Breath Hydrogen Excretion Research Articles

Gastric physiology and function: effects of fruit juices.

The stomach stores food and starts digesting protein and fat. Lipids, sugars, certain amino acids, and nutrients of high osmolality trigger sensory mechanisms from the intestine which inhibit gastric emptying. Food rich in carbohydrates leaves the stomach slower than protein-rich food, and emptying is slowest after a meal containing lipid. For carbohydrate beverages, the gastric emptying rate is primarily determined by the volume, caloric content, and osmolality of fluid ingested. Gastric emptying rates vary among isocaloric beverages of different type (e.g., sucrose, fructose, galactose) or forms (e.g., maltodextrins, starches) of carbohydrate. For instance, gastric emptying is faster for a fructose solution compared with isocaloric glucose and galactose solutions. A maltodextrin or a sucrose solution empties faster than a glucose solution. This is possibly due to the greater inhibitory feedback associated with the introduction of glucose in the duodenum. In addition, fruit juices contain soluble fibers which further modulate the gastric emptying. Noninvasive methods to study gastric emptying have recently been developed. The pattern of the myoelectric activity of the gastric contraction and the effect of meals on this pattern can now be recorded by cutaneous electrodes. In healthy children ingesting different juices, the myoelectric pattern of the stomach (indicator of the gastric emptying) correlates with the carbohydrate absorption (measured by breath hydrogen excretion). Fast gastric emptying was associated with greater production of breath hydrogen. The malabsorption of juice carbohydrates may in part be related to their effect on gastric motility.

Breath hydrogen and methane excretion produced by commercial beverages containing dietary fiber.

Soft drinks containing dietary fiber are popular in Japan. There seem to be two types, one containing polydextrose and the other, oligosaccharide. These beverages are claimed to be useful for constipation or obesity, but data are scanty. We examined four such fiber-containing beverages [Fibe-mini Otsuka Pharmaceuticals (Tokyo, Japan), Seni and Oligo Takeda Food Engineering (Osaka, Japan), Oligo CC (Calpis Food Engineering, Tokyo, Japan), and Sapitus 5289 Nakakita Pharmaceuticals (Nagoga, Japan)] for large intestine fermentability by measuring breath hydrogen (H2) and methane (CH4). Five healthy subjects (two men, three women, 22-48 years old) participated in the study. Breath H2 and CH4 were measured with a MicroLyzer (Quintron Instruments, Milwaukee, Wis.). Breath H2 increased within 2h of beverage consumption, but CH4 excretion was observed in only two subjects. Orocecal transit time was constant for all beverages. Total H2 plus CH4 excretion (AUC; area under the curve) after lactulose was 1294 +/- 250 ppm x min/g fiber. AUC for Oligo CC was significantly greater than that for Fibe-mini or Sapitus 5289 (P < 0.05). The AUCs of Fibe-mini, Seni and Oligo, Oligo CC, and Sapitus 5289 were 41%, 129%, 174%, and 40%, respectively, that of lactulose. It is concluded that commercial fiber-containing drinks produce H2, and CH4 in some people. Oligosaccharide produces more H2 and CH4 than polydextrose.

Improvement of Lactose Digestion in Humans by Ingestion of Unfermented Milk Containing Bifidobacterium longum

Fifteen lactose malabsorbers were studied to evaluate the effects of consumption of milk containing different strains of Bifidobacterium longum on lactose digestion. Influences of different growth substrates, bile sensitivity, and lactose transport on lactose digestion by bifidobacteria were also investigated. Lactose malabsorption was determined by measuring breath hydrogen excretion of subjects fed four different test milks (three of which contained 5 × 108 cfu/ml of B. longum) on 4 different d using a randomized, double-blinded trial. Test milks included 1) 400ml of lowfat milk (control), 2) 400ml of milk containing B. longum B6 that had been grown with lactose, 3) 400ml of milk containing B. longum B6 grown with lactose plus glucose, or 4) 400ml of milk containing B. longum ATCC 15708 grown with lactose. β-Galactosidase activity was highest in milk containing B6 grown with lactose but was extremely low in milk containing B6 grown with lactose and glucose. Consumption of milk containing B6 grown with lactose resulted in significantly less hydrogen production and flatulence than occurring after consumption of control milk or the milk containing B6 grown with both lactose and glucose. Hydrogen production after ingestion of 15708 was also significantly lower than hydrogen production after ingestion of the control milk. We concluded that milks containing B. longum might reduce breath hydrogen response and symptoms from lactose malabsorption when the culture is grown in a medium containing only lactose to induce a higher β-galactosidase level and increase rate of lactose uptake.

