Breath Hydrogen Determination Research Articles

Diurnal versus Nocturnal Exercise-Effect on the Gastrointestinal Tract.

The study aimed to determine the effect of diurnal versus nocturnal exercise on gastrointestinal integrity and functional responses, plasma lipopolysaccharide binding protein (LBP) and soluble CD14 (sCD14) concentrations (as indirect indicators of endotoxin responses), systemic inflammatory cytokine profile, gastrointestinal symptoms, and feeding tolerance. Endurance runners (n = 16) completed 3 h of 60% V˙O2max (22.7°C, 45% relative humidity) running, on one occasion performed at 0900 h (400 lx; DAY) and on another occasion at 2100 h (2 lx; NIGHT). Blood samples were collected pre- and postexercise and during recovery to determine plasma concentrations of cortisol, catecholamines, claudin-3, I-FABP, LBP, and sCD14 and inflammatory cytokine profiles by ELISA. Orocecal transit time (OCTT) was determined by lactulose challenge test given at 150 min, with concomitant breath hydrogen (H2) and gastrointestinal symptom determination. Cortisol increased substantially pre- to postexercise on NIGHT (+182%) versus DAY (+4%) (trial-time, P = 0.046), with no epinephrine (+41%) and norepinephrine (+102%) trial differences. I-FABP, but not claudin-3, increased pre- to postexercise on both trials (mean = 2269 pg·mL-1, 95% confidence interval = 1351-3187, +143%) (main effect of time [MEOT], P < 0.001). sCD14 increased pre- to postexercise (trial-time, P = 0.045, +5.6%) and was greater on DAY, but LBP decreased (MEOT, P = 0.019, -11.2%) on both trials. No trial difference was observed for systemic cytokine profile (MEOT, P = 0.004). Breath H2 responses (P = 0.019) showed that OCTT was significantly delayed on NIGHT (>84 min, with n = 3 showing no breath H2 turning point by 180 min postexercise) compared with DAY (mean = 54 min, 95% confidence interval = 29-79). NIGHT resulted in greater total gastrointestinal symptoms (P = 0.009) compared with DAY. No difference in feeding tolerance markers was observed between trials. Nocturnal exercise instigates greater gastrointestinal functional perturbations and symptoms compared with diurnal exercise. However, there are no circadian differences to gastrointestinal integrity and systemic perturbations in response to the same exertional stress and controlled procedures.

Breath Hydrogen as a Biomarker for Glucose Malabsorption after Roux-en-Y Gastric Bypass Surgery

Objective. Abdominal symptoms are common after bariatric surgery, and these individuals commonly have upper gut bacterial overgrowth, a known cause of malabsorption. Breath hydrogen determination after oral glucose is a safe and inexpensive test for malabsorption. This study is designed to investigate breath hydrogen levels after oral glucose in symptomatic individuals who had undergone Roux-en-Y gastric bypass surgery. Methods. This is a retrospective study of individuals (n = 63; 60 females; 3 males; mean age 49 years) who had gastric bypass surgery and then glucose breath testing to evaluate abdominal symptoms. Results. Among 63 postoperative individuals, 51 (81%) had a late rise (≥45 minutes) in breath hydrogen or methane, supporting glucose malabsorption; 46 (90%) of these 51 subjects also had an early rise (≤30 minutes) in breath hydrogen or methane supporting upper gut bacterial overgrowth. Glucose malabsorption was more frequent in subjects with upper gut bacterial overgrowth compared to subjects with no evidence for bacterial overgrowth (P < 0.001). Conclusion. These data support the presence of intestinal glucose malabsorption associated with upper gut bacterial overgrowth in individuals with abdominal symptoms after gastric bypass surgery. Breath hydrogen testing after oral glucose should be considered to evaluate potential malabsorption in symptomatic, postoperative individuals.

