Hydrogen breath test as a diagnostic tool
DOI:
https://doi.org/10.12775/QS.2024.18.53566Keywords
Hydrogen breath test, Carbohydrate malabsorption, Lactose malabsorption, Fructose malabsorption, SIBOAbstract
Introduction and Purpose:
Hydrogen breath tests serve the crucial purpose of evaluating the absorption of nutrients in the small intestine, particularly when carbohydrates are not properly absorbed, leading to bacterial overgrowth. These tests are non-invasive, cost-effective, and widely accessible diagnostic tools used to assess various gastrointestinal disorders. The objective of this review is to evaluate the effectiveness and methodology of Hydrogen breath testing (HBT).
State of knowledge:
The disposal of hydrogen gas is essential for maintaining efficient microbial fermentation processes in the gut. Hydrogenotrophic microbes, including acetogens, methanogenic archaea, and sulfate-reducing bacteria, are responsible for this process. Hydrogen breath tests, conducted with substrates like glucose and lactulose, aid in diagnosing conditions such as small intestinal bacterial overgrowth (SIBO), lactose and fructose intolerance, and other carbohydrate absorption disorders. These tests generate a large volume of data, which can be analyzed using data mining techniques to uncover new hypotheses.
Conclusions:
Hydrogen breath tests, using various substrates, are effective in diagnosing gastrointestinal disorders such as SIBO and carbohydrate malabsorption. They offer valuable insights into microbial processes in the gut and can inform individualized treatment strategies. However, careful consideration of contraindications and proper test administration protocols is essential for accurate diagnosis and interpretation of results.
References
Ghoshal UC. How to interpret hydrogen breath tests. J Neurogastroenterol Motil. 2011;17(3):312-7. https://doi.org/10.5056/jnm.2011.17.3.312
Levitt MD, Bond JH, Jr. Volume, composition, and source of intestinal gas. Gastroenterology. 1970;59(6):921-9. https://doi.org/10.1016/S0016-5085(19)33654-6
Nava GM, Carbonero F, Croix JA, Greenberg E, Gaskins HR. Abundance and diversity of mucosa-associated hydrogenotrophic microbes in the healthy human colon. ISME J. 2012;6(1):57-70. https://doi.org/10.1038/ismej.2011.90
Schwabe AD, Cozzetto FJ, Bennett LR, Mellinkoff SM. Estimation of fat absorption by monitoring of expired radioactive carbon dioxide after feeding a radioactive fat. Gastroenterology. 1962;42:285-91. https://doi.org/10.1016/S0016-5085(62)80027-4
Gasbarrini A, Corazza GR, Gasbarrini G, Montalto M, Di Stefano M, Basilisco G, et al. Methodology and indications of H2-breath testing in gastrointestinal diseases: the Rome Consensus Conference. Aliment Pharmacol Ther. 2009;29 Suppl 1:1-49. https://doi.org/10.1111/j.1365-2036.2009.03951.x
Pimentel M, Saad RJ, Long MD, Rao SSC. ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth. Am J Gastroenterol. 2020;115(2):165-78. https://doi.org/10.14309/ajg.0000000000000501
Oquendo MA, Baca-Garcia E, Artes-Rodriguez A, Perez-Cruz F, Galfalvy HC, Blasco-Fontecilla H, et al. Machine learning and data mining: strategies for hypothesis generation. Mol Psychiatry. 2012;17(10):956-9. https://doi.org/10.1038/mp.2011.173
Ledochowski M. Hydrogen Breath tests. Verlag Ledochowski. Innsbruck. 2008.
Wetzel K. H2-breath tests for medical research and clinical diagnosis. Fischer Analysen Instrumente GmbH (FAN). Leipzig. 2015.
Ghoshal UC, Ghoshal U, Das K, Misra A. Utility of hydrogen breath tests in diagnosis of small intestinal bacterial overgrowth in malabsorption syndrome and its relationship with oro-cecal transit time. Indian J Gastroenterol. 2006;25(1):6-10. PMID: 16567886.