Diagnostic value of dumping provocation in patients after gastric surgery.

In patients after gastric surgery it is often difficult to discern symptoms from dumping from other postcibal complaints. Strict criteria for dumping provocation test have not been defined. The sensitivity and specificity of a dumping provocation using 50 g of glucose orally was assessed in 48 patients after gastric surgery, of whom 19 had a typical history of early dumping and 11 had a history of late dumping. Factors were heart rate, packed cell volume, breath hydrogen excretion, and blood glucose concentration. An increase in heart rate of > or = 10 beats/min in the 1st h had a sensitivity of 100% and a specificity of 94% in detecting early dumping. An early rise in breath H2 excretion showed a sensitivity of 84% and specificity of 94%. The nadir blood glucose concentration was not a sensitive or specific indicator for late dumping. Both an increase in heart rate of > or = 10 beats/min and a positive breath hydrogen excretion are sensitive indicators for early dumping. Late dumping is better recognized by the occurrence of subjective symptoms during provocation.

Fruit juice malabsorption: not only fructose

Malabsorption of free fructose, when ingested in excess over glucose, is considered a significant factor in apple juice induced diarrhoea. Absorption of the carbohydrates in fruit juices was investigated by means of the hydrogen breath test in 15 healthy children aged 2.2-6.4 years, consuming 15 ml kg-1 of each juice with a maximum of 375 ml. Incomplete absorption was found following the ingestion of apple juice (5/5), grape juice (10/10) and bilberry juice (8/10), although the last two contain equivalent concentrations of fructose and glucose. When the same tests were repeated after yeast treatment of the juices, which leads to major reductions in fructose and glucose contents, malabsorption was found to persist. No symptoms were observed following any of the tests. Our results suggest a significant role for other carbohydrates than fructose, possibly those originating from the fruit skin, with respect to fruit juice-induced breath hydrogen excretion.

Fluid intake and industrial processing in apple juice induced chronic non-specific diarrhoea.

Dietary factors have been shown to contribute to the occurrence or persistence of chronic non-specific diarrhoea (CNSD). Among these are low dietary fat, high fluid consumption, and the consumption of apple juice. Prompted by the clinical impression that freshly pressed and unprocessed ('cloudy') apple juice was less likely to induce diarrhoea than normal, enzymatically processed ('clear') apple juice, both juices were compared in terms of carbohydrate malabsorption, gastric emptying, and effects on defecation patterns. Clear and cloudy apple juice differ in their fibre and non-absorbable monosaccharide and oligosaccharide contents. Ten healthy children aged 3.6 to 5.9 years ingested 10 ml/kg of clear and cloudy apple juice; in five of them it was enriched with 40 mg of [1-13C]-glycine. Clear apple juice resulted in increased (> or = 20 ppm) breath hydrogen excretion in 8/10, compared with 5/10 after cloudy apple juice; peak breath hydrogen was higher in the clear apple juice group (35 (4) and 18 (3) ppm, respectively). Gastric emptying as determined by means of labelled breath carbon dioxide (13CO2) excretion was similar with both juices. In a four week crossover clinical trial 12 children, formerly diagnosed as having CNSD, were given extra clear fluids (excluding fruit juices; > or = 50% over basal consumption), clear apple juice, or cloudy apple juice, for five day periods. Extra fluids and cloudy apple juice did not influence stool frequency and consistency compared with the basal period. In contrast, clear apple juice significantly promoted diarrhoea. It is suggested that, in addition to fructose, the increased availability of non-absorbable monosaccharides and oligosaccharides as a result of the enzymatic processing of apple pulp is an important aetiological factor in apple juice induced CNSD.

