Breath Test Research Articles

Comparison of metronidazole versus clarithromycin in first-line vonoprazan-based triple therapy for Helicobacter pylori: A multicenter randomized trial in Japan.

To date, no randomized trials have compared the efficacy of 7-day vonoprazan, amoxicillin, and metronidazole triple therapy (VAM) versus 7-day vonoprazan, amoxicillin, and clarithromycin triple therapy (VAC) as a first-line treatment for Helicobacter pylori eradication. This study was performed to compare the efficacy of VAM and VAC as first-line treatments. This prospective multicenter randomized trial was performed in Japan and involved 124 H. pylori-positive patients without a history of eradication. Patients without antibiotic resistance testing of H. pylori were eligible. The patients were randomized to receive either VAC (vonoprazan 20 mg + amoxicillin 750 mg + clarithromycin 200 or 400 mg twice a day) or VAM (vonoprazan 20 mg + amoxicillin 750 mg + metronidazole 250 mg twice a day) for 7 days, with stratification by age and sex. Eradication success was evaluated using the 13C-urea breath test. We evaluated safety using patient questionnaires (UMIN000025773). The intention-to-treat and per-protocol eradication rates of VAM were 91.3% (95% confidence interval [CI], 82.0-96.7%) and 92.6% (95% CI, 83.7-97.6%), respectively, and those of VAC were 89.1% (95% CI, 77.8-95.9%) and 96.1% (95% CI, 86.5-99.5%), respectively. No significant difference was observed between VAM and VAC in either analysis (P = 0.76 and P = 0.70, respectively). Abdominal fullness was more frequent in patients who received VAM than VAC. These findings suggest that VAM as a first-line treatment in Japan can be categorized as grade B (intention-to-treat cure rate of 90-95%) and have potential as a first-line national insurance -approved regimen.

Effect of implementation strategies on the routine provision of antenatal care addressing smoking in pregnancy: study protocol for a non-randomised stepped-wedge cluster controlled trial

IntroductionGlobally, guideline-recommended antenatal care for smoking cessation is not routinely delivered by antenatal care providers. Implementation strategies have been shown to improve the delivery of clinical practices across a variety...

Various Diagnostic Methods for <i>Helicobacter pylori</i> Infection

<i>Helicobacter pylori</i> (<i>H. pylori</i>) is a bacterium that colonizes the human stomach, leading to various gastrointestinal diseases including gastritis, peptic ulcers, and gastric cancer. There is no gold standard test that relies entirely on one method in <i>H. pylori</i> diagnosis. We must be aware of the pros and cons of various testing methods to perform an appropriate test according to the situation. Accurate diagnosis and eradication therapy are essential for disease management. Diagnostic methods include invasive techniques like tissue biopsy and rapid urease test, as well as non-invasive tests such as urea breath test, serology test, and stool antigen test. Each method has its advantages and limitations, requiring careful consideration in clinical practice. Understanding these diagnostic tools is crucial for effective <i>H. pylori</i> management and prevention of associated complications.

Practices of Gastroenterologists in Cameroon on the Management of Helicobacter Pylori Infection

Background: In Africa and Cameroon in particular, there is no consensus guideline for diagnosis and treatment of Helicobacter pylori infection (HPI). The aim of this study was to describe the current practices on management of H. pylori infection among gastroenterologists in Cameroon and compare with existing guidelines. Methods: This was an observational and descriptive study from October 1st 2020- July 31st 2021. All consenting gastroenterologist practicing in Cameroon were consecutively included. Data collected included socio-demographic and clinical data (pre-eradication diagnostic tests, treatment schemes and drug regimens, post-eradication control test). Data obtained was analyzed using IBM-SPSS version 26.0. Results: Fifty participants were approached among which 40 responded giving a response rate of 80%. The mean age of participants was 47.8 ±10.8 years with a male predominance with a sex ratio of 1.85. The median number of years of practice as a gastroenterologist was 9 years (IQR 5.0-18.8). The main pre-eradication diagnostic tests were histology (82.5 %). The main treatment protocols used as first line for eradication were: non-bismuth concomitant quadruple therapy for 28 participants (70.0%). Thirteen participants (32.5%) routinely requested for eradication control. The main post-eradication control test used included: urea breathe test; 22 participants (55.0%), histology; 13 participants (32.5%). Conclusion: In Cameroon most gastroenterologists had practices like those recommended in the developed world on the management of HPI with some degree of variability. This variability in practices observed highlights the need for local guidelines based on empirical evidence of treatment efficacy, available diagnostic test, and costefficiency.

