W1834 Small Bowel Bacterial Overgrowth in Symptomatic Children – An Under-Diagnosed Disorder? (original) (raw)
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Lactulose Hydrogen Breath Test and Functional Symptoms in Pediatric Patients
Digestive Diseases and Sciences, 2012
Background The role of small intestinal bacterial overgrowth (SIBO) in functional digestive disorders in the pediatric population is a matter of controversy, since methods currently used to establish this diagnosis are difficult to interpret. The aim of this work was to analyze the characteristics of the lactulose H 2 breath test (LHBT) in children with functional gastrointestinal symptoms according to more recent criteria. Methods Seventy-two patients and 17 controls were enrolled. A questionnaire was administered regarding digestive symptoms (abdominal pain, bloating, vomiting, and bowel-movement disorders). A lactose hydrogen breath test was performed to rule out lactose malabsorption and a LHBT was used to measure the time elapsed between lactulose oral ingestion and an increment of H 2 concentration of 20 ppm over basal. Results There were no differences of age and gender between patients and controls. Mean time to 20-ppm change was shorter in patients (56.3 ± 3 min) compared to healthy children (74.7 ± 5 min), p \ 0.05. In 39% of patients, rise of H 2 occurred during the first 40 min after lactulose ingestion, and in almost all controls, an increment was observed between 50 and 90 min (p \ 0.05). Symptoms were unrelated to time to 20-ppm change. Conclusions An abnormal LHBT was found in children with functional symptoms of the digestive tract, but the exact mechanism involved, accelerated intestinal transit or SIBO, needs to be confirmed by an additional method.
The American journal of gastroenterology, 2017
Breath tests (BTs) are important for the diagnosis of carbohydrate maldigestion syndromes and small intestinal bacterial overgrowth (SIBO). However, standardization is lacking regarding indications for testing, test methodology and interpretation of results. A consensus meeting of experts was convened to develop guidelines for clinicians and research. Pre-meeting survey questions encompassing five domains; indications, preparation, performance, interpretation of results, and knowledge gaps, were sent to 17 clinician-scientists, and 10 attended a live meeting. Using an evidence-based approach, 28 statements were finalized and voted on anonymously by a working group of specialists. Consensus was reached on 26 statements encompassing all five domains. Consensus doses for lactulose, glucose, fructose and lactose BT were 10, 75, 25 and 25 g, respectively. Glucose and lactulose BTs remain the least invasive alternatives to diagnose SIBO. BT is useful in the diagnosis of carbohydrate maldi...
Carbohydrate malabsorption in infants with diarrhea studied with the breath hydrogen test
The Journal of Pediatrics, 1983
Fermentation of malabsorbed carbohydrate (CHO) reaching the colon was studied by measuring peak breath hydrogen (He) production between feedings in 28 He-producing hospitalized infants with diarrhea. Patients who required fewer than six days of hospitalization had lower breath ~ values when tested soon after admission than those who required longer stays. Patients hospitalized for more than five days had lower H2 amounts at discharge than on admission. Peak breath H2 values decreased when glucose was substituted for glucose polymers in formulas, or when the formula was fed by continuous drip via a nasogastric tube instead of by orally administered bolus. Glucose-positive and acidic stools were encountered occasionally and were associated with decreased He levels. The responses of 112 levels, stool pH, and glucose excretion after changes in patient management or intestinal metabolism of CHO reflect alterations in the balance between proximal intestinal absorption and distal colonic fermentation. Malabsorbed CHO that reaches a competent colon is utilized via microbial conversion, as indicated by high H2 levels, in the absence of glucose-positive and acidic stools. The presence of glucose in the feces or acidic stools indicates an inability of the colon to completely metabolize and absorb ClIO or its products of fermentation. (J PEDIATR 102:371, 1983)
Digestive and Liver Disease, 2020
Background: Small intestinal bacterial overgrowth (SIBO) has been reported with varying prevalence, depending upon the criteria used for diagnosis. Lactulose and glucose breath tests are the most used in clinical settings. Early rises of hydrogen excretion during a lactose breath test suggest SIBO, but the finding could result from accelerated mouth-to-caecum transit time. Aims: Defining the prevalence of early hydrogen peaks during lactose breath tests and assessing the proportion of patients affected by SIBO. Methods: An early (≤ 60) hydrogen excretion peak was observed in 120/663 patients with positive lactose hydrogen breath test. Eighty-one of them underwent a 50 g-9sample-glucose hydrogen breath test to diagnose SIBO. Results: The glucose breath test proved positive in 11/81 (13.6%) patients. The positivity rate was 18.2% (2/11) in those with the first peak detected at 30 and 12.8% (9/70) in those with the peak occurring at 60. Conclusions: Early hydrogen excretion peaks are rarely associated with SIBO. The low positive predictive value indicates that the finding does not help identifying patients at high risk for this condition. Indirectly, the present data support the opinion that the prevalence of SIBO diagnosed by standard lactulose breath tests is much lower than reported, and the reliability of the test is low.
