Breath Hydrogen Concentration Research Articles

Gut fermentation seems to promote decompression sickness in humans.

Massive bubble formation after diving can lead to decompression sickness (DCS) that can result in neurological disorders. In experimental dives using hydrogen as the diluent gas, decreasing the body's H2 burden by inoculating hydrogen-metabolizing microbes into the gut reduces the risk of DCS. In contrast, we have shown that gut bacterial fermentation in rats on a standard diet promotes DCS through endogenous hydrogen production. Therefore, we set out to test these experimental results in humans. Thirty-nine divers admitted into our hyperbaric center with neurological DCS (Affected Divers) were compared with 39 healthy divers (Unaffected Divers). Their last meal time and composition were recorded. Gut fermentation rate was estimated by measuring breath hydrogen 1-4 h after the dive. Breath hydrogen concentrations were significantly higher in Affected Divers (15 ppm [6-23] vs. 7 ppm [3-12]; P = 0.0078). With the use of a threshold value of 16.5 ppm, specificity was 87% [95% confidence interval (CI) 73-95] for association with neurological DCS onset. We observed a strong association between hydrogen values above this threshold and an accident occurrence (odds ratio = 5.3, 95% CI 1.8-15.7, P = 0.0025). However, high fermentation potential foodstuffs consumption was not different between Affected and Unaffected Divers. Gut fermentation rate at dive time seemed to be higher in Affected Divers. Hydrogen generated by fermentation diffuses throughout the body and could increase DCS risk. Prevention could be helped by excluding divers who are showing a high fermentation rate, by eliminating gas produced in gut, or even by modifying intestinal microbiota to reduce fermentation rate during a dive.

Resection of the large bowel suppresses hunger and food intake and modulates gastrointestinal fermentation.

To assess appetite and gut hormone levels in patients following partial (PR) or total resection (TR) of the large bowel. A comparative cross sectional study was carried out with healthy controls (n = 99) and patients who had undergone PR (n = 64) or TR (n = 12) of the large bowel. Participants consumed a standard (720 kcal) breakfast meal at 0830 (t = 0) h followed by lactulose (15 g) and a buffet lunch (t = 210 min). Participants rated the subjective feelings of hunger at t = -30, 0, 30, 60, 120, and 180 min. Breath hydrogen (BH) concentrations were also evaluated. In a matched subset (11 controls, 11 PR and 9 TR patients) PYY and GLP-1 concentrations were measured following breakfast. The primary outcome measure was appetite, as measured using visual analogue scales and the buffet lunch. The secondary outcome was BH concentrations following a test meal. PR and TR participants had lower hunger and energy intake at the buffet lunch meal compared to controls. PR subjects had higher BH concentrations compared to controls and TR subjects. BH levels correlated with circulating GLP-1 levels at specific time points. PR or TR of the large bowel reduced feelings of hunger and energy intake, and PR increased gastrointestinal fermentation.

Hydrogen excretion in pediatric lactose malabsorbers: relation to symptoms and the dose of lactose.

IntroductionLactose malabsorption arises from lactase deficiency and may lead to lactose intolerance – gastrointestinal symptoms after lactose ingestion. Occurrence and severity of the symptoms are influenced by many factors, including the dose of lactose and the intensity of its colonic fermentation to short chain fatty acids and gases.Material and methodsThe hydrogen breath test (HBT) after 30 g or 50 g of lactose was performed in 387 children. Further analysis included children who had a positive HBT result. The HBT parameters were net hydrogen concentration in each breath and total net hydrogen concentration during the HBT. The time of the first hydrogen rise was also calculated. HBT parameters were analyzed according to symptoms occurrence (lack or present), symptoms severity (lack, moderate or severe) and the dose of lactose (30 g or 50 g).ResultsOne hundred and six children (12.1 years, 46 boys) had a positive HBT result. Symptoms occurrence was positively related to net hydrogen concentration at 30 min, 60 min and 90 min (p < 0.001 at each time point), as well as to the total net hydrogen concentration (p < 0.001). There were no differences in hydrogen excretion between subjects with moderate and severe symptoms after lactose ingestion. Symptoms were more frequent in subjects given 50 g of lactose than in those given 30 g of lactose (79% vs. 47%, p = 0.003). In both dose groups symptoms occurrence was related to hydrogen excretion.ConclusionsSymptoms occurrence is closely related to hydrogen excretion and to the dose of ingested lactose.

Small Intestinal Bacterial Overgrowth in Patients with Refractory Functional Gastrointestinal Disorders.

