Digestive Diseases and Sciences

, Volume 52, Issue 5, pp 1253–1258 | Cite as

Breath Hydrogen Test in the Diagnosis of Environmental Enteropathy in Children Living in an Urban Slum

  • Jairo César dos Reis
  • Mauro Batista de Morais
  • Carlos Alberto Garcia Oliva
  • Ulysses Fagundes-Neto
Original Paper


The aim of this study was to evaluate the breath hydrogen test in the diagnosis of small intestine bacterial overgrowth associated with asymptomatic environmental enteropathy in children living in an urban slum. Fifty school-age children living in a slum and 50 children who attended a private health clinic in the same town were included in the study. Breath hydrogen test was carried out after the administration of lactulose or glucose on two different days. Bacterial overgrowth was diagnosed when the hydrogen concentration increased more than 20 ppm in a sample collected for up to 60 min. Production of hydrogen was greater after the ingestion of lactulose than after the ingestion of glucose. Bacterial overgrowth was noted in 37.5% of the children living in the slum and in 2.1% of the control group (P < 0.001). The children living in the slum presented a higher proportion of bacterial overgrowth when lactulose was used in the breath hydrogen test.


Breath hydrogen test Environmental enteropathy Glucose Lactulose Children Small intestine bacterial overgrowth 


  1. 1.
    Fagundes-Neto U (1996) Enteropatia ambiental. Revinter, Rio de JaneiroGoogle Scholar
  2. 2.
    Morais MB, Fagundes-Neto U (2003) Enteropatia ambiental. Estud Avançados 17:137–148Google Scholar
  3. 3.
    Klipstein FA (1970) Recent advances in tropical malabsorption. Scand J Gastroenterol Suppl 6:93–114PubMedGoogle Scholar
  4. 4.
    Gerson CD, Kent TH, Saha JR, Siddiqi N, Lindenbaum J (1971) Recovery of small-intestinal structure and function after residence in the tropics. II. Studies in Indians and Pakistanis living in New York City. Ann Intern Med 75(1):41–48PubMedGoogle Scholar
  5. 5.
    Fagundes-Neto U, Viaro T, Wehba J, Patrício FR, Machado NL (1983) Enteropatia tropical: na infância: uma síndrome decorrente da contaminação ambiental (enteropatia ambiental). J Pediatr (Rio de J) 54:313–319Google Scholar
  6. 6.
    Fagundes-Neto U, Viaro T, Wehba J, Patrício FR, Machado NL (1984) Tropical enteropathy (environmental enteropathy) in early childhood: a syndrome caused by contaminated environment. J Trop Pediatr 30(4):204–209PubMedGoogle Scholar
  7. 7.
    Morais MB, Fagundes Neto U, Machado NL (1984) Enteropatia ambiental em criancas moradoras na periferia da cidade de Sao Paulo. J Pediatr (Rio de J.) 57(1):32–36Google Scholar
  8. 8.
    King CE, Toskes PP (1979) Small intestine bacterial overgrowth. Gastroenterology 76:1035–1055PubMedGoogle Scholar
  9. 9.
    Lichtman SN (2000) Bacterial overgrowth. In: Walker A, Durie PR, Hamilton JR, Walker-Smith JÁ, Watkins (eds) Pediatric gastrointestinal disease. Decker, Hamilton, Ontario, pp 569–582Google Scholar
  10. 10.
    Morais MB, Fagundes Neto U (2004) Small-bowel bacterial overgrowth. In: Guandalini S (ed) Textbook of pediatric gastroenterology and nutrition. Parthenon, Lancaster, pp 201–212Google Scholar
  11. 11.
