Hydrogen Breath Tests: Are They Really Useful in the Nutritional Management of Digestive Disease?

Abstract

Background: Carbohydrate malabsorption is a frequent digestive problem associated with abdominal pain, bloating and diarrhea. Hydrogen breath testing (BT) represents the most reliable and validated diagnostic technique. The aim of this manuscript was to clarify the usefulness of BTs in the nutritional management of these disorders. Methods: A literature search for BT related to carbohydrate malabsorption was carried out using the online databases of Pubmed, Medline and Cochrane. Results: Lactose BT showed good sensitivity and optimal specificity for lactose malabsorption. However, an accurate diagnosis of lactose intolerance should require blind lactose challenge although this method is difficult to utilize in clinical practice. Regarding dose-depending fructose and sorbitol malabsorption, BTs could not add diagnostic advantage compared with a direct dietary intervention. In addition, carbohydrates are fundamental components of fermentable oligo-, di- and monosaccharides and polyols (FODMAPs). Before starting a low FODMAP diet, lactose BT should be suggested in a population with low prevalence of hypolactasia. Conclusions: BTs represent a valid and noninvasive technique in many digestive conditions. Regarding the management of carbohydrate intolerance, lactose BT can be recommended with some limitations. No sufficient evidence is available about the usefulness of BTs for other sugars in clinical practice.

Lactose Malabsorption and Presumed Related Disorders: A Review of Current Evidence

“…Absorption of lactose requires lactase-phlorizin hydrolase (LPH) activity in the small intestinal brush border. LM is directly caused by LPH deficiency, namely hypolactasia [ 2 , 3 , 4 , 5 , 6 ]. Hypolactasia comprises three distinct forms: congenital, primary and secondary [ 3 , 5 ].…”

“…LM is directly caused by LPH deficiency, namely hypolactasia [ 2 , 3 , 4 , 5 , 6 ]. Hypolactasia comprises three distinct forms: congenital, primary and secondary [ 3 , 5 ].…”

“…Primary hypolactasia occurs in a large proportion of the population, and it is the most frequent condition related to LM [ 5 ]. In particular, primary lactase deficiency is related to an autosomal recessive condition resulting from the physiological and progressive decline of lactase activity in the intestinal brush border [ 5 ]. A single nucleotide polymorphism, C/T-13910, has been correlated with lactase persistence or not persistence in several populations [ 5 , 8 ].…”

“…As a consequence of an osmotic action that increases the volume of intestinal contents, the undigested lactose is fermented by the colonic flora, exacerbating digestive symptoms. Non-invasive hydrogen breath testing (BT) is generally considered the most reliable and recommended diagnostic technique [ 5 , 6 ] to detect LM. On the other hand, LI is not synonymous with LM.…”

“…In fact, only some patients with LM report symptoms. A blind lactose challenge should be the recommended method to objectively demonstrate LI [ 5 ]. A lactose-restricted diet and the use of pharmacological lactase supplements represent the recommended therapeutic strategy.…”