Background/AimsSmall intestinal bacterial overgrowth (SIBO) is considered to be involved in the pathogenesis of functional gastrointestinal disorders (FGID). However, the prevalence and clinical conditions of SIBO in patients with FGID remain to be fully elucidated. Here, we examined the frequency of SIBO in patients with refractory FGID.MethodsWe prospectively enrolled patients with refractory FGID based on Rome III criteria. A glucose hydrogen breath test (GHBT) was performed using a gas analyzer after an overnight fast, with breath hydrogen concentration measured at baseline and every 15 minutes after administration of glucose for a total of 3 hours. A peak hydrogen value ≥ 10 ppm above the basal value between 60 and 120 minutes after administration of glucose was diagnosed as SIBO.ResultsA total of 38 FGID patients, including 11 with functional dyspepsia (FD), 10 with irritable bowel syndrome (IBS), and 17 with overlapping with FD and IBS, were enrolled. Of those, 2 (5.3%) were diagnosed with SIBO (one patient diagnosed with FD; the other with overlapping FD and IBS). Their symptoms were clearly improved and breath hydrogen levels decreased to normal following levofloxacin administration for 7 days.ConclusionsTwo patients initially diagnosed with FD and IBS were also diagnosed with SIBO as assessed by GHBT. Although the frequency of SIBO is low among patients with FGID, it may be important to be aware of SIBO as differential diagnosis when examining patients with refractory gastrointestinal symptoms, especially bloating, as a part of routine clinical care.

Comparison of ALT Levels and BMI in Patients with Chronic Hepatitis B and Non Alcoholic Steatohepatitis

(NAFLD) is a common chronic liver disease that occurs due to accumulation of fat in liver. The disease is commonly associated with obesity, but prevalence of NAFLD is increasing in non-obese Indian population nowadays. It is postulated that insulin resistance, small bowel bacterial overgrowth, increased intestinal permeability and low-grade endotoxemia may be responsible for steatosis and pathogenesis of NAFLD. The present study was undertaken to evaluate SIBO, endotoxemia and insulin resistance in lean and obese NAFLD patients. Methodology: The prevalence of SIBO was determined using the glucose hydrogen breath test (GHBT). The SIBO was diagnosed positive if the fasting breath hydrogen (H2) concentration was >20 ppm or there was increase of H2 levels >12 ppm over the baseline following ingestion of glucose. The lipopolysaccharide (LPS)-binding protein (LBP) was determined by ELISA. HOMA-IR that measures insulin resistance was assessed by taking fasting serum insulin and fasting blood glucose into consideration. Results: The prevalence of SIBO was determined by GHBT done in171 consecutive NAFLD patients and percentage prevalence was 20.5%. The NAFLD patients were further stratified to groups BMI 25 and percentage prevalence was 4% ( 25 BMI, n = 29), respectively and 0% in disease control (CHB, n = 25) and healthy control (n = 16) group, respectively. The LBP is synthesized by hepatocytes and intestinal epithelial cells. Normal LBP serum concentrations are 5–10 mg/ml and may rise up to 200 mg/ml immediately during induction of an acute-phase response. We have observed LBP level within normal range and among the groups, the mean concentrations in the serum are as follows: 7.91 0.73 mg/ml ( 25 BMI, n = 8), 4.0 1.88 mg/ml (CHB, n = 6), 2.96 1.24 mg/ml (healthy, n = 5). As per IDF guidelines for metabolic syndrome, increased risks of insulin resistance (HOMA IR >1.6–2.5) are 32% ( 25 BMI, n = 29), 13% (CHB, n = 25) and 0% (Healthy, n = 16). The insulin resistant (HOMA IR >2.5) prevalence among groups are 24% ( 25 BMI, n = 29), 9% (CHB, n = 25) and 0% (Healthy, n = 16). Conclusion: We have observed higher prevalence of SIBO in >25 BMI NAFLD group than that of the <25 BMI group. There is also prevalence (3.5%) of methanogenic bacteria in NAFLD population. The LBPmay be considered as surrogate marker for SIBO in GHBT negative cases. Increased risk of insulin resistance was also observed in lean NAFLD patients when compared to obese NAFLD patients. Corresponding author: Baibaswata Nayak. E-mail: baibaswata@yahoo.com

Glucose hydrogen breath test for small intestinal bacterial overgrowth in children with abdominal pain-related functional gastrointestinal disorders.