    Metz G, Gassul MA, Drasar BS, Jenkis DJA, Blendis LM (1976) Breath hydrogen test for small intestinal bacterial colonization. Lancet 1:668–669PubMedCrossRefGoogle Scholar
  12. 12.
    Rhodes JM, Middleton P, Jewell DP (1979) The lactulose hydrogen breath test as a diagnostic test for small bowel bacterial overgrowth. Scand J Gastroenterol 14:333–336PubMedCrossRefGoogle Scholar
  13. 13.
    King CE, Toskes PP (1984) A breath tests in the diagnosis of small intestine bacterial overgrowth. Crit Rev Clin Lab Sci 21:269PubMedCrossRefGoogle Scholar
  14. 14.
    Corazza G, Menozzi GM, Strocchi A, Rascitil L, Vaira D, Lecchini R, Avanzini P, Chezzi C, Gasbarrini G (1990) The diagnosis of small bowel bacterial overgrowth. Gastroenterology 98:302–309PubMedGoogle Scholar
  15. 15.
    Riordan SM, McIver CJ, Wakefield D, Bolin TD, Ducombe VM, Thomas MC (2000) Evaluation of the rice breath hydrogen test for small intestinal bacterial overgrowth. Am J Gastroenterol 95:2858–2864PubMedCrossRefGoogle Scholar
  16. 16.
    Pereira SP, Khin-Maung U, Bolin TD, Duncombe VM, Nyunt-Nyunt W, Myo-Khin, Linklater JM: A pattern of breath hydrogen excretion suggesting small bowel bacterial overgrowth in Burmese village children. J Pediatr Gastroenterol Nutr 13:32–38Google Scholar
  17. 17.
    Reis JC, Morais MB, Fagundes-Neto U (1999) Teste do H2 no ar expirado na avaliação de absorção de lactose e sobrecrescimento bacteriano no intestino delgado de escolares. Arq Gastroenterol 36:169–176PubMedCrossRefGoogle Scholar
  18. 18.
    Alves GMS, Morais MB, Fagundes-Neto U (2002) Estado nutricional e teste do hidrogênio no ar expirado com lactose e lactulose em crianças indígenas Terenas. J Pediatr (Rio J) 78:113–119CrossRefGoogle Scholar
  19. 19.
    Vanderhoof JA, Young RJ, Murray N, Kaufman S (1998) Treatment strategies for small bowel bacterial overgrowth in small bowel syndrome. J Pediatr Gastroenterol Nutr 27:155–160PubMedCrossRefGoogle Scholar
  20. 20.
    Thompson DG, O’Brien JD, Haardie JM (1986) Influence of the oropharyngeal microflora on the measurement of exhaled breath hydrogen. Gastroenterology 91:853–860PubMedGoogle Scholar
  21. 21.
    Dean AG, Dean JA, Coulombier D, Brendel KA, Smith DC, Burton AH (1994) Epi info 2000: a word processor database and statistics program for epidemiology on microcomputers. Center for Disease Control and Prevention, Atlanta, GAGoogle Scholar
  22. 22.
    World Health Organization (1995) Physical status. The use and interpretation of antropometry. WHO Technical Report Series 854. WHO, GenevaGoogle Scholar
  23. 23.
    Jandel (1995) Sigma Stat Statistical Software 2.0Google Scholar
  24. 24.
    Silva NS (2001) Cultura de bactérias aeróbias e anaeróbias e teste do hidrogênio no ar expirado no diagnóstico de sobrecrescimento bacteriano no intestino delgado. Tese, Universidade Federal de São Paulo, São Paulo, BrazilGoogle Scholar

Copyright information

© Springer Science&#x002B;Business Media, Inc. 2006

Authors and Affiliations

  • Jairo César dos Reis
    • 1
  • Mauro Batista de Morais
    • 2
    • 3
  • Carlos Alberto Garcia Oliva
    • 2
  • Ulysses Fagundes-Neto
    • 2
  1. 1.Division of PediatricsUniversity of MaríliaMariliaBrazil
  2. 2.Federal University of Sao PauloSao PauloBrazil
  3. 3.Sao PauloBrazil

Personalised recommendations