Caffeine affects the symptoms of lactose intolerance but not breath hydrogen excretion: [formula omitted], M. Yapor and E. Hernandez, Department of Pediatrics, Division of GI & Nutrition, Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY

Caffeine affects the symptoms of lactose intolerance but not breath hydrogen excretion: [formula omitted], M. Yapor and E. Hernandez, Department of Pediatrics, Division of GI & Nutrition, Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY

Tolerance and absorption of lactose from milk and yogurt during short-bowel syndrome in humans

This study aimed to compare the absorption and tolerance of 20-g lactose loads as milk and yogurt in 17 patients with short-bowel syndrome with either a terminal jejunostomy (group A, n = 6) or a jejunocolic anastomosis (group B, n = 11). Records and measurements during the 8 h after the meals included fecal weight, symptoms, lactose and hexose flow rates in stomal effluents (group A), and breath-hydrogen excretion (group B). In group A lactose was better absorbed in the form of yogurt than in the form of milk (mean +/- SE: 76 +/- 6% vs 50 +/- 9%, P < 0.05), whereas no significant difference could be detected by using the breath-hydrogen test in group B. The excellent tolerance to 20 g lactose from milk and yogurt suggests that lactose should not be excluded from the diet of these subjects.

Chemotherapy-induced lactose intolerance in adults.

Anorexia and weight loss contribute to the morbidity and mortality from cancer. This study was designed to test the hypothesis that chemotherapy produces lactose intolerance which could have an adverse effect on the nutritional status of patients receiving cytotoxic drugs. Twenty-seven patients were evaluated for the development of lactose intolerance during chemotherapy. Lactose breath hydrogen testing (LBHT) was used to assess lactose malabsorption objectively. This test is based on the principle that in patients with lactase deficiency, lactose is not hydrolyzed in the small intestine and ultimately is degraded by colonic bacteria. This results in the production of hydrogen gas, which is excreted by the lungs and can be quantified with a breath hydrogen analyzer. Of the 27 patients studied, 8 (30%) had an abnormal postchemotherapy LBHT results, and for the population as a whole, postchemotherapy LBHT values were significantly greater than prechemotherapy values (P = 0.04). However, only three patients (11%) showed clinical symptoms of lactose intolerance during the post-chemotherapy LBHT. Five patients had asymptomatic elevations in breath hydrogen excretion on prechemotherapy testing. One of these patients had a further increase in hydrogen excretion on Day 8 after chemotherapy, which was accompanied by symptoms of lactose intolerance. Twenty-two patients had normal prechemotherapy LBHT results. Two of these patients had abnormal post-chemotherapy LBHT results, which were associated with symptoms of lactose intolerance. Although chemotherapy may interfere with lactose metabolism, the development of symptomatic lactose intolerance is uncommon. Dietary restriction of milk products in patients receiving chemotherapy therefore is not warranted unless clinical symptoms of lactose intolerance are observed.

Effect of resistant starch on colonic fermentation, bile acid metabolism, and mucosal proliferation.

Resistant starch is by definition that part of starch that escapes digestion in the small bowel. Cecal fermentation of resistant starch into short-chain fatty acids will result subsequently in a decrease in pH. Thus, resistant starch may have the same effect on colonic luminal contents and mucosa as some fiber components. We studied the effects of adding 45 g native amylomaize (Hylon-VII) to a standardized diet in 14 healthy volunteers on fermentation and colonic mucosal proliferation. Hylon-VII is a high amylose maize starch, containing 62% resistant starch. During amylomaize consumption, breath hydrogen excretion rose 85% and fecal short chain fatty acid output increased 35% (P < 0.01). Excretion of primary bile acids increased and the soluble deoxycholic acid concentration decreased by 50% (P = 0.002). Subsequently, cytotoxicity of the aqueous phase of feces--as measured on a colon cancer cell line--decreased (P = 0.007). Colonic mucosal proliferation in rectal biopsies (proliferating cell nuclear antigen immunostaining) decreased from 6.7 to 5.4% (P = 0.05). We speculate that resistant starch consumption decreases colonic mucosal proliferation as a result of the decreased formation of cytotoxic secondary bile acids, which is possibly mediated through acidification of the large bowel by production of short-chain fatty acids.