A potential link between small intestinal bacterial overgrowth (SIBO) and abdominal pain-related functional gastrointestinal disorders (AP-FGID) has been suggested by symptom similarities and by the reported prevalence of SIBO in children with irritable bowel syndrome (IBS) and functional AP. The aim of this study is to evaluate the prevalence of SIBO using the glucose hydrogen breath test (GHBT), in a cohort of Dutch children with AP-FGID fulfilling the Rome III criteria, and to identify potential predictors. Children ages 6 to 18 years with AP-FGID fulfilling the Rome III criteria were included. All of the children underwent a GHBT. SIBO was diagnosed if the fasting breath hydrogen concentration was ≥20 ppm or an increase in H2 levels of ≥12 ppm above the baseline value was measured after ingestion of glucose. Gastrointestinal symptoms were collected using a standardised AP questionnaire. A total of 161 Dutch children with AP-FGID were enrolled. Twenty-three patients (14.3%) were diagnosed as having SIBO, as assessed by GHBT; 78% of the children diagnosed as having SIBO had fasting hydrogen levels ≥20 ppm. IBS was significantly more found in children with SIBO compared with children without SIBO (P = 0.001). An altered defecation pattern (ie, change in frequency or form of stool) (P = 0.013), loss of appetite (P = 0.007), and belching (P = 0.023) were significantly more found in children with SIBO compared with those without SIBO. SIBO is present in 14.3% of children presenting with AP-FGID. IBS, altered defecation pattern, loss of appetite, and belching were predictors for SIBO in children with AP-FGID.

Bacterial overgrowth can be detected by breath hydrogen measurement before clinical manifestations in suckling lambs

Hydrogen breath test is a non-invasive and inexpensive method for estimation of small bowel transit time, detection of excess bacteria in the small intestine and demonstration of maldigestion or malabsorption. Until now, little has been known about breath hydrogen excretion in lambs. The aim of our study was to assess the patterns of breath hydrogen excretion in lambs before and after feeding ewe’s milk, and to evaluate pathological and/or physiological alterations in the lambs’ gastrointestinal function. We assumed that intestinal disorders may influence the breath hydrogen concentrations, which could be detected early in the subclinical stage. A total of 52 healthy black-headed Dorper lambs were included in the study. Breath hydrogen was measured after overnight fasting and at 30, 60 and 90 min after the start of feeding. There was a 2-week follow-up period after the measurements to assess the gastrointestinal health of lambs. During the follow-up period, clinical signs of diarrhoea developed in 6 lambs. Based on our results in healthy lambs, the median concentration of baseline breath hydrogen was 1.00 parts per million (minimum: 0.00, maximum: 2.00). We observed a significant elevation in breath hydrogen concentrations 60 min after feeding (P= 0.004), whereas the values detected 30 min after feeding were similar to the baseline values. Regarding the lambs in which clinical signs of diarrhoea developed, we revealed significantly higher baseline breath hydrogen concentrations compared to those which remained healthy (P&lt; 0.001). Our observations underline that hydrogen breath test may be a useful tool for indicating potential bacterial overgrowth before any clinical signs of diarrhoea.

Lactose intolerance in Indonesian children.

"Lactose intolerance (LI)" is considered a common problem in Asians, and in many parts of the world. Its prevalence and age of manifestation varies between by Asian country, for possible genetic or cultural reasons. Studies in Indonesian children 3-15 years old (y) are available within the past two decades, using a pure lactose tolerance test. The prevalences of lactose malabsorption (LM) in pre-elementary (3-5 y), elementary (6-11 y), and junior high (12-14 y) school-children were 21.3%, 57.8%, and 73%, respectively. An increasing trend for LM prevalence was seen within the pre-elementary group, from 9.1% at 3 y to 28.6% at 5 y. The most frequent symptoms of LI in junior high school (JHS) group were abdominal pain (64.1%), abdominal distention (22.6%), nausea (15.1%), flatulence (5.7%), and diarrhea (1.9%), mostly within one hour of lactose ingestion. In children with regular and irregular milk drinking, LM occurred in 81.2% and 69.6%; LI was found in 56.2% and 52.1%, respectively. Most JHS children with dairy-associated recurrent abdominal pain (RAP) symptoms proved to be malabsorbers. Dairy products most related to RAP were milk and yogurt. LI was found in 81% of RAP children with abdominal pain most frequently, followed by nausea, bloating, diarrhea, borborygmi, and flatulence. Symp-tom onset occurred 30 minutes after lactose ingestion, especially nausea, bloating, and abdominal pain. In RAP children LI symptoms mostly found in breath hydrogen concentration>20 ppm. More LI symptoms were found in lactose malabsorbers, but symptoms were mild and generally disappeared in 7 hours, and in most by 15 hours.