Hydrogen Breath Tests: Are They Really Useful in the Nutritional Management of Digestive Disease?
Nutrients
Background: Carbohydrate malabsorption is a frequent digestive problem associated with abdominal pain, bloating and diarrhea. Hydrogen breath testing (BT) represents the most reliable and validated diagnostic technique. The aim of this manuscript was to clarify the usefulness of BTs in the nutritional management of these disorders. Methods: A literature search for BT related to carbohydrate malabsorption was carried out using the online databases of Pubmed, Medline and Cochrane. Results: Lactose BT showed good sensitivity and optimal specificity for lactose malabsorption. However, an accurate diagnosis of lactose intolerance should require blind lactose challenge although this method is difficult to utilize in clinical practice. Regarding dose-depending fructose and sorbitol malabsorption, BTs could not add diagnostic advantage compared with a direct dietary intervention. In addition, carbohydrates are fundamental components of fermentable oligo-, di- and monosaccharides and polyols...
Journal of Paediatrics and Child Health, 2000
Objective: To assess the validity and clinical application of a hand-held breath hydrogen (H 2 ) analyzer (BreatH2, Europa Scientific, Crewe, UK). Methodology: Breath samples of patients referred to the Gastroenterology Unit, Women's and Children's Hospital, North Adelaide, South Australia, for confirmation of the diagnosis of carbohydrate malabsorption were analysed with the Quintron microlyzer (Quintron Instrument Co., Milwaukee, USA) and the BreatH2 analyser, using the Quintron microlyzer as the gold standard. Results: Twenty-nine breath H 2 tests (BHT) were performed in 29 patients aged 2 months to 61 years. The sensitivity and specificity of the BreatH2 analyser in detecting a positive BHT using the Quintron microlyser as the gold standard were 0.90 and 0.95 with positive and negative predictive values of 0.90 and 0.95, respectively. There was one false positive and one false negative reading. Bland-Altman plots showed a high degree of agreement between the values obtained with two different methods. Conclusions: The diagnosis of carbohydrate malabsorption, using a portable breath H 2 analyser (BreatH2), achieved an acceptable degree of sensitivity and specificity, enabling it to be used where no alternative is available.
United European Gastroenterology Journal, 2021
IntroductionMeasurement of breath hydrogen (H2) and methane (CH4) excretion after ingestion of test‐carbohydrates is used for different diagnostic purposes. There is a lack of standardization among centers performing these tests and this, together with recent technical developments and evidence from clinical studies, highlight the need for a European guideline.MethodsThis consensus‐based clinical practice guideline defines the clinical indications, performance, and interpretation of H2‐CH4‐breath tests in adult and pediatric patients. A balance between scientific evidence and clinical experience was achieved by a Delphi consensus that involved 44 experts from 18 European countries. Eighty eight statements and recommendations were drafted based on a review of the literature. Consensus (≥80% agreement) was reached for 82. Quality of evidence was evaluated using validated criteria.ResultsThe guideline incorporates new insights into the role of symptom assessment to diagnose carbohydrat...