Breath hydrogen determination in patients following partial gastrectomy

AIM The study was aimed at the unknown mechanisms of gastrointestinal symptoms and accompanied malnutrition in patients following partial gastrectomy. METHODS Thirty six patients who had their gastric resection at least five years ago and forty one normal controls were included in the study. Nutritional status as indicated by anthropometry measurements, glucose hydrogen breath test G HBT) before and after antibiotic treatment and mouth cecum transit time (MCTT) with lactose hydrogen breath test (L HBT) were simultaneously determined. The Student's t test was used for statistical analysis of all the data of the study. RESULTS Anthropometry measurements showed that decreased values (at least 10% lower than the ideal values) of body weight (BW), triceps skinfold thickness (TSF) and mid arm circumference (MC) were observed in 63 2%, 94 7% and 73 3% of the patients studied respectively. A positive result of 50g G HHBT was seen in 10 out of 26 patients (38 5%) who undertook the test. Six of the 9 patients with negative 50g G HBT were positive following a 80g G HBT. Hydrogen excretion in six patients with positive 50g or 80g G BHT were significantly decreased after antibiotic treatment. Further studies of 25 L BHT showed a significant difference of MCTTs either between the post gastrectomy patients with or without chronic diarrhea, or between patient and control groups, i.e., an average MCTT of 58 8, 85 7 and 105 9 minutes in each group. CONCLUSION Malnutrition was common in patients a few years after their gastrectomies. About forty percent of positive G HBT, and effective antibiotic treatment and reduced MCTT determination were observed in these patients. The results suggested that bacterial overgrowth and increased small bowel transit may play a role in the development of gastrointestinal symptoms and related malnutrition in patients following gastrectomy.

Jejunal bacterial overgrowth and intestinal permeability in children with immunodeficiency syndromes.

Seventeen paediatric patients with immunodeficiency syndromes (10 with selective IgA deficiency, four with panhypogammaglobulinaemia, and three with selective T cell deficiency) were investigated for bacterial overgrowth of the small intestine and gut permeability to macromolecules. Five of 12 patients showed viable bacterial counts of more than 2 x 10(5)/ml in jejunal fluid. Bacterial overgrowth was also confirmed indirectly by breath hydrogen determination, which was higher than 10 ppm in four of the five patients with positive jejunal culture. Gut permeability to lactulose and L-rhamnose was abnormal in 16 of the 17 immunodeficient patients, who also had higher mean urinary excretion ratios than control subjects-mean (SD) values were 0.216 (0.160) and 0.029 (0.002), respectively. These studies indicate that bacterial overgrowth of the small intestine is a common feature in immunodeficient patients, regardless of the immunological abnormality. Moreover, these patients have an increased gut permeability to macromolecules.

A study of lactose absorption capacity in twins

Lactose absorption capacity was determined by lactose tolerance tests with breath hydrogen determination in 102 healthy, adult, Hungarian pairs of twins in order to test monogenic Mendelian inheritance of the absorptive lactase phenotypes, lactose absorber and lactose malabsorber. Of the total, 52 pairs were monozygous (MZ) and 50 dizygous (DZ) twins of identical sex. All MZ twins were concordant with respect to lactase phenotype. Among DZ twins, the distribution of lactase phenotypes was in agreement with Hardy-Weinberg expectations derived from the frequencies of the hypolactasia gene in DZ and MZ twins, and in the general Budapest population. In the second part of the study, three commonly used methods of lactose tolerance testing, the blood glucose, the blood galactose, and the breath hydrogen tests, were compared in 49 pairs of twins concordant for lactase phenotype. Blood galactose concentration showed the greatest and only significant difference between the intrapair correlation coefficients of MZ and DZ, and no overlap between lactose absorbers and lactose malabsorbers. The intrapair correlation coefficients of peak breath hydrogen concentration in MZ and DZ twins did not significantly differ from zero, but the resolution of lactase phenotypes was satisfactory. Differences in glucose absorption and concentration in lactose absorbers and malobsorbers overlapped considerably, and among lactose absorbers correlation coefficients in DZ were higher than in MZ twins. In MZ and DZ twins, the difference in concordance and constancy of lactose intolerance symptoms was not significant.

Prevalence of primary adult lactose malabsorption in Pakistan.