Detection and clinical application of red blood cell survival.

There are 2 techniques for detecting red blood cell survival (RBCS) detection techniques: red blood cell labeling test and carbon monoxide (CO) breath test. The former has disadvantages such as long measurement times and complicated procedures, while the latter is simple, convenient, moderately priced, and capable of dynamically monitoring changes in RBCS before and after treatment. Currently, the CO breath test is gradually being implemented in clinical practice. RBCS is not only applied to hematologic diseases such as multiple myeloma, myelodysplastic syndromes, lymphoma, and thalassemia, but also to non-hematologic diseases like type 2 diabetes and chronic kidney disease. It can assist in diagnosis, guide treatment, evaluate drug treatment efficacy, and predict disease progression.

Measurement uncertainty of ethyl alcohol concentration in the exhaled breath of drivers and determination of sobriety at the time of incident.

The aim of the study was to determine the components of measurement uncertainty in the concentration of alcohol in exhaled breath and to determine the state of sobriety at the time of incident. Based on the literature review and the authors' experience in providing opinions for law enforcement and the judiciary, the influence of various factors on the final interpretation of sobriety state is described on the basis of measurement uncertainty of breath analyzers, uncertainty of retrospective and prospective calculations, and uncertainty related to the conversion of alcohol concentrations detected during breath and blood tests. The paper pays particular attention to interpreting the concentrations of ethanol in exhaled breath close to the legal limits of the state of sobriety and the state after alcohol use, or the state after alcohol use and the state of insobriety. Analyzing the results of an exhaled breath test concerning concentrations close to the values of 0.1 mg/dm3 and 0.25 mg/dm3, it is necessary to take into account the factors affecting the measurements obtained, including the measurement uncertainty of the determination of alcohol in exhaled breath, the processes of absorption, distribution and metabolism of ethyl alcohol, and the possibility of the presence of alcohol lingering in the oral cavity. The incorrect execution of measurements of the tested person's alcohol concentration is also a problematic issue. When determining sobriety state by means of retrospective and prospective calculations, it is important to remember that the uncertainty of the result is affected by a number of factors and depends, among other things, on the information provided by the suspect. Hence, the expert should draw conclusions particularly cautiously and any overestimation or underestimation of the components of uncertainty can lead to erroneous conclusions. Awareness of the uncertainties inherent in the results of a sobriety test or alcohol calculation allows for meaningful interpretation of test results and determination of the sobriety state of the person tested.

Distinguishing thrombotic thrombocytopenic purpura from primary immune thrombocytopenia accompanied by anemia using the carbon monoxide breath test

ABSTRACT Objectives Thrombotic thrombocytopenic purpura (TTP) is a rare but life-threatening hematological disorder. Early differentiation between TTP and primary immune thrombocytopenia (ITP) accompanied by anemia is crucial to initiate an appropriate therapeutic strategy. The objective of this study was to evaluate the predictive value of red blood cell lifespan (RBCLS), determined using the carbon monoxide breath test, in the differential diagnosis of these two diseases. Methods We conducted a retrospective analysis of 23 patients with TTP and 32 patients with ITP accompanied by anemia. RBCLS measurements were compared and evaluated between these two patient groups. Results TTP patients had a significantly shorter mean RBCLS (20 ± 8 days) than patients with ITP accompanied by anemia (77 ± 22 days, P < 0.001) and healthy controls (114 ± 25 days, P < 0.001). In TTP patients, RBCLS showed a significant negative correlation with reticulocyte percentage and lactic dehydrogenase levels (P < 0.001). When using a standard baseline of 75 days, RBCLS demonstrated a sensitivity of 100% and specificity of 53.1% in identifying TTP. The diagnostic accuracy could reach 93% by excluding the impact of gastrointestinal bleeding. By employing the Receiver Operator Characteristics (ROC) curve, the area under the curve for RBCLS was 0.985 (95% CI: 0–1, P < 0.01) in predicting TTP, with an optimal cut-off value of 32 days, and sensitivity and specificity of 95.7% and 96.9%, respectively. Conclusions Our study proposes a simple and accessible method for evaluating RBCLS to differentiate between TTP and ITP accompanied by anemia.

