Breath hydrogen in pneumatosis cystoides intestinalis.

Abstract

SUMMARY Pneumatosis cystoides intestinalis (PCI) is an uncommon condition of unknown aetiology. Bacterial gas production may be an important aetiological factor, but experimental evidence in humans has been lacking. We have studied breath hydrogen excretion as an index of bacterial gas production in 12 patients with PCI and have shown that four out of five with demonstrable cysts produced unusually high levels of hydrogen while fasting. This abnormality has not been previously reported. One patient showed resolution of PCI after antibiotic treatment. These findings confirm the importance of bacterial gas production in the pathogenesis of PCI.There has been much speculation about the aetiology of pneumatosis cystoides intestinalis (PCI), an uncommon condition characterised by the presence of gas-filled cysts within the walls and mesentery of the intestine. The most widely accepted theories have proposed a mechanical origin for the cysts (Koss 1952;Keyting et al., 1961), but mechanical theories alone fail to account for the finding that hydrogen, a gas never produced by mammalian cells, may comprise up to 50 % of the gas content of the cysts (Forgacs et al., 1973).Measurement of breath hydrogen is now an established method of studying bacterial activity in the intestine (Hepner, 1974) and we have therefore studied breath hydrogen excretion in our patients with PCI.

Computed tomography in pneumatosis intestinalis: Differential diagnosis and therapeutic consequences

“…The released hydrogen diffuses into the intestinal wall and becomes trapped, thus forming the cysts seen in pneumatosis cystoides intestinalis. The increase in, or premature excretion of, hydrogen in the expired air seen subsequent to a carbohydrate-loading test [7] is consistent with this theory. Case 5, who presumably developed a pneumatosis cystoides intestinalis due to an intestinal pseudoobstruction, exhibited premature H2 expiration, a sign of bacterial overgrowth in the small intestine.…”

Pneumatosis Intestinalis in Adults: Management, Surgical Indications, and Risk Factors for Mortality

“…9 The intraluminal theory suggests that air travels across the bowel wall because of pressure and/or mucosal compromise. 10,11 The bacterial theory hypothesizes that bacteria invade a compromised mucosal wall and then release hydrogen. 12,13 A combination of factors is also possible, with pulmonary obstruction, for example, leading to intraabdominal pressure fluctuations that then enhance air movement across the compromised bowel wall.…”

Breath Hydrogen (H2) and Methane (CH4) Excretion Patterns in Normal Man and in Clinical Practice

“…These may include the study of small intestinal transit time [Bond and Levitt, 1975;, the metabolism of dietary fibre in the colon [Hickey, Calloway and Murphy, 1972;Tadesse and Eastwood, 1978), the diagnosis of disaccharidase deficiencies [Calloway and Murphy, 1968;Metz, Gassull, Leeds, Blendis and Jenkins, 1976;Newcomer, Thomas, McGill and Hofmann, 1977], small intestinal bacterial colonisation [Metz, Gassull, Drasar, Jenkins and Blendis, 1976] and pneumatosis cystoides intestinalis [Gillon, Tadesse, Logan, Holt and Sircus, 1978; Van der Linden and Marsell, 1979], and the study of bacterial activity in the gut [Gilat, Ben Hur, Gelman-Malachi, Terdiman and Peled, 1978]. The central principle in most tests is that any carbohydrate which is not digested and absorbed in the upper small intestinal tract (i.e.…”