Gastrointestinal tolerance and utilization of agave inulin by healthy adults

Little clinical research exists on agave inulin as a fiber source. Due to differences in botanical origin and chemical structure compared to other inulin-type fibers, research is needed to assess gastrointestinal (GI) tolerance following consumption. This study aimed to evaluate GI tolerance and utilization of 5.0 and 7.5 g per day of agave inulin in healthy adults (n = 29) using a randomized, double-blind, placebo-controlled crossover trial consisting of three 21 day periods with 1 week washouts among periods. GI tolerance was assessed via daily and weekly questionnaires, three fecal samples were collected on days 16-20 of each period, and breath hydrogen testing was completed on the final day of each treatment period. Survey data were compared using a generalized linear mixed model. All other outcomes were analyzed using a mixed linear model with a repeated measures procedure. Composite GI intolerance scores for 5.0 and 7.5 g treatments were both greater (P < 0.05) than control, however, scores were low, with means of 0.4, 1.9, and 2.3 on a 0-12 point composite scale for 0, 5.0, and 7.5 g treatments, respectively. There were slight increases (P < 0.05) in bloating, flatulence, and rumbling frequency with 5.0 and 7.5 g agave inulin. Abdominal pain and rumbling intensity were marginally greater (P < 0.05) with 7.5 g. Bloating and flatulence intensity increased (P < 0.05) with 5.0 g and 7.5 g. Agave inulin did not affect diarrhea (P > 0.05). Number of bowel movements per day increased, stools were softer, and stool dry matter percentage was lower with 7.5 g (P < 0.05). Breath hydrogen concentrations increased (P < 0.001) from 5-8 hour postprandial when participants consumed agave inulin compared to control. These data demonstrate that doses up to 7.5 g per day of agave inulin led to minimal GI upset, do not increase diarrhea, and improve laxation in healthy young adults.

Lactulose ameliorates cerebral ischemia–reperfusion injury in ratsby inducing hydrogen by activating Nrf2 expression

Molecular hydrogen has been proven effective in ameliorating cerebral ischemia/reperfusion (I/R) injury by selectively neutralizing reactive oxygen species. Lactulose can produce a considerable amount of hydrogen through fermentation by the bacteria in the gastrointestinal tract. To determine the neuroprotective effects of lactulose against cerebral I/R injury in rats and explore the probable mechanisms, we carried out this study. The stroke model was produced in Sprague–Dawley rats through middle cerebral artery occlusion. Intragastric administration of lactulose substantially increased breath hydrogen concentration. Behavioral and histopathological verifications matched biochemical findings. Behaviorally, rats in the lactulose administration group won higher neurological scores and showed shorter escape latency time in the Morris test. Morphologically, 2,3,5-triphenyltetrazolium chloride showed smaller infarction volume; Nissl staining manifested relatively clear and intact neurons and TUNEL staining showed fewer apoptotic neurons. Biochemically, lactulose decreased brain malondialdehyde content, caspase-3 activity, and 3-nitrotyrosine and 8-hydroxy-2-deoxyguanosine concentration and increased superoxide dismutase activity. The effects of lactulose were superior to those of edaravone. Lactulose orally administered activated the expression of NF-E2-related factor 2 (Nrf2) in the brain as verified by RT-PCR and Western blot. The antibiotics suppressed the neuroprotective effects of lactulose by reducing hydrogen production. Our study for the first time demonstrates a novel therapeutic effect of lactulose on cerebral ischemia/reperfusion injury and the probable underlying mechanisms. Lactulose intragastrically administered possessed neuroprotective effects on cerebral I/R injury in rats, which could be attributed to hydrogen production by the fermentation of lactulose through intestinal bacteria and Nrf2 activation.