Minimally Invasive Approaches to Diagnose and Monitor Eosinophilic GI Diseases.

This review seeks to understand novel avenues for eosinophilic GI disease management. Biomarkers offer a unique and non-invasive approach to tracking EoE disease progression. While no biomarkers have definitively met the diagnostic criteria for eosinophilic GI diseases, some biomarkers have been shown to be associated with disease activity. Here, we examine the potential of recently studied biomarkers. Current research shows advancements in blood, luminal fluid, and breath testing. Particular areas of interest include mRNA analyses, protein fingerprinting, amplicon sequence variants (ASVs), T cells and IgE receptors, eosinophilic cationic proteins, cytokines, and nitric oxide exhalation. Preliminary results showed that mucosal biomarkers, directly captured from the esophagus, may reflect the best representation of biopsy-based results, in contrast to biomarkers obtained from indirect or peripheral (blood, breath) methods. However, this is based on limited clinical studies without sufficient numbers to evaluate true diagnostic accuracy. Large-scale randomized trials are needed to fully ascertain both the optimal sampling technique and the specific biomarkers that reflect diagnostic status of the disease.

Small Intestine Bacterial Overgrowth is associated with increased Campylobacter and epithelial injury in duodenal biopsies of Bangladeshi children.

Small intestine bacterial overgrowth (SIBO) has been associated with enteric inflammation, linear growth stunting, and neurodevelopmental delays in children from low-income countries. Little is known about the histologic changes or epithelial adherent microbiota associated with SIBO. We sought to describe these relationships in a cohort of impoverished Bangladeshi children. Undernourished 12-18-month-old children underwent both glucose hydrogen breath testing for SIBO and duodenoscopy with biopsy. Biopsy samples were subject to both histological scoring and 16s rRNA sequencing. 118 children were enrolled with 16s sequencing data available on 53. Of 11 histological features, we found that SIBO was associated with one, enterocyte injury in the second part of the duodenum (R = 0.21, p = 0.02). SIBO was also associated with a significant increase in Campylobacter by 16s rRNA analysis (Log 2-fold change of 4.43; adjusted p = 1.9 x 10-6). These findings support the growing body of literature showing an association between SIBO and enteric inflammation and enterocyte injury and further delineate the subgroup of children with environmental enteric dysfunction who have SIBO. Further, they show a novel association between SIBO and Campylobacter. Mechanistic work is needed to understand the relationship between SIBO, enterocyte injury, and Campylobacter.

Liver Stiffness Determined by Transient Elastography Is a Simple and Highly Accurate Predictor for Presence of Liver Cirrhosis in Clinical Routine

Introduction: Early detection of patients with advanced chronic liver disease is critical for the prevention of complications and inclusion in surveillance programs for hepatocellular carcinoma. In daily clinical care, it remains challenging to differentiate early cirrhosis from lower fibrosis grades without performing a liver biopsy. The aim of the present study was to assess the performance of different non-invasive detection tools to differentiate cirrhosis from lower fibrosis grades. Methods: Data of 116 patients (51 male, 65 female) with chronic liver disease of various origins undergoing liver biopsy was analyzed. Routine laboratory values, liver stiffness measurement (LSM) by transient elastography, and histological liver assessment were collected. Results: Robust and significant correlations with the histological fibrosis stage were identified for LSM (r = 0.65), the FAST score (0.64), the FIB-4 (0.48), serum aspartate aminotransferase (AST) concentration (0.41), NFS (0.33), international normalized ratio (INR; 0.30), methacetin breath test results (−0.40), and serum albumin concentration (−0.29) by spearman rank correlation. Receiver operating characteristic curves were built for these parameters to separate patients with cirrhosis from those with any other fibrosis stage. The highest AUC was achieved by LSM (0.9130), followed by the FAST score (0.8842), the FIB-4 (0.8644), the NFS (0.8227), INR (0.8142), serum albumin (0.7710), and serum AST (0.7620). The most promising clinical applicability would be an LSM value of 12.2 kPa, achieving 95.7% sensitivity and 75.3% specificity. Conclusion: LSM and FAST score seem to be robust non-invasive measurements for liver fibrosis. LSM and FAST scores may have the potential to reliably detect patients with liver cirrhosis in clinical routine settings.