Breath hydrogen excretion after oral administration of xylose to cats

ABSTRACTMaximum breath hydrogen excretion after the oral administration of xylose to 11 healthy cats ranged from 0.13 ml/hour to 0.47 ml/hour, with a mean of 0.18 ml/hour. After oral administration of xylose, breath hydrogen excretion in five cats with chronic diarrhoea and, or, vomiting was significantly different (P&lt;0.001) compared with healthy cats. Increased breath hydrogen excretion occurred before xylose was given and at all measurement times after its administration to the sick cats (P&lt;0.05), indicating carbohydrate malassimilation. In four sick cats, large increases in breath hydrogen excretion occurred, with maximum values ranging from 1.21 to 1.56 ml/hour, but in one cat the maximum value was only 0.28 ml/hour. Plasma xylose concentrations in cats with chronic diarrhoea and, or, vomiting were not significantly different from healthy cats (P&gt;0.05) and thus did not demonstrate carbohydrate malassimilation. A hiatus hernia was seen on radiographic views of the thorax and abdomen of one cat with chronic vomiting. Inflammatory bowel disease was found in three of the five sick cats after upper gastrointestinal endoscopic examination and mucosal biopsy. Clostridium species were isolated in increased numbers from the cats with chronic diarrhoea and, or, vomiting (P&lt;0.005), after quantitative bacterial culture of small intestinal fluid specimens obtained endoscopically. Clostridium species were isolated from all five cats with chronic diarrhoea and, or, vomiting but from only one of eight healthy cats. However, whether a specific bacterial pathogen caused the increased breath hydrogen excretion found in these cats could not be determined from this study.

Evaluation of liquid yeast-derived sucrase enzyme replacement in patients with sucrase-isomaltase deficiency

Background: No enzyme replacement therapy exists for patients with congenital sucrase-isomaltase deficiency (CSID). A by-product of the manufacture of baker's yeast is a liquid preparation containing high sucrase activity. The aim of the present study was to investigate the activity and stability of this preparation and its effect on breath hydrogen excretion and gastrointestinal symptoms after sucrose ingestion in 14 patients with CSID. Methods: The homogeneity of yeast sucrase was studied by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and its activity was measured. Stability at various temperatures and pH ranges and in the presence of gastric aspirate, pepsin, and bovine serum albumin was assessed. Fourteen patients with CSID underwent double-blind placebo-controlled breath tests with yeast sucrase. They then completed an 8-week dose response study that used different enzyme concentrations while consuming a sucrose-containing diet. Results: Liquid yeast sucrase is highly glycosylated, contains no lactase activity, and is stable at 4 °C and over a wide range of pH. Pepsin digestion of the enzyme in vitro can be blunted by bovine serum albumin and by increasing the pH. Yeast sucrase reduces breath hydrogen excretion in patients with CSID who are given a sucrose load (P < 0.001) and allows most patients to consume a sucrose-containing diet. Conclusions: Liquid yeast sucrase offers effective enzyme replacement therapy for patients with CSID.

Effect of an alpha-glucosidase inhibitor on intestinal fermentation and faecal lipids in diabetic patients.

Eight non-insulin-dependent diabetes mellitus patients, in whom oral hypoglycaemic agents were not effective, were treated with an alpha-glucosidase inhibitor, AO-128 (0.9 mg/day) for 6 months. After 6 months of treatment there was a statistically significant decrease in the blood glucose level 1 and 2 h postprandially. The 2 h blood glucose level was also significantly reduced after 2 months' treatment. The insulin and HbA1c levels after 2 and 6 months' treatment were lower than those before administration. Faecal weight, the frequency of bowel movements, the ratio of hydroxy fatty acids to total fatty acids, and faecal short-chain carboxylic acid content were all increased significantly during treatment. The initially hard stools became normal or soft, although no actual diarrhoea developed. Both faecal bile-acid excretion and the ratio of primary bile acids to total bile acids were increased significantly after 2 months, but they showed some recovery towards the pretreatment levels after 6 months' treatment. There was no distinct change in neutral sterol and fatty acid excretion. Breath hydrogen excretion showed a slight increase after treatment. These results suggest that intestinal fermentation was promoted and the intestinal transit time was shortened by AO-128 administration.

