Significance of hydrogen breath tests in children with suspected carbohydrate malabsorption

Däbritz, Jan; Mühlbauer, Michael; Domagk, Dirk; Voos, Nicole; Henneböhl, Geraldine; Siemer, M.-L.; Foell, Dirk

doi:10.1186/1471-2431-14-59

Cited by 36 publications

(46 citation statements)

References 35 publications

(54 reference statements)

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“…Therefore, the majority of the patients showed an improvement of symptoms after the fructose-free diet, which further confounds the validity of testing with 50 g fructose. These high-rate findings are congruent with findings of other groups [27,30,31]. But, a dosage of 50 g fructose might lead to a substantial amount of false positive respondents.…”

Section: Strengths and Limitationssupporting

confidence: 82%

The Predictive Value of the Hydrogen Breath Test in the Diagnosis of Fructose Malabsorption

et al. 2018

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Background: Fructose malabsorption is commonly diagnosed by the hydrogen fructose (H₂) breath test. However, the mechanisms behind fructose malabsorption in humans are not well understood and the clinical relevance of this test is considered controversial. Hence, the main aim of this study is to evaluate the predictive value of the H₂ breath test. Methods: Regarding exclusion criteria, the study enrolled 562 consecutive patients, enlisted to a gastroenterology clinic between 2009 and 2011 for testing malabsorption. In the final data analysis, 246 patients were included. Ecotrophologists used 3 categories to rate dietary success: complete response, partial response and no response to the diet. They also rated the occurrence of abdominal pain, diarrhoea and bloating during the H₂ breath test. Ordinal regression analysis using SPSS was performed to evaluate whether H₂ breath test results – measured as the maximum H₂ level, the maximum increase in H₂, and the area under the curve (AUC) – predicted dietary success or failure. Correlation analyses were applied to test whether symptoms of fructose malabsorption correlated with the H₂ breath test measures. Finally, we evaluated whether cut-off-values of 40 or 60 parts per million (ppm) serve better than the test measure of 20 ppm to diagnose fructose malabsorption. Results: When a fructose-free diet was administered it was found that 103 patients (41.9%) were complete responders, 116 (47.2%) were partial responders and 27 (11%) were non-responders. The H₂ breath test with the 20 ppm cut-off-value, that is, the maximum H₂ level, the maximum increase in H₂, and the AUC did not predict dietary response (all 95% CI ns). This was also the case when using 40 or 60 ppm as cut-off-values (all 95% CI ns). Abdominal pain during the test correlated significantly with the AUC. Diarrhoea and bloating correlated significantly with the AUC, the maximum H₂ level and the maximum increase in H₂ (p < 0.05). Conclusions: The H₂ breath test produced no predictive value for the fructose-free diet outcomes; its value as a predictive test is therefore questionable. However, the symptoms of fructose malabsorption correlated significantly with the H₂ breath test measures, and this is an indication that there is at least a degree of validity of the H2 breath test beyond the simple detection or exclusion of fructose malabsorption.

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Section: Strengths and Limitationssupporting

confidence: 82%

The Predictive Value of the Hydrogen Breath Test in the Diagnosis of Fructose Malabsorption

et al. 2018

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“…Of these, 121 (55%) had fructose malabsorption, of whom 93 (77%) had improvement on a dietitian-recommended low-fructose diet. Dabritz et al [27] included fructose hydrogen breath testing in their review and found that 55/142 (39%) children had fructose malabsorption. As several in the Dabritz cohort had multiple positive carbohydrate tests, the number of children who specifically responded to a fructose-restricted diet is unclear.…”

Section: Carbohydrate Intolerancementioning

confidence: 99%

“…Hyams [28] published a case report describing a 15-year-old girl with chronic abdominal pain attributed to sorbitol ingestion from sugar-free gum which improved with elimination of the sorbitol source. In their retrospective study of hydrogen breath testing in children with RAP, Dabritz et al [27] found that 109/146 (75%) children had sorbitol malabsorption; 27/31 (87%) improved on a sorbitol-restricted diet.…”

Section: Carbohydrate Intolerancementioning

confidence: 99%

Dietary Carbohydrates and Childhood Functional Abdominal Pain

Chumpitazi

Shulman²

2016

Ann Nutr Metab

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Childhood functional gastrointestinal disorders (FGIDs) affect a large number of children throughout the world. Carbohydrates (which provide the majority of calories consumed in the Western diet) have been implicated both as culprits for the etiology of symptoms and as potential therapeutic agents (e.g., fiber) in childhood FGIDs. In this review, we detail how carbohydrate malabsorption may cause gastrointestinal symptoms (e.g., bloating) via the physiologic effects of both increased osmotic activity and increased gas production from bacterial fermentation. Several factors may play a role, including: (1) the amount of carbohydrate ingested; (2) whether ingestion is accompanied by a meal or other food; (3) the rate of gastric emptying (how quickly the meal enters the small intestine); (4) small intestinal transit time (the time it takes for a meal to enter the large intestine after first entering the small intestine); (5) whether the meal contains bacteria with enzymes capable of breaking down the carbohydrate; (6) colonic bacterial adaptation to one's diet, and (7) host factors such as the presence or absence of visceral hypersensitivity. By detailing controlled and uncontrolled trials, we describe how there is a general lack of strong evidence supporting restriction of individual carbohydrates (e.g., lactose, fructose) for childhood FGIDs. We review emerging evidence suggesting that a more comprehensive restriction of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) may be effective. Finally, we review how soluble fiber (a complex carbohydrate) supplementation via randomized controlled intervention trials in childhood functional gastrointestinal disorders has demonstrated efficacy.

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“…Children under the age of 10 years have a reduced capacity to absorb fructose, and yet this age group typically consumes large amounts in the form of fruit and/or fruit juices as well as high-fructose corn syrup. Limiting this ingredient alone or in combination with other culprits may be an effective approach to alleviate IBS symptoms in pediatrics 10 .…”

Section: Nutritional Interventions For Ibsmentioning

confidence: 99%

A nutritional approach for managing irritable bowel syndrome

Bhesania

Cresci²

2017

Current Opinion in Pediatrics

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Purpose of review Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder encountered by the pediatrician and consultant. The primary focus of this review is to provide an update on beneficial nutritional interventions for managing this patient population with discussion on gut microbiome effects. Recent findings A common complaint amongst the pediatric population is IBS-related recurrent abdominal pain. The prevalence of IBS is estimated to range between 6%–14% and is defined by the Rome III criteria for functional gastrointestinal disorders. Recent studies highlight the role of nutritional interventions in mitigating symptoms of IBS. While eliminating foods which aggravate IBS gastrointestinal symptoms has become a main nutritional approach for acute management of IBS, recent literature reflects how this may impact the gut microbiome and potentially have long-term implications. Summary There are emerging studies suggesting IBS symptomatic improvement with different dietary interventions in the pediatric population, but most of what is known at this time has been extrapolated from the adult literature.

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Significance of hydrogen breath tests in children with suspected carbohydrate malabsorption

Cited by 36 publications

References 35 publications

The Predictive Value of the Hydrogen Breath Test in the Diagnosis of Fructose Malabsorption

The Predictive Value of the Hydrogen Breath Test in the Diagnosis of Fructose Malabsorption

Dietary Carbohydrates and Childhood Functional Abdominal Pain

A nutritional approach for managing irritable bowel syndrome

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