Semiquantitative assessment of breath hydrogen testing
Article first published online: 22 AUG 2013
© 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd
Journal of Gastroenterology and Hepatology
Volume 28, Issue 9, pages 1450–1456, September 2013
How to Cite
Barrett, J. S., Kalubovila, U., Irving, P. M. and Gibson, P. R. (2013), Semiquantitative assessment of breath hydrogen testing. Journal of Gastroenterology and Hepatology, 28: 1450–1456. doi: 10.1111/jgh.12199
- Issue published online: 22 AUG 2013
- Article first published online: 22 AUG 2013
- Accepted manuscript online: 21 MAR 2013 05:26AM EST
- Manuscript Accepted: 6 MAR 2013
- diarrhea and malabsorption < gastroenterology;
- functional disorders < gastroenterology;
- IBD: clinical trials < gastroenterology
Background and Aim
A major use of breath hydrogen testing is to assess absorptive capacity for sugars to assist dietary design for management of gut symptoms. Qualitative reporting takes no account of the vigor of hydrogen response and provides little insight into degrees of malabsorption. This study aimed to describe a semiquantitative reporting method and to compare results with those reported qualitatively.
In consecutive Caucasian patients with Crohn's disease (n = 87), ulcerative colitis (59), functional gastrointestinal disorders (FGID) (162), and healthy controls (76), area under the curve was calculated for lactulose (15 g). This was compared with that for lactose (50 g) and fructose (35 g). Degree of malabsorption was categorized into arbitrary groups.
Semiquantitative results for ≥ 30% (designated “convincing”) malabsorption was most similar to those using a qualitative cutoff value of 20 ppm, but in 38% and 21% of patients, the classification of malabsorption (nil or clinically significant) changed for fructose and lactose, respectively. Using a cutoff of 10 ppm, 49% and 5% were classified differently. Crohn's disease had a higher prevalence (42%) of convincing fructose malabsorption than controls (24%) or patients with FGID (33%) (P < 0.02). Highest prevalence of convincing lactose malabsorption (38%) was in ulcerative colitis, greater than controls (18%) and FGID (18%) (P < 0.02).
Semiquantitative assessment provides different results with different clinical implications in more than one third of patients, but disease-related alterations in prevalence are similar to those defined qualitatively. This method may be preferable because it lessens the confounding influence of the vigor of the hydrogen response.