Pediatric Research, 1978
We have applied the gas chromatographic analysis of hydrogen (HZ) in expired air to the determination of carbohvdrate malabsorption in children. A compact, inexpensive, a& simple gas chromatograph was specifically adapted to the measurement of low concentration of HZ. A collection procedure using the sampling of expired air at evenly spaced intervals with a low resistance facemask was used to obviate the need for closed, continuous rebreathing systems of breath collection. Under different experimental conditions, HZ concentrations ranged from 11-166 ppm. During fasting, however, Hz concentrations in preschool children were extraordinarily stable and uniform. The velocity of HZ excretion from graded doses of 1.5, 3, and 6 g of the nonabsorbable disaccharide, lactulose, was linear with a response of 1.2 cc Hz/2 hr/g nonabsorbed carbohydrate. Formal clinical lactose tolerance tests were devised using the oral administration of 1.75 g lactose/kg body weight. The increase in HZ concentration was compared with the rise in plasma glucose. Maximum increases in Hz concentration of less than 15 ppm
Food & Function, 2012
The measurement of hydrogen in exhaled breath is widely accepted as a non-invasive yet efficient means to evaluate carbohydrate malabsorption. Hydrogen is not normally produced by mammalian cells and its appearance in breath indicates incomplete small intestinal carbohydrate absorption with subsequent breakdown of the carbohydrate by anaerobic bacteria in the colon. This study was undertaken to evaluate the absorption of a novel, slowly digestible carbohydrate sweetener, sucromalt. Two experiments occurred approximately 2 weeks apart with the participants randomly consuming one of two test foods on each visit. Following baseline breath hydrogen measurements, healthy 8-10 year-old children (n ¼ 10) consumed a yogurt breakfast containing either 15 g of inulin (positive control) or 30 g of sucromalt. Every 15 min during the next 6 h, samples of exhaled breath were taken from each participant for hydrogen content analysis, thereby establishing 24 total data points. Participants' 6 h breath hydrogen responses were plotted against their baseline measurement and appropriate statistical evaluations were applied to the data. Following ingestion of inulin, breath hydrogen stayed near baseline for approximately 2 h but rose rapidly thereafter to a steady state of 20-30 ppm, which continued to the end of the study period. In contrast, exhaled hydrogen following sucromalt ingestion remained at or near baseline for the entire 6 h test period. A significantly higher level of hydrogen was exhaled with inulin ingestion compared to sucromalt (incremental area under the curve, p ¼ 0.002). Results indicated complete absorption of sucromalt's saccharide constituents in children.
Revista de gastroenterología de México, 2012
Background: There is growing evidence that gut flora plays a role in the development of Irritable Bowel Syndrome (IBS). Abdominal bloating is a common symptom in these patients and the severity of this symptom could be related to the variations in their fermentative profiles, obtained by measuring the levels of breath hydrogen excretion after lactulose ingestion. Aims: Our objective was to determine the difference in abdominal bloating severity between IBS patients with high vs low levels of breath hydrogen excretion after lactulose administration. Methods: Lactulose breath tests were carried out on IBS patients in our institution between July 2009 and August 2010. Patients were requested to fill out a validated questionnaire to assess the severity of their symptoms. Abdominal bloating severity score was compared among patients with high and low breath hydrogen levels. Results: A total of 234 patients were enrolled. There was a statistically significant difference in the abdominal bloating severity score between groups: 7.0 (5.7-8.0) vs 6.5 (5.0-7.5), p=0.001. The comparison among IBS patients with constipation (IBS-C) in both groups also showed a statistically significant difference: 7.5 (6.0-8.5) vs 5.8 (3.5-7.2), p=0.0051. Conclusions: Those patients with a low level of breath hydrogen excretion after lactulose ingestion presented with significantly greater abdominal bloating than those with a high level of breath hydrogen excretion.