Highly viscous guar gum shifts dietary amino acids from metabolic use to fermentation substrate in domestic cats

The present study evaluated the potential of affecting amino acid metabolism through intestinal fermentation in domestic cats, using dietary guar gum as a model. Apparent protein digestibility, plasma fermentation metabolites, faecal fermentation end products and fermentation kinetics (exhaled breath hydrogen concentrations) were evaluated. Ten cats were randomly assigned to either guar gum- or cellulose-supplemented diets, that were fed in two periods of 5 weeks in a crossover design. No treatment effect was seen on fermentation kinetics. The apparent protein digestibility (P= 0.07) tended to be lower in guar gum-supplemented cats. As a consequence of impaired small-intestinal protein digestion and amino acid absorption, fermentation of these molecules in the large intestine was stimulated. Amino acid fermentation has been shown to produce high concentrations of acetic and butyric acids. Therefore, no treatment effect on faecal propionic acid or plasma propionylcarnitine was observed in the present study. The ratio of faecal butyric acid:total SCFA tended to be higher in guar gum-supplemented cats (P= 0.05). The majority of large-intestinal butyric acid is absorbed by colonocytes and metabolised to 3-hydroxy-butyrylcoenzyme A, which is then absorbed into the bloodstream. This metabolite was analysed in plasma as 3-hydroxy-butyrylcarnitine, which was higher (P= 0.02) in guar gum-supplemented cats. In all probability, the high viscosity of the guar gum supplement was responsible for the impaired protein digestion and amino acid absorption. Further research is warranted to investigate whether partially hydrolysed guar gum is useful to potentiate the desirable in vivo effects of this fibre supplement.

Tu1397 Chronic Constipation in Canada - Prevalence and Patient Perspective

Introduction: Bloating, abdominal distension and flatulence represent very frequent complaints in children with irritable bowel syndrome (IBS). These symptoms are frequently associated to excessive intestinal gas. Hence the reduction of gas production can be considered an effective therapeutic strategy. Alpha-Galactosidase has been shown to reduce gas production and related symptoms in adults. Aim: to evaluate the efficacy and tolerability of Alphagalactosidase on gas related symptoms in pediatric IBS patients. Patients and Methods: this was a single center, randomized, double-blind, placebo-controlled, parallel-group study performed in tertiary care setting. Fifty-two pediatric patients (32 female, median age 8 yrs, range 4-17) with IBS according to Rome III criteria were randomized to receive placebo (n = 25) or Alpha-galactosidase (n = 27) (Sinaire, Promefarm). Both treatments were given as drops or tablets according to body weight at the beginning of each of three meals for 2 weeks. Children were followed up two weeks after the end of treatment. Parent and/or selfassessment of the severity of gas related symptoms (bloating, flatulence, abdominal distension and abdominal spasms) were recorded 3 times daily during the treatment period using a validated visual score. The primary endpoint was reduction in the severity of bloating at the end of treatment compared to baseline. Secondary endpoints were reduction in the severity of other symptoms. As a measure of intestinal gas production, breath hydrogen concentration was measured at baseline and at the end of treatment. Results: α-galactosidase significantly reduced the severity of bloating (p = 0,023) and flatulence (p = 0,005) as compared with placebo. No significant differences were found for abdominal spasms and abdominal distension. The administration of Alpha-galactosidase had no significant effect on breath hydrogen excretion as compared with placebo (p = 0,54). The benefical effects of treatment tended to disappear in both groups at the end of follow-up. No treatmentrelated adverse events were reported during treatment. Conclusions: Although larger and longer trials are needed to confirm our results, Alpha-galattosidase looks a safe and effective agent for managing gas related symptoms in pediatric IBS.

Tu1398 One Year Treatment of Childhood Constipation Comparing PEG 3350 With Electrolytes Versus PEG 4000: A Double Blind Randomized Controlled Trial

Introduction: Bloating, abdominal distension and flatulence represent very frequent complaints in children with irritable bowel syndrome (IBS). These symptoms are frequently associated to excessive intestinal gas. Hence the reduction of gas production can be considered an effective therapeutic strategy. Alpha-Galactosidase has been shown to reduce gas production and related symptoms in adults. Aim: to evaluate the efficacy and tolerability of Alphagalactosidase on gas related symptoms in pediatric IBS patients. Patients and Methods: this was a single center, randomized, double-blind, placebo-controlled, parallel-group study performed in tertiary care setting. Fifty-two pediatric patients (32 female, median age 8 yrs, range 4-17) with IBS according to Rome III criteria were randomized to receive placebo (n = 25) or Alpha-galactosidase (n = 27) (Sinaire, Promefarm). Both treatments were given as drops or tablets according to body weight at the beginning of each of three meals for 2 weeks. Children were followed up two weeks after the end of treatment. Parent and/or selfassessment of the severity of gas related symptoms (bloating, flatulence, abdominal distension and abdominal spasms) were recorded 3 times daily during the treatment period using a validated visual score. The primary endpoint was reduction in the severity of bloating at the end of treatment compared to baseline. Secondary endpoints were reduction in the severity of other symptoms. As a measure of intestinal gas production, breath hydrogen concentration was measured at baseline and at the end of treatment. Results: α-galactosidase significantly reduced the severity of bloating (p = 0,023) and flatulence (p = 0,005) as compared with placebo. No significant differences were found for abdominal spasms and abdominal distension. The administration of Alpha-galactosidase had no significant effect on breath hydrogen excretion as compared with placebo (p = 0,54). The benefical effects of treatment tended to disappear in both groups at the end of follow-up. No treatmentrelated adverse events were reported during treatment. Conclusions: Although larger and longer trials are needed to confirm our results, Alpha-galattosidase looks a safe and effective agent for managing gas related symptoms in pediatric IBS.

