Hydrogen and Methane Breath Test in the Diagnosis of Lactose Intolerance

Charlotte De Geyter,Bruno Hauser,Kris Van De Maele,Yvan Vandenplas

doi:10.3390/nu13093261

Abstract

The hydrogen (H2) breath test is a non-invasive investigation used to diagnose lactose intolerance (LI). Patients with LI may also expire increased amounts of methane (CH4) during a lactose test. The aim of this study is to evaluate the contribution of CH4 measurements. We tested 209 children (1–17 years old) with symptoms suggesting LI with lactose H2 and CH4 breath tests. The result was positive when the H2 excretion exceeded 20 parts per million (ppm) and the CH4 was 10 ppm above the baseline. A clinician, blinded for the results of the breath test, registered the symptoms. Of the patient population, 101/209 (48%) were negative for both H2 and CH4; 96/209 (46%) had a positive H2 breath test result; 31/96 (32%) were also positive for CH4; 12/209 (6%) patients were only positive for CH4. The majority of hydrogen producers showed symptoms, whereas this was only the case in half of the H2-negative CH4 producers. Almost all patients treated with a lactose-poor diet reported significant symptom improvement. These results indicate that CH4 measurements may possibly be of additional value for the diagnosis of LI, since 5.7% of patients were negative for H2 and positive for CH4, and half of them experienced symptoms during the test.

Highlights

Lactose intolerance is defined as the occurrence of symptoms such as abdominal pain, bloating, and diarrhea after the ingestion of lactose in patients with lactose malabsorption. congenital and secondary lactase deficiencies occur, most children suffer from a “primary late onset” [1] or “adult type” lactase deficiency due to the non-persistence of the enzyme lactase-phlorizin hydrolase after childhood [2].Adequate amounts of lactase, present in the villi of the small intestinal brush border, are required for the digestion of lactose
Lactose is metabolized into carbon dioxide, methane (CH4 ), propionic and butyric acids, and hydrogen (H2 )
Almost all (53/56) children in our study indicated fewer gastrointestinal complaints when on a lactose-free diet, suggesting that they likely did suffer from lactose intolerance

Summary

Introduction

Lactose intolerance is defined as the occurrence of symptoms such as abdominal pain, bloating, and diarrhea after the ingestion of lactose in patients with lactose malabsorption. congenital and secondary lactase deficiencies occur, most children suffer from a “primary late onset” [1] or “adult type” lactase deficiency due to the non-persistence of the enzyme lactase-phlorizin hydrolase after childhood [2].Adequate amounts of lactase, present in the villi of the small intestinal brush border, are required for the digestion of lactose. Lactose intolerance is defined as the occurrence of symptoms such as abdominal pain, bloating, and diarrhea after the ingestion of lactose in patients with lactose malabsorption. Lactose is metabolized into carbon dioxide (leading to bloating), methane (CH4 ), propionic and butyric acids (short-chain fatty acids, leading to osmotic diarrhea), and hydrogen (H2 ). Gasses such as H2 and CH4 accumulate in the intestine, and pass through the intestinal wall into the bloodstream and are transported to the lungs, where they are excreted in the exhaled breath [3]. A threshold of 3 ppm was proposed [27]. It was stated that patients usually produce either H2 or CH4 , and only rarely produce both [25]

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