Indian Journal of Clinical Biochemistry

, Volume 29, Issue 4, pp 398–405 | Cite as

Hydrogen Breath Tests in Gastrointestinal Diseases

  • Satya Vati RanaEmail author
  • Aastha Malik
Review Article


Hydrogen breath tests are widely used to explore pathophysiology of functional gastrointestinal (GI) disorders. Small intestinal bacterial overgrowth (SIBO) and carbohydrate malabsorption are disorders detected by these tests that have been proposed to be of great importance for symptoms of GI diseases. Glucose hydrogen breath test is more acceptable for diagnosis of SIBO whereas lactose and fructose hydrogen breath tests are used for detection of lactose and fructose maldigestion respectively. Lactulose hydrogen breath test is also used widely to measure the orocecal transit time for GI motility. These methods are noninvasive and inexpensive. Many patients with functional gut disorders are unaware of the relationship between diet and GI symptoms they present. In particular, patients with chronic symptoms may regard their condition as normal and may not be aware that their symptoms can be effectively managed following a proper diagnosis. Patients with symptoms of abdominal pain, bloating, flatulence and altered bowel movements (diarrhea and constipation), or with a medical diagnosis of irritable bowel syndrome or celiac disease, may have undiagnosed carbohydrate malabsorption or SIBO. Hydrogen breath tests are specific and sensitive diagnostic tests that can be used to either confirm or eliminate the possibility of carbohydrate malabsorption or SIBO in such patients. Breath tests, though valuable tools, are underutilized in evaluating dyspepsia and functional bloating and diarrhea as well as suspected malabsorption. However, because of their simplicity, reproducibility and safety of procedure they are now being substituted to more uncomfortable and expensive techniques that were traditionally used in gastroenterology.


Hydrogen breath tests Carbohydrate malabsorption Small intestinal bacterial overgrowth Orocecal transit time 