Tu1396 Identification of Pro-Secretory Components in STW 5, a Fixed Herbal Combination Medicine to Treat Functional Gut Disorders

Introduction: Bloating, abdominal distension and flatulence represent very frequent complaints in children with irritable bowel syndrome (IBS). These symptoms are frequently associated to excessive intestinal gas. Hence the reduction of gas production can be considered an effective therapeutic strategy. Alpha-Galactosidase has been shown to reduce gas production and related symptoms in adults. Aim: to evaluate the efficacy and tolerability of Alphagalactosidase on gas related symptoms in pediatric IBS patients. Patients and Methods: this was a single center, randomized, double-blind, placebo-controlled, parallel-group study performed in tertiary care setting. Fifty-two pediatric patients (32 female, median age 8 yrs, range 4-17) with IBS according to Rome III criteria were randomized to receive placebo (n = 25) or Alpha-galactosidase (n = 27) (Sinaire, Promefarm). Both treatments were given as drops or tablets according to body weight at the beginning of each of three meals for 2 weeks. Children were followed up two weeks after the end of treatment. Parent and/or selfassessment of the severity of gas related symptoms (bloating, flatulence, abdominal distension and abdominal spasms) were recorded 3 times daily during the treatment period using a validated visual score. The primary endpoint was reduction in the severity of bloating at the end of treatment compared to baseline. Secondary endpoints were reduction in the severity of other symptoms. As a measure of intestinal gas production, breath hydrogen concentration was measured at baseline and at the end of treatment. Results: α-galactosidase significantly reduced the severity of bloating (p = 0,023) and flatulence (p = 0,005) as compared with placebo. No significant differences were found for abdominal spasms and abdominal distension. The administration of Alpha-galactosidase had no significant effect on breath hydrogen excretion as compared with placebo (p = 0,54). The benefical effects of treatment tended to disappear in both groups at the end of follow-up. No treatmentrelated adverse events were reported during treatment. Conclusions: Although larger and longer trials are needed to confirm our results, Alpha-galattosidase looks a safe and effective agent for managing gas related symptoms in pediatric IBS.

Beneficial Effects of Long‐Term Consumption of a Probiotic Combination of Lactobacillus casei Shirota and Bifidobacterium breve Yakult May Persist After Suspension of Therapy in Lactose‐Intolerant Patients

The efficacy of some probiotic strains for the management of lactose intolerance remains to be established. To evaluate the effects of a 4-week consumption of a probiotic product containing Lactobacillus casei Shirota and Bifidobacterium breve Yakult (10(7)-10(9) CFU of each strain) on symptoms and breath hydrogen exhalation after a lactose load in lactose-intolerant patients and whether the beneficial results persisted after probiotic discontinuation. Twenty-seven patients with lactose maldigestion and intolerance participated in this study, which comprised 4 hydrogen breath tests: baseline condition (20 g lactose), after lactase ingestion (9000 FCC units), at the end of 4-week probiotic supplementation, and a follow-up test performed 3 months after probiotic discontinuation. For each test, the area under the breath hydrogen concentration vs time curve (AUC(180 min)) was calculated, and symptom scores were recorded. The probiotic combination significantly reduced symptom scores (P < .01) and breath hydrogen AUC (P = .04) compared with the baseline condition. The comparison with the lactase test showed that symptom scores were similar (P > .05), despite the significantly higher (P = .01) AUC values after probiotic use. In the follow-up test, symptom scores and breath hydrogen AUC values remained similar to those found at the end of probiotic intervention. Four-week consumption of a probiotic combination of L casei Shirota and B breve Yakult seems to improve symptoms and decrease hydrogen production intake in lactose-intolerant patients. These effects may persist for at least 3 months after suspension of probiotic consumption.