Gupta D, Ghoshal UC, Misra A, Misra A, Choudhuri G, Singh K. Lactose intolerance in patients with irritable bowel syndrome from northern India: a case-control study. J Gastroenterol Hepatol. 2007;22(12):2261-5. https://doi.org/10.1111/j.1440-1746.2007.04986.x
Babu J, Kumar S, Babu P, Prasad JH, Ghoshal UC. Frequency of lactose malabsorption among healthy southern and northern Indian populations by genetic analysis and lactose hydrogen breath and tolerance tests. Am J Clin Nutr. 2009;91:140-6. https://doi.org/10.3945/ajcn.2009.27946
Hammer HF, Hammer J. Diarrhea Caused By Carbohydrate Malabsorption. Gastroenterol Clin North Am. 2012;41:611-27. https://doi.org/10.1016/j.gtc.2012.06.003
Brannon PM, Carpenter TO, Fernandez JR, et al. NIH consensus development conference statement: lactose intolerance and health. NIH Consens State Sci Statements. 2010;27:1-27. PMID: 20186234.
Kretchmer N. On the homology between human development and pediatrics. Pediatr Res. 1968;2:283-6. https://doi.org/10.1203/00006450-196807000-00007
Srinivasan R, Minocha A. When to suspect lactose intolerance; symptomatic, ethnic, and laboratory clues. Postgrad Med. 1998;104:109-23. https://doi.org/10.3810/pgm.1998.09.577
Zhao J, Fox M, Cong Y, et al. Lactose intolerance in patients with chronic functional diarrhoea: the role of small intestinal bacterial overgrowth. Aliment Pharmacol Ther. 2010;31:892-900. https://doi.org/10.1111/j.1365-2036.2010.04252.x
Kuokkanen M, Kokkonen J, Enattah NS, Ylisaukko-Oja T, Komu H, Varilo T, et al. Mutations in the Translated Region of the Lactase Gene (LCT) Underlie Congenital Lactase Deficiency. Am J Hum Genet. 2006;78:339-44. https://doi.org/10.1086/500053
Suarez FL, Savaiano DA, Levitt MD. A comparison of symptoms after the consumption of milk or lactose-hydrolyzed milk by people with self-reported severe lactose intolerance. N Engl J Med. 1995;333:1-4. https://doi.org/10.1056/nejm199507063330101
Vesa TH, Korpela RA, Sahi T. Tolerance to small amounts of lactose in lactose maldigesters. Am J Clin Nutr. 1996;64:197-201. https://doi.org/10.1093/ajcn/64.2.197
Vesa TH, Seppo LM, Marteau PR, et al. Role of irritable bowel syndrome in subjective lactose intolerance. Am J Clin Nutr. 1998;67:710-5. https://doi.org/10.1093/ajcn/67.4.710
Simrén M, Stotzer PO. Use and abuse of hydrogen breath tests. Gut. 2006;55:297-303. https://doi.org/10.1136/gut.2005.075127
Putkonen L, Yao CK, Gibson PR. Fructose malabsorption syndrome. Curr Opin Clin Nutr Metab Care. 2013;16:473-7. https://doi.org/10.1097/MCO.0b013e328361c556
Rumessen JJ. Fructose and related food carbohydrates. Sources, intake, absorption, and clinical implications. Scand J Gastroenterol. 1992;27:819-28. https://doi.org/10.3109/00365529209000148
Eisenmann A, Amann A, Said M, et al. Implementation and interpretation of hydrogen breath tests. J Breath Res. 2008;2:1752-5. https://doi.org/10.1088/1752-7155/2/4/046002
Rumessen JJ, Gudmand-Hoyer E. Absorption capacity of fructose in healthy adults. Comparison with sucrose and its constituent monosaccharides. Gut. 1986;27:1161-8. https://doi.org/10.1136/gut.27.10.1161
Truswell AS, Seach JM, Thorburn AW. Incomplete absorption of pure fructose in healthy subjects and the facilitating effect of glucose. Am J Clin Nutr. 1988;48:1424-30. https://doi.org/10.1093/ajcn/48.6.1424