  1. 1.
    Harger RN, Forney RB, Barnes HB. Estimation of the level of blood alcohol from the analysis of breath. In: First international conference on alcohol and traffic, Stockholm, Sweden; 1950. pp. 107–21.Google Scholar
  2. 2.
    Borkenstein RF, Smith H. The breathalyzer and its application. Med Sci Law. 1961;2:13–22.Google Scholar
  3. 3.
    Pauling L, Robinson AB, Teranishi R, Cary P. Quantitative analysis of urine vapor and breath by gas–liquid partition chromatography. Proc Natl Acad Sci USA. 1971;68:2374–6.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Newcomer AD, McGill DB, Thomas PJ, Hofmann AF. Prospective comparison of indirect methods for detecting lactase deficiency. N Engl J Med. 1975;293:1232–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Bond JH, Levitt MD. Effect of dietary fiber on intestinal gas production and small bowel transit time in man. Am J Clin Nutr. 1978;31(10 Suppl):S169–74.PubMedGoogle Scholar
  6. 6.
    Bond JH, Levitt MD. Use of breath hydrogen (H2) to quantitate small bowel transit time following partial gastrectomy. J Lab Clin Med. 1977;90:30–6.PubMedGoogle Scholar
  7. 7.
    Srinivasan R, Minocha A. When to suspect lactose intolerance; symptomatic, ethnic, and laboratory clues. Postgrad Med. 1998;104:109–23.PubMedCrossRefGoogle Scholar
  8. 8.
    Solomons NW, García-Ibañez R, Viteri FE. Hydrogen breath test of lactose absorption in adults: the application of physiological doses and whole cow’s milk sources. Am J Clin Nutr. 1980;33:545–54.PubMedGoogle Scholar
  9. 9.
    Rana S, Bhasin DK, Gupta D, Mehta SK. Assessment of optimal dose of lactose for lactose hydrogen breath test in Indian adults. Indian J Gastroenterol. 1995;14:13–4.PubMedGoogle Scholar
  10. 10.
    Qiao R, Hung CY, Zeng G, Vonk RJ, Li L, Ye S. Study on the lowest acceptable intake of cow’s milk for healthy adults. Wei Sheng Yan Jiu. 2006;35:747–9.PubMedGoogle Scholar
  11. 11.
    Levitt MD, Engel RR. Intestinal gas. Adv Intern Med. 1975;20:151–65.PubMedGoogle Scholar
  12. 12.
    Oberacher M, Pohl D, Vavricka SR, Fried M, Tutuian R. Diagnosing lactase deficiency in three breaths. Eur J Clin Nutr. 2011;65:614–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Rana SV, Bhasin DK, Naik N, Subhiah M, Ravinder P. Lactose maldigestion in different age groups of north Indians. Trop Gastroenterol. 2004;25:18–20.PubMedGoogle Scholar
  14. 14.
    Yang Y, He M, Cui H, Bian L, Wang Z. The prevalence of lactase deficiency and lactose intolerance in Chinese children of different ages. Chin Med J (Engl). 2000;113:1129–32.PubMedGoogle Scholar
  15. 15.
    Gupta D, Ghoshal UC, Misra A, Misra A, Choudhuri G, Singh K. Lactose intolerance in patients with irritable bowel syndrome from northern India: a case–control study. J Gastroenterol Hepatol. 2007;22:2261–5.PubMedCrossRefGoogle Scholar
  16. 16.
    Rana SV, Mandal AK, Kochhar R, Katyal R, Singh K. Lactose intolerance in different types of irritable bowel syndrome in north Indians. Trop Gastroenterol. 2001;22:202–4.PubMedGoogle Scholar
  17. 17.
    Babu J, Kumar S, Babu P, Prasad JH, Ghoshal UC. Frequency of lactose malabsorption among healthy southern and northern Indian populations by genetic analysis and lactose hydrogen breath and tolerance tests. Am J Clin Nutr. 2010;91:140–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Kochhar R, Mehta SK, Goenka MK, Mukherjee JJ, Rana SV, Gupta D. Lactose intolerance in idiopathic ulcerative colitis in north Indians. Indian J Med Res. 1993;98:79–82.PubMedGoogle Scholar
  19. 19.
    Cabrera-Acosta GA, Milke-García MP, Ramírez-Iglesias MT, Uscanga L. Deficient lactose digestion and intolerance in a group of patients with chronic nonspecific ulcerative colitis: a controlled, double-blind, cross-over clinical trial. Rev Gastroenterol Mex. 2012;77:26–30.PubMedGoogle Scholar
  20. 20.
    Ginard D, Riera J, Bonet L, Barranco L, Reyes J, Escarda A, et al. Lactose malabsorption in ulcerative colitis. A case–control study. Gastroenterol Hepatol. 2003;26:469–74.PubMedCrossRefGoogle Scholar