Lactose absorption capacity was examined in 414 apparently healthy, adult Pakistani subjects. In a subgroup of 44 subjects, the lactose tolerance test was performed using both blood glucose and breath hydrogen determination. The remaining 370 probands were examined using a field version of the breath hydrogen test. In the total sample of 414 probands, 248 lactose malabsorbers were identified (60%). This result differs considerably from previous reports of very low frequencies of lactose malabsorption in Pakistan and neighbouring areas.

Prevalence of primary adult lactose malabsorption in Poland

Lactose-absorption capacity was examined in 275 apparently healthy Polish adolescents and adults (214 females and 61 males with an average age of 29.1 years) using a field version of the lactose-tolerance test with breath hydrogen determination. In the total group, 172 lactose absorbers (62.5%) and 103 lactose malabsorbers (37.5%) were identified. Reported milk intolerance and symptoms of lactose intolerance were significantly more frequent in lactose malabsorbers. Subdivision according to the birthplaces of the probands' grandparents did not reveal significant regional differences. The unexpectedly high frequency of lactose malabsorption is further evidence for concentric genetic clines of lactase gene frequencies extending from southern Scandinavia, the area with the lowest observed frequencies of selective adult hypolactasia, to the south and the east.

Prevalence of primary adult lactose malabsorption and awareness of milk intolerance in Italy

A total of 308 healthy Italian adults (192 females, 116 males; mean age 29.2 yr) were examined using a field version of the lactose tolerance test with breath hydrogen determination. Two geographical groups were formed according to the birth places of the probands' grandparents: 208 subjects from northern Italy (mainly from the regions of Piemonte, Lombardia, and Veneto) and 100 probands from Sicily. Lactose malabsorption was diagnosed in 106 subjects in group “north” (51 %) and in 71 subjects in group “Sicily” (71 %). Awareness of milk intolerance was more frequent in lactose malabsorbers. The incidence of diarrhea after the test dose of lactose was significantly higher in “aware” lactose malabsorbers, when compared with persons of the same group who had not experienced milk intolerance. The significant difference in lactose malabsorption frequency between northern Italy and Sicily is further evidence of a north-south gradient of lactase gene frequencies in Europe.

Prevalence of primary adult lactose malabsorption in Hungary

Lactose absorption capacity was estimated in 820 apparently healthy, well nourished, Hungarian adults and adolescents (560 females, 260 males, aged 16-54 years) using a field version of the lactose tolerance test with breath hydrogen determination. The test identified 497 lactose absorbers with low, and 323 lactose malabsorbers with high hydrogen excretion 120-150 min after an oral load of 50 g lactose. The prevalence of lactose malabsorption in the general Hungarian sample (n = 535) was 37%. In subgroups from the western and eastern Hungarian plains, frequency of lactose malabsorption reached almost 30%. It tended to be higher in Upper Hungary (ca. 40%) and in subjects stemming from former Hungarian areas in the Carpathian bend. Lactose malabsorption in a Hungarian ethnic subgroup, the Matyo (n = 172), did not differ significantly from that in the general population. Among Romai ("Gypsies", n = 113), the prevalence of lactose malabsorption was significantly higher (56%). Awareness of milk intolerance was significantly more frequent, and severe symptoms of lactose intolerance during the test occurred almost exclusively in lactose malabsorbers.

Distribution of human adult lactase phenotypes in the population of Austria.

A total of 528 unrelated, apparently healthy, adult and adolescent Austrians (270 females, 258 males, mean age 22.1 years) were examined for lactose absorption capacity employing a noninvasive field test based on breath hydrogen (H2) determination. Subjects exhibiting a change of breath hydrogen concentration of less than 15 volumes per million (vpm) after a load of 50 g lactose (n = 422) were classified as lactose absorbers, 106 probands (20.1%) showing increases of breath hydrogen concentration between 16 and 111 vpm were diagnosed as lactose malabsorbers. The distribution of the lactase phenotypes was independent of age and sex. Intolerance symptoms after lactose administration were significantly more frequent in lactose malabsorbers. Grouping of probands according to the birth-places of their grandparents revealed significant differences in the distribution of the lactase phenotypes in East and West Austria (East 25%, West 15% lactose malabsorbers). These differences are discussed in the light of the population history of these regions.