Breath metabolomics for diagnosis of acute respiratory distress syndrome

BackgroundAcute respiratory distress syndrome (ARDS) poses challenges in early identification. Exhaled breath contains metabolites reflective of pulmonary inflammation.AimTo evaluate the diagnostic accuracy of breath metabolites for ARDS in invasively ventilated intensive care unit (ICU) patients.MethodsThis two-center observational study included critically ill patients receiving invasive ventilation. Gas chromatography and mass spectrometry (GC–MS) was used to quantify the exhaled metabolites. The Berlin definition of ARDS was assessed by three experts to categorize all patients into “certain ARDS”, “certain no ARDS” and “uncertain ARDS” groups. The patients with “certain” labels from one hospital formed the derivation cohort used to train a classifier built based on the five most significant breath metabolites. The diagnostic accuracy of the classifier was assessed in all patients from the second hospital and combined with the lung injury prediction score (LIPS).ResultsA total of 499 patients were included in this study. Three hundred fifty-seven patients were included in the derivation cohort (60 with certain ARDS; 17%), and 142 patients in the validation cohort (47 with certain ARDS; 33%). The metabolites 1-methylpyrrole, 1,3,5-trifluorobenzene, methoxyacetic acid, 2-methylfuran and 2-methyl-1-propanol were included in the classifier. The classifier had an area under the receiver operating characteristics curve (AUROCC) of 0.71 (CI 0.63–0.78) in the derivation cohort and 0.63 (CI 0.52–0.74) in the validation cohort. Combining the breath test with the LIPS does not significantly enhance the diagnostic performance.ConclusionAn exhaled breath metabolomics-based classifier has moderate diagnostic accuracy for ARDS but was not sufficiently accurate for clinical use, even after combination with a clinical prediction score.

The role of intestinal microbiota in the development of dysfunction of the biliary system in children

Objective: to study the state of the intestinal and biliary microbiota in children with intestinal and gallbladder dysfunction and to determine the features of the component composition of the biliary microbiota. Methods: We examined 20 children with irritable bowel syndrome (IBS). The presence of small intestinal bacterial overgrowth (SIBO) syndrome was determined (using a hydrogen breath test with lactulose), microbial markers of the intestinal and biliary microbiota (using gas chromatography-mass spectrometry). We also performed microscopy of bile (phase-contrast light microscopy) obtained through duodenal intubation. Results: In all children with IBS, SIBO was verified in the small intestine, with insufficiency of the ileocecal valve in half of them, associated with hypomotor dyskinesia of the gallbladder. Microscopy of the bile revealed a large number of crystals and leukocytes. A study of microbial markers of intestinal and biliary microbiota in all children with IBS and SIBO revealed excessive bacterial associative growth of gram-negative opportunistic bacteria in combination with viruses of the Herpes family. An increase in the level of lipopolysaccharides (2 times higher than normal) and a deficiency of microbial markers of the main groups of microorganisms (anaerobic bacteria) responsible for metabolization processes in the enterohepatic circulation (plasmalogen less than 50 μg/ml) were recorded. Excessive growth of 28 species of opportunistic bacteria was detected in bile in diagnostically significant concentrations associated with hypomotor dysfunction of the gallbladder and lithogenicity of bile. Conclusion: A violation of the biliary microbiota was established with an increase in the proportion of gram-negative opportunistic bacteria, the spectrum of which was close to that of the intestine and their association with intestinal and biliary dyskinesia

Acute Helicobacter pylori infection prevalence and association with metabolic abnormality in general Chinese population: A retrospective study.