  21. 21.
    Skoog SM, Bharucha AE, Zinsmeister AR. Comparison of breath testing with fructose and high fructose corn syrups in health and IBS. Neurogastroenterol Motil. 2008;20:505–11.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Andersson DE, Nygren A. Four cases of long-standing diarrhoea and colic pains cured by fructose-free diet—a pathogenetic discussion. Acta Med Scand. 1978;203:87–92.PubMedCrossRefGoogle Scholar
  23. 23.
    Nelis GF, Vermeeren MA, Jansen W. Role of fructose-sorbitol malabsorption in the irritable bowel syndrome. Gastroenterology. 1990;99:1016–20.PubMedGoogle Scholar
  24. 24.
    Symons P, Jones MP, Kellow JE. Symptom provocation in irritable bowel syndrome. Effects of differing doses of fructose–sorbitol. Scand J Gastroenterol. 1992;27:940–4.PubMedCrossRefGoogle Scholar
  25. 25.
    Rao SSC, Attaluri A, Anderson L, Stumbo P. The ability of the normal human small intestine to absorb fructose: evaluation by breath testing. Clin Gastroenterol Hepatol. 2007;5:959–63.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Densupsoontorn N, Jirapinyo P, Thamonsiri N, Wongarn R. Fructose malabsorption in Thai adult. Asia Pac J Clin Nutr. 2007;16:209–12.PubMedGoogle Scholar
  27. 27.
    Reyes-Huerta JU, de la Cruz-Patiño E, Ramírez-Gutiérrez de Velasco A, Zamudio C, Remes-Troche JM. Fructose intolerance in patients with irritable bowel syndrome: a case–control study. Rev Gastroenterol Mex. 2010;75:405–11.PubMedGoogle Scholar
  28. 28.
    Metz G, Gassull MA, Drasar BS, Jenkins DJ, Blendis LM. Breath-hydrogen test for small-intestinal bacterial colonisation. Lancet. 1976;1(7961):668–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Posserud I, Stotzer PO, Björnsson ES, Abrahamsson H, Simrén M. Small intestinal bacterial overgrowth in patients with irritable bowel syndrome. Gut. 2007;56:802–8.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Pimentel M, Park S, Mirocha J, Kane SV, Kong Y. The effect of a nonabsorbed oral antibiotic (rifaximin) on the symptoms of the irritable bowel syndrome: a randomized trial. Ann Intern Med. 2006;145:557–63.PubMedCrossRefGoogle Scholar
  31. 31.
    Rana SV, Sinha SK, Sikander A, Bhasin DK, Singh K. Study of small intestinal bacterial overgrowth in North Indian patients with irritable bowel syndrome: a case control study. Trop Gastroenterol. 2008;29:23–5.PubMedGoogle Scholar
  32. 32.
    Yakoob J, Abbas Z, Khan R, Hamid S, Awan S, Jafri W. Small intestinal bacterial overgrowth and lactose intolerance contribute to irritable bowel syndrome symptomatology in Pakistan. Saudi J Gastroenterol. 2011;17:371–5.PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Sachdeva S, Rawat AK, Reddy RS, Puri AS. Small intestinal bacterial overgrowth (SIBO) in irritable bowel syndrome: frequency and predictors. J Gastroenterol Hepatol. 2011;26(Suppl 3):135–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Ghoshal UC, Kumar S, Mehrotra M, Lakshmi C, Misra A. Frequency of small intestinal bacterial overgrowth in patients with irritable bowel syndrome and chronic non-specific diarrhea. J Neurogastroenterol Motil. 2010;16:40–6.PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Reddymasu SC, Sostarich S, McCallum RW. Small intestinal bacterial overgrowth in irritable bowel syndrome: are there any predictors? BMC Gastroenterol. 2010;10:23.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Rana SV, Sinha SK, Lal S, Sikander A, Singh K. Small intestinal bacterial overgrowth in North Indian patients with celiac disease. Trop Gastroenterol. 2007;28:159–61.PubMedGoogle Scholar
  37. 37.
    Ghoshal UC, Ghoshal U, Misra A, Choudhuri G. Partially responsive celiac disease resulting from small intestinal bacterial overgrowth and lactose intolerance. BMC Gastroenterol. 2004;4:10.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Tursi A, Brandimarte G, Giorgetti G. High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal. Am J Gastroenterol. 2003;98:839–43.PubMedCrossRefGoogle Scholar