Drinking hydrogen water and intermittent hydrogen gas exposure, but not lactulose or continuous hydrogen gas exposure, prevent 6-hydorxydopamine-induced Parkinson’s disease in rats

BackgroundLactulose is a synthetic disaccharide that can be catalyzed only by intestinal bacteria in humans and rodents, and a large amount of hydrogen is produced by bacterial catalysis of lactulose. We previously reported marked effects of ad libitum administration of hydrogen water on prevention of a rat model of Parkinson’s disease (PD).MethodsEnd-alveolar breath hydrogen concentrations were measured in 28 healthy subjects and 37 PD patients, as well as in 9 rats after taking hydrogen water or lactulose. Six-hydroxydopamine (6-OHDA)-induced hemi-PD model was stereotactically generated in rats. We compared effects of hydrogen water and lactulose on prevention of PD. We also analyzed effects of continuous and intermittent administration of 2% hydrogen gas.ResultsHydrogen water increased breath hydrogen concentrations from 8.6 ± 2.1 to 32.6 ± 3.3 ppm (mean and SEM, n = 8) in 10 min in healthy subjects. Lactulose increased breath hydrogen concentrations in 86% of healthy subjects and 59% of PD patients. Compared to monophasic hydrogen increases in 71% of healthy subjects, 32% and 41% of PD patients showed biphasic and no increases, respectively. Lactulose also increased breath hydrogen levels monophasically in 9 rats. Lactulose, however, marginally ameliorated 6-OHDA-induced PD in rats. Continuous administration of 2% hydrogen gas similarly had marginal effects. On the other hand, intermittent administration of 2% hydrogen gas prevented PD in 4 of 6 rats.ConclusionsLack of dose responses of hydrogen and the presence of favorable effects with hydrogen water and intermittent hydrogen gas suggest that signal modulating activities of hydrogen are likely to be instrumental in exerting a protective effect against PD.

PP2 EFFICACY AND TOLERABILITY OF α-GALACTOSIDASE ON GAS RELATED SYMPTOMS IN PEDIATRIC IRRITABLE BOWEL SYNDROME. A RANDOMIZED, DOUBLE-BLIND, PLACEBO CONTROLLED TRIAL

Introduction: Bloating, abdominal distension and flatulence represent very frequent complaints in children with irritable bowel syndrome (IBS). These symptoms are frequently associated to excessive intestinal gas. Hence the reduction of gas production can be considered an effective therapeutic strategy. Alpha-Galactosidase has been shown to reduce gas production and related symptoms in adults. Aim: to evaluate the efficacy and tolerability of Alphagalactosidase on gas related symptoms in pediatric IBS patients. Patients and Methods: this was a single center, randomized, double-blind, placebo-controlled, parallel-group study performed in tertiary care setting. Fifty-two pediatric patients (32 female, median age 8 yrs, range 4-17) with IBS according to Rome III criteria were randomized to receive placebo (n = 25) or Alpha-galactosidase (n = 27) (Sinaire, Promefarm). Both treatments were given as drops or tablets according to body weight at the beginning of each of three meals for 2 weeks. Children were followed up two weeks after the end of treatment. Parent and/or selfassessment of the severity of gas related symptoms (bloating, flatulence, abdominal distension and abdominal spasms) were recorded 3 times daily during the treatment period using a validated visual score. The primary endpoint was reduction in the severity of bloating at the end of treatment compared to baseline. Secondary endpoints were reduction in the severity of other symptoms. As a measure of intestinal gas production, breath hydrogen concentration was measured at baseline and at the end of treatment. Results: α-galactosidase significantly reduced the severity of bloating (p = 0,023) and flatulence (p = 0,005) as compared with placebo. No significant differences were found for abdominal spasms and abdominal distension. The administration of Alpha-galactosidase had no significant effect on breath hydrogen excretion as compared with placebo (p = 0,54). The benefical effects of treatment tended to disappear in both groups at the end of follow-up. No treatmentrelated adverse events were reported during treatment. Conclusions: Although larger and longer trials are needed to confirm our results, Alpha-galattosidase looks a safe and effective agent for managing gas related symptoms in pediatric IBS.