Helicobacter pylori (H pylori) infection was common worldwide and previous researches on the correlation between H pylori infection and metabolic abnormality provided inconsistent conclusions. We assessed acute H pylori infection prevalence and the relationship with metabolic abnormality in general Chinese population. Participants attending for the physical examination underwent a carbon-13 urea breath test. For individual, the following data were collected: age, gender, body mass index (BMI), systolic blood pressure, diastolic blood pressure, total protein, albumin, globulin (GLB), total bilirubin, direct bilirubin (DBIL), indirect bilirubin, alanine transaminase, glutamyl transpeptidase, alkaline phosphatase, cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, urea nitrogen, creatinine, uric acid, fasting plasma glucose (FPG), and homocysteine. A total of 29,154 participants were enrolled. The prevalence of acute H pylori infection was 29.79% (8684/29,154). Spearson correlation analysis showed that gender, BMI, ALB, GLB, total bilirubin, DBIL, indirect bilirubin, and FPG were closely related to H pylori infection. Multinomial logistic regressions analysis with stepwise subset selection further identified gender, BMI, ALB, GLB, DBIL, and FPG as independent risk factors for acute H pylori infection. Our results indicated that acute H pylori infection might has a significant impact on metabolic abnormalities, which should be further confirmed.

Volatilomic profiles of gastric juice in gastric cancer patients

Volatilomics is a powerful tool capable of providing novel biomarkers for the diagnosis of gastric cancer. The main objective of this study was to characterize the volatilomic signatures of gastric juice in order to identify potential alterations induced by gastric cancer. Gas chromatography with mass spectrometric detection, coupled with headspace solid phase microextraction as the pre-concentration technique, was used to identify volatile organic compounds (VOCs) released by gastric juice samples collected from 78 gastric cancer patients and two cohorts of controls (80 and 96 subjects) from four different locations (Latvia, Ukraine, Brazil, and Colombia). 1440 distinct compounds were identified in samples obtained from patients and 1422 in samples provided by controls. However, only 6% of the VOCs exhibited an incidence higher than 20%. Amongst the volatiles emitted, 18 showed differences in their headspace concentrations above gastric juice of cancer patients and controls. Ten of these (1-propanol, 2,3-butanedione, 2-pentanone, benzeneacetaldehyde, 3-methylbutanal, butylated hydroxytoluene, 2-pentyl-furan, 2-ethylhexanal, 2-methylpropanal and phenol) appeared at significantly higher levels in the headspace of the gastric juice samples obtained from patients; whereas, eight species showed lower abundance in patients than found in controls. Given that the difference in the volatilomic signatures can be explained by cancer-related changes in the activity of certain enzymes or pathways, the former set can be considered potential biomarkers for gastric cancer, which may assist in developing non-invasive breath tests for the diagnosis of this disease. Further studies are required to elucidate further the mechanisms that underlie the changes in the volatilomic profile as a result of gastric cancer.

Equivalence Trial of the Non-Bismuth 10-Day Concomitant and 14-Day Hybrid Therapies for Helicobacter pylori Eradication in High Clarithromycin Resistance Areas.

Background and aim: We conducted an equivalence trial of quadruple non-bismuth "concomitant" and "hybrid" regimens for H. pylori eradication in a high clarithromycin resistance area. Methods: There were 321 treatment-naïve H. pylori-positive individuals in this multicenter clinical trial randomized to either the hybrid (esomeprazole 40 mg/bid, amoxicillin 1 g/bid for 7 days, then 7 days esomeprazole 40 mg/bid, amoxicillin 1 g/bid, clarithromycin 500 mg/bid, and metronidazole 500 mg/bid) or the concomitant regimen (all medications given concurrently bid for 10 days). Eradication was tested using histology and/or a 13C-urea breath test. Results: The concomitant regimen had 161 patients (90F/71M, mean 54.5 years, 26.7% smokers, 30.4% ulcer) and the hybrid regimen had 160 (80F/80M, mean 52.8 years, 35.6% smokers, 31.2% ulcer). The regimens were equivalent, by intention to treat 85% and 81.8%, (p = 0.5), and per protocol analysis 91.8% and 87.8%, (p = 0.3), respectively. The eradication rate by resistance, between concomitant and hybrid regimens, was in susceptible strains (97% and 97%, p = 0.6), clarithromycin single-resistant strains (86% and 90%, p = 0.9), metronidazole single-resistant strains (96% and 81%, p = 0.1), and dual-resistant strains (70% and 53%, p = 0.5). The side effects were comparable, except for diarrhea being more frequent in the concomitant regimen. Conclusions: A 14-day hybrid regimen is equivalent to a 10-day concomitant regimen currently used in high clarithromycin and metronidazole resistance areas. Both regimens are well tolerated and safe.

