Breath Hydrogen Testing in East and Southeast Asia

Abstract

Breath hydrogen tests are popular, noninvasive tests for the assessment of carbohydrate fermentation in patients with irritable bowel syndrome (IBS) and functional dyspepsia (FD). There is limited information regarding the utility of breath hydrogen and methane tests in IBS and FD patients in East and Southeast Asia. This review aims to summarize current literature about common indications of breath testing in this region, the genesis of functional gastrointestinal symptoms by provocative breath testing and provide suggestions for correct use. The most common testing indication is the assessment of lactose intolerance, followed by small intestinal bacterial overgrowth (SIBO) and differentiation of intestinal gas profiles in research setting. Studies in this region not only documented a high prevalence of lactose malabsorption but a population, both healthy and IBS, that is highly symptomatic to typical lactose intakes. Breath hydrogen assessment of other fermentable carbohydrates (FODMAPs) are fairly uncommon, whereas methane breath testing is almost nonexistent. Cumulative hydrogen production following lactulose was also not excessive in IBS patients compared with controls. The evidence however, for the detection of SIBO suggests limited reliability in the use of lactulose or glucose breath testing alone and inconclusive data on its correlation with symptoms. Conversely, little has been carried out in FD. In conclusion, breath testing should be limited in the predicting patients with SIBO for directing clinical management but can be considered in the objective assessment of lactose malabsorption within a low FODMAP diet. Recommendations to improve the interpretation of breath testing in research were also provided.

Response to Sachdeva et al.

“…Second, we agree that a validation cohort is needed; however, Gottlieb et al (3) published similar results indicating that single methane measurement predicts intestinal methanogen overgrowth (IMO). Third, we agree with the limitations of the LBT raised by the authors and Yao et al, (4) with some reservations. A common criticism, especially of LBT, is that it measures orocecal transit time as opposed to small intestinal bacterial overgrowth (SIBO).…”

The Penetration of Renewable and Sustainable Energy in Asia: A State-of-the-Art Review on Net-Metering

“…Central Asia includes Turkmenistan, Kyrgyzstan, Tajikistan, Kazakhstan, and Uzbekistan. East Asian countries are Japan, China, Hong Kong, Macao, South Korea (the Republic of Korea), North Korea, and Mongolia [134,135].…”

The potential role of lactulose pharmacotherapy in the treatment and prevention of diabetes

“…The use of lactulose may not be limited to a laxative agent. Lactulose is routinely used in the management of hepatic encephalopathy (HE), which involves the accumulation of nitrogenous waste products in the systemic circulation ( 1 ). The formation of lactic acid and small amounts of acetic and formic acids results in an acidic environment in the gut, with resultant volatile fatty acid metabolites leading to a decrease in the permeability of the gut membrane ( 2 ).…”

“…This was through increased production of endogenous hydrogen gas (H 2 ) by the fermentation of lactulose in the gut ( 59 ). Lactulose led to a higher production of the non-functional gas H 2 than other natural short-chain fermentable carbohydrates, such as lactose and fructose ( 1 ). H 2 is defined as a selective antioxidant that can selectively neutralize toxic free radicals in the body ( 59 ).…”