  39. 39.
    Yang CY, Chang CS, Chen GH. Small-intestinal bacterial overgrowth in patients with liver cirrhosis, diagnosed with glucose H2 or CH4 breath tests. Scand J Gastroenterol. 1998;33:867–71.PubMedCrossRefGoogle Scholar
  40. 40.
    Morencos FC, de las Heras Castaño G, Martín Ramos L, López Arias MJ, Ledesma F, Pons Romero F. Small bowel bacterial overgrowth in patients with alcoholic cirrhosis. Dig Dis Sci. 1995;40:1252–6.PubMedCrossRefGoogle Scholar
  41. 41.
    Gupta A, Dhiman RK, Kumari S, Rana SV, Agarwal R, Duseja A, et al. Role of small intestinal bacterial overgrowth and delayed gastrointestinal transit time in cirrhotic patients with minimal hepatic encephalopathy. J Hepatol. 2010;53:849–55.PubMedCrossRefGoogle Scholar
  42. 42.
    Rana SV, Sharma S, Kaur J, Sinha SK, Singh K. Comparison of lactulose and glucose breath test for diagnosis of small intestinal bacterial overgrowth in patients with irritable bowel syndrome. Digestion. 2012;85:243–7.PubMedCrossRefGoogle Scholar
  43. 43.
    Usai P, Usai Satta P, Lai M, Corda MG, Piras E, Calcara C, et al. Autonomic dysfunction and upper digestive functional disorders in untreated adult coeliac disease. Eur J Clin Invest. 1997;27:1009–15.PubMedCrossRefGoogle Scholar
  44. 44.
    Giorgetti GM, Tursi A, Brandimarte G, Rubino E, Gasbarrini G. Dysmotility-like dyspeptic symptoms in coeliac patients: role of gluten and Helicobacter pylori infection. Dig Liver Dis. 2000;32:73–4.PubMedCrossRefGoogle Scholar
  45. 45.
    Rana SV, Sharma S, Sinha SK, Prasad KK, Bhasin DK, Singh K. Orocecal transit time in patients with celiac disease from North India: a case control study. Trop Gastroenterol. 2008;29:98–100.PubMedGoogle Scholar
  46. 46.
    Chiarioni G, Bassotti G, Germani U, Battaglia E, Brentegani MT, Morelli A, et al. Gluten-free diet normalizes mouth-to-cecum transit of a caloric meal in adult patients with celiac disease. Dig Dis Sci. 1997;42:2100–5.PubMedCrossRefGoogle Scholar
  47. 47.
    Rana SV, Kochhar R, Pal R, Nagi B, Singh K. Orocecal transit time in patients in the chronic phase of corrosive injury. Dig Dis Sci. 2008;53:1797–800.PubMedCrossRefGoogle Scholar
  48. 48.
    Rana SV, Sinha SK, Prasad KK, Sharma SK, Kaur J, Rana SS, et al. W1838 Orocecal transit time and small intestinal bacterial overgrowth in patients with microscopic colitis. Gastroenterology. 2010;138:S-750.Google Scholar
  49. 49.
    Cuoco L, Montalto M, Jorizzo RA, Santarelli L, Arancio F, Cammarota G, et al. Eradication of small intestinal bacterial overgrowth and orocecal transit in diabetics. Hepatogastroenterology. 2002;49:1582–6.PubMedGoogle Scholar
  50. 50.
    Rana S, Bhansali A, Bhadada S, Sharma S, Kaur J, Singh K. Orocecal transit time and small intestinal bacterial overgrowth in type 2 diabetes patients from North India. Diabetes Technol Ther. 2011;13:1115–20.PubMedCrossRefGoogle Scholar
  51. 51.
    Faria M, Pavin EJ, Parisi MC, Lorena SL, Brunetto SQ, Ramos CD, et al. Delayed small intestinal transit in patients with long-standing type 1 diabetes mellitus: investigation of the relationships with clinical features, gastric emptying, psychological distress, and nutritional parameters. Diabetes Technol Ther. 2013;15:32–8.PubMedCrossRefGoogle Scholar
  52. 52.
    Heaton KW, Emmett PM, Symes CL, Braddon FE. An explanation for gallstones in normal-weight women: slow intestinal transit. Lancet. 1993;341(8836):8–10.PubMedCrossRefGoogle Scholar
  53. 53.
    Rana SV, Kaur J, Gupta R, Gupta V, Rana SS, Bhasin DK. Su1190 Effect of cholecystectomy on orocecal transit time and small intestinal bacterial overgrowth in patients with gallstones. Gastroenterology. 2012;142(5)(Suppl 1):S-447.Google Scholar

Copyright information

© Association of Clinical Biochemists of India 2014

Authors and Affiliations

  1. 1.Department of GastroenterologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
  2. 2.Department of Super Specialty GastroenterologyPGIMERChandigarhIndia

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