Hydrogen breath test in patients with severe constipation: the interference of the mixing of intestinal content

M, Di Stefano; Mengoli, Caterina; Bergonzi, M.; Miceli, Emanuela; Pagani, Elisabetta

doi:10.1111/nmo.12456

Cited by 11 publications

(11 citation statements)

References 19 publications

(32 reference statements)

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“…We excluded patients with constipation because it has been reported that constipation patients may harbor preformed gas in hard stools, and the gas can be released when mixing of the intestinal content is induced [27]. In our study, no patients had a BSFS of 1 or 2, which has been reported to be associated with preformed gas in the stool [27].…”

Section: Discussionmentioning

confidence: 99%

Effect of Rice, Wheat, and Mung Bean Ingestion on Intestinal Gas Production and Postprandial Gastrointestinal Symptoms in Non-Constipation Irritable Bowel Syndrome Patients

et al. 2019

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The aim of this study is to evaluate the effect of rice, mung bean, and wheat noodle ingestion on intestinal gas production and postprandial gastrointestinal (GI) symptoms in non-constipation irritable bowel syndrome (IBS) patients. Methods: Twenty patients (13 F, 46 ± 11 y) underwent 8 h breath test studies and GI symptom evaluations after standard rice, wheat, or mung bean noodle meals at 8:00 a.m. in a randomized crossover study with a 1-week washout period. The same meal was ingested at 12:00 p.m. Results: The H2 and CH4 concentration in the breath samples were similar at baseline (rice:wheat:mung bean, H2 = 3.6 ± 0.5:4.1 ± 0.5:4.0 ± 0.7 ppm, CH4 = 1.3 ± 0.3:2.1 ± 0.4:1.9 ± 0.4 ppm, p > 0.05). Beginning at the fifth hour after breakfast, H2 and CH4 concentrations significantly increased after wheat compared to rice and mung bean (8 h AUC H2 = 4120 ± 2622:2267 ± 1780:2356 ± 1722, AUC CH4 = 1617 ± 1127:946 ± 664:943 ± 584 ppm-min, respectively) (p < 0.05). Bloating and satiety scores significantly increased after wheat compared to rice (p < 0.05), and increased but did not reach statistical significance compared to mung bean (p > 0.05). A higher bloating score after wheat compared to rice and mung bean was observed clearly after lunch but not after breakfast. Conclusion: Wheat ingestion produced more intestinal gas and more bloating and satiety scores compared to rice and mung bean, especially after lunch. This provides insight into the role of intestinal gas in the development of bloating symptoms in IBS.

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Section: Discussionmentioning

confidence: 99%

Effect of Rice, Wheat, and Mung Bean Ingestion on Intestinal Gas Production and Postprandial Gastrointestinal Symptoms in Non-Constipation Irritable Bowel Syndrome Patients

et al. 2019

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“…In this regard, asymptomatic and/or symptomatic patients as well as GFD non‐responders were considered. Certainly, another source of heterogeneity may be caused by the possibility that a severe constipation or the persistence of intraluminal substrates in CD may affect the results of BT . On the other hand, only one analyzed study reported the values of fasting hydrogen breath excretion, ie, an additional criterion for SIBO diagnosis, and it showed that levels were similar between CD and controls (7 vs 8 ppm, P =.34).…”

Section: Discussionmentioning

confidence: 99%

“…However, some controversial aspects are highlighted by our analysis. Indeed, only three studies were designed as case-control trials and even the control groups were not homogeneously selected, therefore 45,46 On the other hand, only one analyzed study 27 reported the values of fasting hydrogen breath excretion, ie, an additional criterion for SIBO diagnosis, and it showed that levels were similar between CD and controls (7 vs 8 ppm, P=.34). In conclusion, due to these factors of heterogeneity, we attempted to reduce the variability through subgroup analysis, when feasible.…”

Section: Discussionmentioning

confidence: 99%

Small intestinal bacterial overgrowth and celiac disease: A systematic review with pooled‐data analysis

Losurdo

Marra

Shahini

et al. 2017

Neurogastroenterology Motil

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“…A relationship has not been observed between the degree of glycemia elevation and baseline H 2 . This may be explained by the fact that glycemia is not influenced by the factors that increase baseline H 2 production, such as not following the recommended diet or the release of H 2 retained in the small bowel [19]. As LTT results are independent from baseline H 2 levels, LTT emerges as an alternative to HBT in patients with elevated baseline H 2 for whom HBT is not recommended.…”

Section: Discussionmentioning

confidence: 99%

Lactose tolerance test as an alternative to hydrogen breath test in the study of lactose malabsorption

Sendino

Sandúa

Calleja

et al. 2020

Advances in Laboratory Medicine / Avances en Medicina De Laboratorio

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ObjectivesLactose malabsorption is generally assessed by hydrogen breath testing (HBT). However, this test is not recommended in patients with high baseline hydrogen concentrations (H2B). In addition, breath testing is not recommended in the current situation created by the COVID-19 pandemic, due to the potential infectiveness of the samples. The objective is to assess concordance between HBT and lactose tolerance test (LTT) depending on H2B concentrations.MethodsA total of 430 patients (40 years, Q1–Q3 = 28–54 years; 66.7% women) suspected of lactose malabsorption were included in the study. Breath and heparinized blood samples were collected at baseline and sequentially after the intake of 50 g of lactose, to measure hydrogen in breath and glycemia in blood, respectively.ResultsH2B was <10 ppm in 69.5% of subjects; 10–20 ppm in 14.7%; and >20 ppm in 15.8% of subjects. In patients with H2B <20 ppm, concordance between HBT and LTT was moderate and consistently improved when the cut-off in LTT was set at 15 mg/dL. The increase in hydrogen and glucose correlated negatively (r=−0.389; p<0.05). The increase in glycemia during LTT was not influenced by H2B levels obtained in HBT.ConclusionsLTT emerges as an alternative to HBT to assess lactose malabsorption in the presence of high H2B levels or when breath testing is not recommended by the circumstances. The best concordance was obtained when the cut-off for LTT was set at 15 mg/dL.

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Hydrogen breath test in patients with severe constipation: the interference of the mixing of intestinal content

Abstract: Severely constipated patients may harbor preformed gas in hard stools which can be released when mixing of the intestinal content is induced. This mechanism may interfere with breath test results.

Cited by 11 publications

References 19 publications

Effect of Rice, Wheat, and Mung Bean Ingestion on Intestinal Gas Production and Postprandial Gastrointestinal Symptoms in Non-Constipation Irritable Bowel Syndrome Patients

Effect of Rice, Wheat, and Mung Bean Ingestion on Intestinal Gas Production and Postprandial Gastrointestinal Symptoms in Non-Constipation Irritable Bowel Syndrome Patients

Small intestinal bacterial overgrowth and celiac disease: A systematic review with pooled‐data analysis

Lactose tolerance test as an alternative to hydrogen breath test in the study of lactose malabsorption

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