Intestinal bile acid malabsorption in cystic fibrosis.

This study aimed at examining the mechanisms participating in excessive faecal bile acid loss in cystic fibrosis. The study was designed to define the relation between faecal fat and faecal bile acid loss in patients with and without cystic fibrosis related liver disease; to assess terminal ileal bile acid absorption by a seven day whole body retention of selenium labelled homotaurocholic acid (SeHCAT); and to determine if small intestinal bacterial overgrowth contributes to faecal bile acid loss. The study population comprised 40 patients (27 men; median age 18 years) with cystic fibrosis (n = 8) and without (n = 32) liver disease and eight control subjects. Faecal bile acid excretion was significantly higher in cystic fibrosis patients without liver disease compared with control subjects (mean (SEM) 21.5 (2.4) and 7.3 (1.2) micromoles/kg/24 hours respectively; p < 0.01) and patients with liver disease (7.9 (1.3) micromoles/kg/24 hours; p < 0.01). No correlation was found between faecal fat (g fat/24 hours) and faecal bile acid (micromoles 24 hours) excretion. Eight (33%) of cystic fibrosis patients had seven day SeHCAT retention < 10% (normal retention > 20%). SeHCAT retention in cystic fibrosis patients with liver disease was comparable with control subjects (30.0 (SEM) 8.3% v 36.8 (5.9)%; p = NS) while SeHCAT retention in cystic fibrosis patients who did not have liver disease was significantly reduced (19.9 (3.8); p < 0.05). Although evidence of small bowel bacterial overgrowth was present in 40% of patients no relation was found between breath hydrogen excretion, faecal fat, and faecal bile acid loss. The results are consistent with the presence of an abnormality in terminal ideal function in patients with cystic fibrosis who do not have liver disease and that a defect in the ileal absorption of bile acids may be a contributory factor to excessive faecal bile acid loss. Faecal bile acid loss in cystic fibrosis is unrelated to the presence of intraluminal fat or intestinal bacterial overgrowth.

Effects of the amylose content of breakfast and lunch on postprandial variables in male volunteers

The impact of the amylose content of breakfast and lunch on postprandial variables was investigated in 22 normal-weight healthy males. Areas under the curve for insulin but not glucose were significantly smaller after the high-amylose breakfasts. Areas under the curve for both glucose and insulin were significantly smaller after the high-amylose lunches. Breath-hydrogen excretion over 14 h after breakfast indicated good digestibility of both types of meals. No systematic effect of amylose content on appetite or fullness ratings was observed. The amylose content of meals affects postprandial responses, but the effects are small and depend on meal size or composition.

Relationship between methane production and breath hydrogen excretion in lactose-malabsorbing individuals.

Recent studies have shown reduced breath hydrogen (H2) excretion in methane (CH4)-producing healthy individuals following ingestion of lactulose. This questions the reliability of the breath hydrogen test (BHT) in CH4 excretors, but the relationship between CH4 and H2 excretion in other clinical applications of the BHT is not known. We reviewed BHT results in two groups of subjects: (1) 385 children tested for lactose malabsorption in a hospital setting, and (2) 109 lactose-malabsorbing patients tested with a home kit. The percentage of lactose malabsorbers in group 1 (51%) was the same regardless of CH4-producing status (P = 0.97). The BHT data from group 2 showed a positive correlation (r = 0.6, P < 0.000001) between the magnitude of the rise in CH4 and H2 concentrations, and the H2 excretion curves were significantly higher in the CH4-producing individuals. We conclude that attention to CH4-producing status is not necessary in the interpretation of the lactose BHT.

Variability of breath hydrogen excretion in breast-fed infants during the first three months of life

Breath hydrogen excretion was measured serially in breast-fed infants. There was marked variability in H2 excretion, both within and between infants. The findings indicate that unabsorbed food is not the only substrate, and that breath H2 may not be an effective method to assess carbohydrate absorption in young infants.

Breath hydrogen excretion in healthy premature infants.