Ghoshal UC, Kumar S, Mehrotra M, Lakshmi C, Misra A. Frequency of small intestinal bacterial overgrowth in patients with irritable bowel syndrome and chronic non-specific diarrhea. J Neurogastroenterol Motil. 2010;16:40-6. https://doi.org/10.5056/jnm.2010.16.1.40
Rezaie A, Buresi M, Lembo A, Lin H, McCallum R, Rao S, Schmulson M, Valdovinos M, Zakko S, Pimentel M. Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus. Am J Gastroenterol. 2017;112:775-84. https://doi.org/10.1038/ajg.2017.46
Wilder-Smith CH, Materna A, Wermelinger C, Schuler J. Fructose and lactose intolerance and malabsorption testing: The relationship with symptoms in functional gastrointestinal disorders. Aliment Pharmacol Ther. 2013;37:1074-83. https://doi.org/10.1111/apt.12306
Rao SS, Attaluri A, Anderson L, Stumbo P. Ability of the normal human small intestine to absorb fructose: Evaluation by breath testing. Clin Gastroenterol Hepatol. 2007;5:959-63. https://doi.org/10.1016/j.cgh.2007.04.008
Yao CK, Tuck CJ, Barrett JS, Canale KE, Philpott HL, Gibson PR. Poor reproducibility of breath hydrogen testing: Implications for its application in functional bowel disorders. United Eur Gastroenterol J. 2017;5:284-92. https://doi.org/10.1177/2050640616657978
Rezaie A, Pimentel M, Rao SS. How to test and treat small intestinal bacterial overgrowth: an evidence-based approach. Curr Gastroenterol Rep. 2016;18:8. https://doi.org/10.1007/s11894-015-0482-9
Quigley EM, Abu-Shanab A. Small intestinal bacterial overgrowth. Infect Dis Clin North Am. 2010;24:943-59. https://doi.org/10.1016/j.idc.2010.07.007
Daniluk J. Management of Small Intestinal Bacterial Overgrowth Syndrome. A Discussion of the 2020 American College of Gastroenterology Guidelines. Med Prakt. 2020;9:39-47. Polish.
Jabłkowski M, Białkowska-Warzecha J, Jabłkowska A. Small intestine bacterial overgrowth – SIBO. How to diagnose and treat it in the practice of the family physician according to new guidelines. Lekarz POZ. 2022;8(1):24-36. Polish.
Rana SV, Sharma S, Kaur J, Sinha SK, Singh K. Comparison of lactulose and glucose breath test for diagnosis of small intestinal bacterial overgrowth in patients with irritable bowel syndrome. Digestion. 2012;85:243-7. https://doi.org/10.1159/000336174
Pimentel M, Chow EJ, Lin HC. Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome: a double-blind, randomized, placebo-controlled study. Am J Gastroenterol. 2003;98:412-9. https://doi.org/10.1016/S0002-9270(02)05902-6
Pimentel M, Chow EJ, Lin HC. Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol. 2000;95:3503-6. https://doi.org/10.1016/S0002-9270(00)02161-4
Posserud I, Stotzer PO, Björnsson ES, Abrahamsson H, Simrén M. Small intestinal bacterial overgrowth in patients with irritable bowel syndrome. Gut. 2007;56:802-8. https://doi.org/10.1136/gut.2006.108712
Walters B, Vanner SJ. Detection of bacterial overgrowth in IBS using the lactulose H breath test: comparison with C-D-xylose and healthy controls. Am J Gastroenterol. 2005;100:1566-70.
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Copyright (c) 2024 Natalia Zozula, Zuzanna Tomczewska, Aleksandra Rykucka, Marcin Wąs, Aleksandra Latała, Justyna Kiełbasa, Agata Kowalczyk, Katarzyna Bil, Iga Ślesicka, Magda Przestrzelska
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