Helicobacter pylori infection and lactose intolerance increase expiratory hydrogen

Schnedl, Wolfgang J.; Meier-Allard, Nathalie; Lackner, Sonja; Enko, Dietmar; Mangge, Harald; Holasek, Sandra

doi:10.17179/excli2021-4508

Cited by 2 publications

(2 citation statements)

References 29 publications

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“…This appears in more than half of patients with complaints on the IBS spectrum and requires not only the restriction of lactose intake but also additional diets to improve GI complaints [ 3 ]. Various combinations of food malabsorption/intolerance [ 5 ], including infection with Helicobacter pylori [ 11 ], were demonstrated to influence LIT breath test results in patients with IBS spectrum complaints. Here we demonstrate that, in our evaluation, at least 50 percent of consecutive LIT patients have additional food intolerance/malabsorption with low serum diamine oxidase (DAO) values, indicating additional histamine intolerance (HIT).…”

Section: Discussionmentioning

confidence: 99%

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Serum Diamine Oxidase Values, Indicating Histamine Intolerance, Influence Lactose Tolerance Breath Test Results

Schnedl¹,

Meier-Allard

Michaelis

et al. 2022

Nutrients

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Lactose intolerance (LIT) is one of the major causes of irritable bowel syndrome (IBS) spectrum complaints. Differences in inadequate lactose digestion are described as various LIT phenotypes with basically unknown pathophysiology. In LIT patients, we retrospectively assessed the effect of histamine intolerance (HIT) on expiratory hydrogen (H2) during H2 lactose breath tests. In a retrospective evaluation of charts from 402 LIT patients, 200 patients were identified as having only LIT. The other 202 LIT patients were found to additionally have diamine oxidase (DAO) values of <10 U/mL, which indicates histamine intolerance (HIT). To identify HIT, standardized questionnaires, low serum DAO values and responses to a histamine-reduced diet were used. Patients were separated into three diagnostic groups according to the result of H2 breath tests: (1) LIT, with an H2 increase of >20 parts per million (ppm), but a blood glucose (BG) increase of >20 mg/dL, (2) LIT with an H2 increase of 20 ppm in combination with a BG increase of <20 mg/dL, and (3) LIT with an exhaled H2 increase of <20 ppm and BG increase of <20 mg/dL. Pairwise comparison with the Kruskal Wallis test was used to compare the areas under the curve (AUC) of LIT and LIT with HIT patients. Exhaled H2 values were significantly higher in H2 > 20 ppm and BG < 20 mg/dL patients with LIT and HIT (p = 0.007). This diagnostic group also showed a significant higher number of patients (p = 0.012) and a significant higher number of patients with gastrointestinal (GI) symptoms during H2 breath tests (p < 0.001). Therefore, low serum DAO values, indicating HIT, influence results of lactose tolerance breath tests.

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Section: Discussionmentioning

confidence: 99%

“…High end-expiratory H 2 levels on lactose breath tests increase the likelihood of additional food intolerance/malabsorption and/or also Helicobacter pylori infection [ 5 , 11 ]. We suggest that in LIT patients, HIT offers an additional option for patients to put complaints of the IBS spectrum into context.…”

Section: Discussionmentioning

confidence: 99%

Serum Diamine Oxidase Values, Indicating Histamine Intolerance, Influence Lactose Tolerance Breath Test Results

Schnedl¹,

Meier-Allard

Michaelis

et al. 2022

Nutrients

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Fecal Calprotectin Elevations Associated with Food Intolerance/Malabsorption Are Significantly Reduced with Targeted Diets

et al. 2023

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Inflammatory bowel disease (IBD) involves two clinically defined entities, namely Crohn’s disease and ulcerative colitis. Fecal calprotectin (FCAL) is used as a marker to distinguish between organic IBD and functional bowel disease in disorders of the irritable bowel syndrome (IBS) spectrum. Food components may affect digestion and cause functional abdominal disorders of the IBS spectrum. In this retrospective study, we report on FCAL testing to search for IBD in 228 patients with disorders of the IBS spectrum caused by food intolerances/malabsorption. Included were patients with fructose malabsorption (FM), histamine intolerance (HIT), lactose intolerance (LIT), and H. pylori infection. We found elevated FCAL values in 39 (17.1%) of 228 IBS patients with food intolerance/malabsorption and H. pylori infection. Within these, fourteen patients were lactose intolerant, three showed fructose malabsorption, and six had histamine intolerance. The others had combinations of the above conditions: five patients had LIT and HIT, two patients had LIT and FM, and four had LIT and H. pylori. In addition, there were individual patients with other double or triple combinations. In addition to LIT, IBD was suspected in two patients due to continuously elevated FCAL, and then found via histologic evaluation of biopsies taken during colonoscopy. One patient with elevated FCAL had sprue-like enteropathy caused by the angiotensin receptor-1 antagonist candesartan. When screening for study subjects concluded, 16 (41%) of 39 patients with initially elevated FCAL agreed to voluntarily control FCAL measurements, although symptom-free and -reduced, following the diagnosis of intolerance/malabsorption and/or H. pylori infection. After the initiation of a diet individualized to the symptomatology and eradication therapy (when H. pylori was detected), FCAL values were significantly lowered or reduced to be within the normal range.

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Helicobacter pylori infection and lactose intolerance increase expiratory hydrogen

Cited by 2 publications

References 29 publications

Serum Diamine Oxidase Values, Indicating Histamine Intolerance, Influence Lactose Tolerance Breath Test Results

Serum Diamine Oxidase Values, Indicating Histamine Intolerance, Influence Lactose Tolerance Breath Test Results

Fecal Calprotectin Elevations Associated with Food Intolerance/Malabsorption Are Significantly Reduced with Targeted Diets

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