Abstract
The measurement of hydrogen–methane breath gases is widely used in gastroenterology to evaluate malabsorption syndromes and bacterial overgrowth. Laboratories offering breath testing provide variable guidance regarding oral hygiene practices prior to testing. Given that oral dysbiosis has the potential to cause changes in breath gases, it raises concerns that oral hygiene is not a standard inclusion in current breath testing guidelines. The aim of this study was to determine how a pre-test mouthwash may impact hydrogen–methane breath test results. Participants presenting for breath testing who had elevated baseline gases were given a chlorhexidine mouthwash. If a substantial reduction in expired hydrogen or methane occurred after the mouthwash, breath samples were collected before and after a mouthwash at all breath sample collection points for the duration of testing. Data were evaluated to determine how the mouthwash might influence test results and diagnostic status. In 388 consecutive hydrogen–methane breath tests, modifiable elevations occurred in 24.7%. Administration of a chlorhexidine mouthwash resulted in significantly (p ≤ 0.05) reduced breath hydrogen in 67% and/or methane gas in 93% of those consenting to inclusion. In some cases, this modified the diagnosis. Mean total gas concentrations pre- and post-mouthwash were 221.0 ppm and 152.1 ppm (p < 0.0001) for hydrogen, and 368.9 ppm and 249.8 ppm (p < 0.0001) for methane. Data suggest that a single mouthwash at baseline has a high probability of returning a false positive diagnosis. Variations in gas production due to oral hygiene practices has significant impacts on test interpretation and the subsequent diagnosis. The role of oral dysbiosis in causing gastrointestinal symptoms also demands exploration as it may be an underlying factor in the presenting condition that was the basis for the referral.
Highlights
The measurement of hydrogen–methane breath gases is widely used in gastroenterology to evaluate malabsorption syndromes and bacterial overgrowth
After collection of a baseline breath sample, the challenge substrate is administered, and subsequent samples of breath are collected at pre-determined intervals for the duration of the test period
Subjects Adult patients (≥ 18 years of age), presenting for hydrogen–methane breath testing for saccharide malabsorption or determination of likelihood of small intestinal bacterial overgrowth (SIBO) were screened for adherence to test preparation, including non-smoking, avoidance of exercise and compliance with a 1-day low residue diet excluding all foods except white rice, fish, chicken, eggs, white bread, clear broths and plain black tea or coffee
Summary
The measurement of hydrogen–methane breath gases is widely used in gastroenterology to evaluate malabsorption syndromes and bacterial overgrowth. Administration of a chlorhexidine mouthwash resulted in significantly (p ≤ 0.05) reduced breath hydrogen in 67% and/or methane gas in 93% of those consenting to inclusion. In some cases, this modified the diagnosis. Increases in expired breath gases in response to ingestion of non-digestible lactulose, or glucose are used to predict small intestinal bacterial overgrowth (SIBO)[1,2,3,4]. After collection of a baseline breath sample, the challenge substrate (usually lactulose, glucose, fructose, or lactose) is administered, and subsequent samples of breath are collected at pre-determined intervals for the duration of the test period.
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