The Adult Carbohydrate Perception Questionnaire Identifies Patients with Lactose or Fructose Intolerance Who Respond to Diet

Plain Language SummaryIntolerance to lactose- or fructose-containing foods is an important reason for diarrhoea, bloating, gas in the abdomen, abdominal pain, nausea, and passing of wind through the anus. In the past, in order to diagnose intolerance, breath tests after ingestion of lactose or fructose have commonly been used, and the results of these breath tests had been used to suggest treatments like diet or food supplements. However, recent scientific publications have shown that the results of breath tests do not predict the response to treatment. It has also been suggested that the documentation of symptoms after ingestion of lactose or fructose with a questionnaire may be better in identifying patients who will benefit from treatment. Such a questionnaire was recently developed and shown to be reliable and useful for the diagnosis of lactose or fructose intolerance. The questionnaire is called adult Carbohydrate Perception Questionnaire (aCPQ). In the current study, we demonstrated that patients with intolerance to lactose or fructose, which was confirmed by a positive result on this aCPQ, benefited significantly from the dietary treatment. The degree of symptom improvement was greatest in patients with the most severe symptoms before treatment. The response to treatment in intolerance was independent of whether or not patients had a positive breath test. The results of this study, however, are preliminary and need to be confirmed by larger controlled studies.

Screening and diagnosis of respiratory diseases using metamaterial based sensitive terahertz impedance spectroscopy

Utilizing LC resonant metamaterials (MM) for terahertz (THz) impedance spectroscopy has opened new avenues for detection of biomolecules and nanoparticles. A recent revelation highlights the pivotal role of coupling between MM resonance and Fabry-Pérot (FP) oscillations of the substrate. This interaction significantly influences the observed spectral shift (ΔF), thereby enhancing the overall sensitivity. In this work, we utilize the FP-MM optical decoupling physics for sensitivity enhancement to detect bio-particles at extremely low concentrations, thereby overcoming the particle detection limit. After implementing these innovations, we discovered that this technology can be leveraged to detect and screen patients infected with the omicron variant of SARS-CoV-2 and other lung related diseases using exhaled breath from patients. Upon achieving excellent agreement between simulations and experimental spectroscopic data, we have successfully detected and screened multiple respiratory-related diseases from the exhaled breath collected on the metasurface in a breathalyzer configuration. We obtained significant ΔF even with ultra-low concentrations of bio-particles and demarcated the ranges of ΔF for different lung diseases that do no overlap and are not constrained by any limit of detection. This work reveals new prospects for diagnosis and screening of multiple respiratory-related diseases with a single and prompt breath test.

Added Value of 13C Analysis in Breath Tests in H2-Negative Subjects to Diagnose Lactose Malabsorption: A Proof of Concept Study.

Diagnosing lactose malabsorption is usually based on hydrogen excretion in breath after a lactose challenge. However, a proportion of subjects with lactose malabsorption will not present a rise in hydrogen. Measuring excretion of methane or stable isotope labeled 13CO2 after ingestion of 13C-lactose has been proposed to mitigate this problem. The aim of the study was to assess the performance of measuring methane and 13CO2 in individuals with normal hydrogen excretion compared to a genetic lactase non-persistence test. Individuals referred for lactose breath testing and healthy controls were included. Participants received 13C-enriched lactose, performed breath testing, and underwent genotyping for a marker of lactase non-persistence (13910C*T). Using genotype as gold standard, the performance of measuring methane and 13CO2 excretion was assessed. 151 subjects participated in the study, 50 of which presented a lactase non-persistent genotype. Of these, 72% were correctly diagnosed through hydrogen excretion of ≥ 20ppm above baseline. In subjects with normal hydrogen excretion, cumulative 13C excretion had an area under the curve (AUC) of the receiver operating characteristics (ROC) curve of 0.852. Sensitivity was 93% and specificity was 51% for the current cutoff of 14.5%. The optimal cutoff was 12.65% (sensitivity 93%, specificity 70%). The ROC curve of peak methane had an AUC of 0.542 (sensitivity of 14%, specificity of 91% for cutoff ≥ 10ppm). In individuals with genetically demonstrated lactase non-persistence and negative hydrogen breath test, the use of 13C-lactose with measurement of 13CO2 excretion and hydrogen is a well-performing test to detect the lactose malabsorption and performs better than methane in our cohort.

