 g lactulose therefore seems unlikely to sufficiently alter growth conditions in the intestine for a significant predisposition to infection with H 2 -consuming enteropathogens such as S . Typhimurium ( www.clinicaltrials.gov NCT02397512 ).