Breath hydrogen excretion during the neonatal period was studied on 84 occasions in 44 well premature infants of 27-37 weeks gestational age who all received lactose-containing feeds. Only one of 15 infants studied during the first 24 h excreted hydrogen. Thereafter, the proportion of infants excreting hydrogen increased daily. From day 5 onwards all the infants studied were found to be excreting hydrogen. The concentration and the volume of hydrogen exhaled by infants ranged from 10-230 parts/10(6) and 2.6-107 microL/min, respectively. Breath hydrogen excretion was variable and showed no relationship to birthweight, gestation period, volume of feed or the time of last feed through there was an increase with the age of the infant. Breath hydrogen excretion appears to be a normal phenomenon in premature infants and is probably related to gut colonization with lactose fermenting organisms.

Enzymes as agents for the treatment of disease

The replacement of genetically deficient enzymes in patients with inherited metabolic disorders by infusion of purified enzymes or by organ transplantation has had very limited success, although good results with bone marrow transplantation have been obtained in some patients with mucopolysaccharidosis, Gaucher disease and inherited immunodeficiency diseases. Genetic engineering of the patient's lymphocytes may ultimately render these approaches redundant, at least for some of these diseases. Treatment of chronic pancreatic insufficiency and of disaccharidase deficiency with oral enzymes can be very effective; therapy can be monitored in the latter by measuring the breath hydrogen excretion and in the former by a range of tests of which stool chymotrypsin assay is the most convenient. Treatment of acute myocardial infarction by intracoronary perfusion of thrombolytic enzymes can improve both cardiac function and long-term survival if given early enough. Successful reperfusion can be identified by changes in the kinetics of serum enzyme release and clearance, especially for the isoenzymes and isoforms of creatine kinase. In cancer chemotherapy, l-asparaginase has long been a useful adjunct in the treatment of acute lymphoblastic leukemia, but recent experience suggests a role in acute non-lymphoblastic leukemia as well.

Effect of Octreotide on Intestinal Motility and Bacterial Overgrowth in Scleroderma

Patients with scleroderma may have abnormal motility of the small intestine, with pseudoobstruction and bacterial overgrowth. Standard stimulatory agents are often ineffective in such patients. Because the somatostatin analogue octreotide evokes intestinal motor activity in normal subjects, we hypothesized that it might increase motility in patients with scleroderma. We studied the effects of octreotide on intestinal motility and plasma motilin concentrations in five fasting patients with scleroderma who had bacterial overgrowth and in six fasting normal subjects. The motor effects of octreotide were correlated with its effects on abdominal symptoms and bacterial overgrowth as determined by the level of breath hydrogen excretion. In the normal subjects, octreotide (10 micrograms subcutaneously) increased the mean (+/- SD) frequency of intestinal migrating complexes, which reflect intestinal motility, from 1.5 +/- 1.0 to 4.1 +/- 1.1 every three hours. In the patients with scleroderma, who had no spontaneous migrating complexes, octreotide (100 micrograms) induced 3.6 +/- 2.3 complexes every three hours. These complexes propagated at the same velocity and had two-thirds the amplitude of the spontaneous complexes in normal subjects. Plasma motilin concentrations, which were higher in the patients with scleroderma (229 +/- 74 pmol per liter) than in the normal subjects (112 +/- 37 pmol per liter), were inhibited by octreotide, suggesting that intestinal activity evoked by octreotide is independent of motilin. Treatment of the patients with scleroderma with octreotide (50 micrograms every evening) for three weeks reduced breath hydrogen excretion while they were fasting from 25 +/- 5 to 4 +/- 2 ppm (P = 0.001) and breath hydrogen excretion after they ingested 50 g of glucose from 46 +/- 24 to 8 +/- 7 ppm (P = 0.015); these reductions were accompanied by a significant decrease in nausea, bloating, and abdominal pain and by less frequent emesis. Octreotide stimulates intestinal motility in normal subjects and in patients with scleroderma. In such patients, the short-term administration of octreotide reduces bacterial overgrowth and improves abdominal symptoms. This agent may be useful for the treatment of intestinal dysmotility in patients with scleroderma.