Dysbiosis and nutrition in steatotic liver disease: addressing the unrecognized small intestinal bacterial overgrowth (SIBO) challenge.

Steatotic liver disease (SLD) is characterized by hepatic fat accumulation, potentially causing major consequences such as liver decompensation. Currently, we lack medications for the treatment of SLD. Therapeutic recommendations for patients include a hypocaloric diet, weight loss, and physical activity. In particular, the Mediterranean diet is frequently recommended. However, this diet might exacerbate intestinal problems in a subset of patients with coexisting small intestinal bacterial overgrowth (SIBO). Previous studies have reported that SIBO is more predominant in patients with fatty liver than in healthy individuals. Both our research and the findings of others have highlighted a challenge related to nutritional therapy in patients with fatty liverwho also suffer from SIBO inasmuch as SIBO induces several phenomena (like bloating or abdominal pain) that can adversely affect patients' quality of life and might be exacerbated by the Mediterranean diet. This may lower their adherence to the intervention. As a solution, we suggest introducing additional diagnostics (e.g., breath test) in patients with SLD who complain of SIBO-like symptoms. The next step is to modify their diets temporarily starting with several weeks of "elimination and sanitation." This would involve restricting products rich in fermentable sugars and polyols, while simultaneously treating the bacterial overgrowth. In summary, while the hypocaloric Mediterranean diet is beneficial for patients with fatty liver, those with coexisting SIBO may experience exacerbated symptoms. It is vital to consider additional diagnostics and dietary modifications for this subset of patients to address both liver and intestinal health concurrently.

The 13C glucose breath test accurately identifies insulin resistance in people with type 1 diabetes.

This study investigated whether the delta-over-baseline of exhaled 13CO2 (Δ13CO2), generated from a 13C glucose breath test (13C-GBT), measured insulin resistance (IR) in people with type 1 diabetes, using the hyperinsulinemic-euglycemic clamp (HEC) as reference method. Secondary objective was to compare the 13C-GBT with the estimated glucose disposal rate (eGDR). A 40 mU/m2/min HEC and two separate 13C-GBTs (euglycemic with insulin bolus and hyperglycemic without bolus) were consecutively performed in 44 adults with type 1 diabetes with varying body compositions. eGDR was calculated based on HbA1c, presence of hypertension and waist circumference. Mean M-value was 5.9 ± 3.1 mg/kg/min, mean euglycemic Δ13CO2 was 6.4 ± 2.1 δ‰, while median eGDR was 5.9 [4.3 - 9.8] mg/kg/min. The hyperglycemic Δ13CO2 did not correlate with the M-value, while the euglycemic Δ13CO2 and the M-value correlated strongly (r = 0.74, p < 0.001). Correlation between M-value and eGDR was more moderate (Spearman's rho = 0.63, p < 0.001). Linear regression showed an association between Δ13CO2 and M-value, adjusted for age, sex and HbA1c (adjusted R² = 0.52, B = 1.16, 95% CI 0.80 - 1.52, p < 0.001). The AUROC for Δ13CO2 to identify subjects with IR (M-value < 4.9 mg/kg/min) was 0.81 (95% CI 0.68 - 0.94, p < 0.001). The optimal cut-off for Δ13CO2 to identify subjects with IR was ≤ 5.8 δ‰. Under euglycemic conditions, the 13C-GBT accurately identified individuals with type 1 diabetes and concurrent IR, suggesting its potential as a valuable non-invasive index.