Beja and Nilotes: nomadic pastoralist groups in the Sudan with opposite distributions of the adult lactase phenotypes.

Lactose tolerance tests with breath hydrogen determination were performed on 585 apparently healthy adolescents and adults in the Democratic Republic of the Sudan. Out of the total, 303 probands belong to the tribal group Beja, traditional nomadic pastoralists in the desert zone between the Nile and the Red Sea. The 282 Nilotes (mainly Dinka) are members of seminomadic cattle breeding tribes in the south of the Sudan. In both populations milk consumption is substantial but only in the Beja true milk dependence, sufficient to result in selective pressures in favour of the lactase persistence allele, is likely to exist. The proportion of lactose malabsorbers was 16.8% in the Beja and 74.5% in the Nilotes. The high prevalence of lactose malabsorption among the Nilotes fits into a converging gradient of lactase gene frequencies along the Nile Valley. The Beja are the first nomadic desert population in North Africa in whom a high prevalence of lactase persistence has been demonstrated on a numerically sufficient sample.

Lack of stimulation of isohemagglutinin antibodies byimmunization with group B streptococcal (Type III) vaccine

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Electrochemical detector for breath hydrogen determination: measurement of small bowel transit time in normal subjects and patients with the irritable bowel syndrome.

A method is described for the measurement of hydrogen in expired air, using an electrochemical detector. The apparatus is simple to use and sensitive. Its application is illustrated by studies of small bowel transit time made by measuring the time between oral ingestion of the unabsorbable carbohydrate lactulose and a rise in the concentration of hydrogen in expired air. In 20 control subjects transit time was 93.0 +/- 6.6 minutes, while in 16 patients with diarrhoea due to the irritable bowel syndrome it was 54.1 +/- 6.3 minutes (P less than 0.001), suggesting an abnormality in small intestinal motility in these patients. Loperamide, a potent antidiarrhoeal agent, increased transit time in 12 of these patients from 56.3 +/- 6.7 to 100.0 +/- 10.2 minutes (P less than 0.001).

Population screening for the human adult lactase phenotypes with a multiple breaths version of the breath hydrogen test.

Lactose tolerance tests with conventional blood glucose determination and with breath hydrogen analysis after storage of breath samples in aluminium aerosol cans were simultaneously performed in 60 healthy adult subjects. Both tests were equally reliable in the diagnosis of the lactase phenotype in healthy persons. In subjects with decreased glucose metabolism the breath hydrogen test seems to be more reliable than the blood glucose test. Provisions for storing breath samples for up to several weeks, avoidance of invasive procedures, and insensivity to glucose absorbed during the test make the present version of the lactose tolerance test with breath hydrogen determination particularly suitable for population studies.

Protein values of milk samples from mothers without biologic pregnancies

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Sucrose malabsorption in children: Noninvasive diagnosis by interval breath hydrogen determination

To assess whether malabsorption of specific sugars is easily detected in a pediatric population by interval measurement of breath hydrogen excretion, hydrogen concentration was determined following administration of oral sucrose to six sucrose-intolerant children with congenital sucrase-isomaltase deficiency and in 16 sucrose-tolerant control subjects. Breath samples were collected by means of a newly devised nasal prong technique not requiring active patient cooperation and suitable for use in all age groups. Breath hydrogen concentrations obtained by samples collected by this method correlated highly (r = 0.94) with the previously validated modified Haldane-Priestley tube method for sampling alveolar air. Identification of sucrose-intolerant individuals was achieved on the basis of hydrogen excretion: peak values, expressed as parts per million above baseline (deltappm), equalled 114 +/- 63 (mean +/- SD) versus 2.4 +/- 3.6 deltappm in control subjects (P = 0.007). Best discrimination between the groups occurred at 90 minutes postingestion. The findings validate this simple method for collection of expired air and demonstrate that breath hydrogen determination permits the noninvasive detection of sucrose malabsorption in children.