Small intestinal bacterial overgrowth (SIBO) in irritable bowel syndrome: Frequency and predictors

Small intestinal bacterial overgrowth (SIBO) has been implicated in pathogenesis of IBS. We aimed to study frequency and predictors of SIBO in patients with IBS. We included 59 consecutive patients of IBS & 37 healthy controls (HC). Evaluation for SIBO was done by glucose breath test (GBT) using 100 gm of glucose after an overnight fast. Breath hydrogen & methane concentration were noted at baseline & every 15 min after administration of glucose for a total of 3 h. Persistent rise in breath hydrogen or methane > 12 ppm above basal was considered diagnostic of SIBO. Of 59 patients, 27 were diarrhoea predominant (D-IBS), 11 were constipation predominant (C-IBS) and 21 were mixed type (M-IBS). Median age of patients (34 [18-47] years) were comparable to controls (35 [20-48] years) (P = 0.21). Patient group was similar to HC in gender distribution (male 41/59 [69.5%]vs 25/37 [67.6%], P = 0.36). SIBO was more frequent in patients with IBS than HC (14/59 [23.7%]vs 1/37 [2.7%], P = 0.008). Patients with D-IBS more often had SIBO as compared to non-D-IBS (10/27 [37%]vs 4/32 [12.5%], P = 0.02). C-IBS had lowest frequency of SIBO (1/11 [9%]) among all IBS subgroups. Patients with history of bloating more often had SIBO as compared to those without this symptom (11/23 [47.8%]vs 3/36 [8.3%], P = 0.002). Among IBS patients, females more often had SIBO as compared to males (8/18 [44.4%]vs 6/41 [14.6%], P = 0.01). SIBO was more frequent in patients with IBS as compared to healthy controls. D-IBS subtype, female gender & bloating were predictors of SIBO in patients with IBS.

Triple sugar screen breath hydrogen test for sugar intolerance in children with functional abdominal symptoms

Sugar intolerance and functional gastrointestinal disorders are both common in school age children. Both may present with similar complaints such as abdominal pain, diarrhea and bloating. Lactose, fructose and sucrose hydrogen breath tests are widely used to detect sugar malabsorption. To determine the proportion of children with symptoms of functional gastrointestinal disorders (FGID) that have sugar intolerance as determined by using a breath hydrogen test. We prospectively enrolled subjects with chronic abdominal pain, bloating and/or chronic diarrhea. All subjects underwent triple sugar screen hydrogen breath test (TSST) using the combined sugar solution. Breath hydrogen concentration ≥ 20 ppm above baseline was interpreted a positive test for sugar malabsorption. A positive hydrogen breath test consistent with sugar malabsorption was found in 5 out of 31 (16%) subjects. Three of these subjects were confirmed to have lactose malabsorption based on small bowel lactase enzyme analysis or subsequent lactose hydrogen breath test. One subject with positive TSST was diagnosed with fructose malabsorption based on dietary history; he improved on a limited fructose diet, and one was diagnosed to have gastric Crohn's disease. Approximately one in six children with symptoms of FGID had sugar intolerance as determined by the TSST.

Failure of d-psicose absorbed in the small intestine to metabolize into energy and its low large intestinal fermentability in humans

Experiments with rats have produced data on the metabolism and energy value of d-psicose; however, no such data have been obtained in humans. The authors assessed the availability of d-psicose absorbed in the small intestine by measuring carbohydrate energy expenditure (CEE) by indirect calorimetry. They measured the urinary excretion rate by quantifying d-psicose in urine for 48 hours. To examine d-psicose fermentation in the large intestine, the authors measured breath hydrogen gas and fermentability using 35 strains of intestinal bacteria. Six healthy subjects participated in the CEE test, and 14 participated in breath hydrogen gas and urine tests. d-Psicose fermentation subsequent to an 8-week adaptation period was also assessed by measuring hydrogen gas in 8 subjects. d-Psicose absorbed in the small intestine was not metabolized into energy, unlike glucose, because CEE did not increase within 3 hours of d-psicose ingestion (0.35 g/kg body weight [BW]). The accumulated d-psicose urinary excretion rates were around 70% for 0.34, 0.17, and 0.08 g/kg BW of ingested d-psicose. Low d-psicose fermentability was observed in intestinal bacteria and breath hydrogen gas tests, in which fructooligosaccharide (0.34, 0.17, and 0.08 g/kg BW) was used as a positive control because its available energy is known to be 8.4 kJ/g. Based on the results of the plot of breath hydrogen concentration vs calories ingested, the energy value of d-psicose was expected to be less than 1.6 kJ/g. Incremental d-psicose fermentability subsequent to an adaptation period was not observed.