Overview of Hydrogen Breath Tests in Gastroenterology Practice
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Hydrogen breath tests are quite popular for diagnosing carbohydrate malabsorption such as lactose and fructose malabsorption, and small intestinal bacterial overgrowth (SIBO). The lactulose hydrogen breath test is also used for estimation of mouth-to-cecum transit time. These are easy to perform and are noninvasive. With growing recognition of food intolerance as the cause of symptoms in patients with irritable bowel syndrome (IBS), and importance of SIBO in pathogenesis of a subset of patients with IBS, the importance of some noninvasive tests for diagnosis of these conditions can’t be overestimated. However, diagnosis of SIBO using hydrogen breath tests have limitations. Though the glucose hydrogen breath test is highly specific, it is quite insensitive. In contrast, double-peak criterion on the lactulose hydrogen breath test is very insensitive and early-peak criterion is quite non-specific. The lactose hydrogen breath test using 25-g lactose is quite sensitive and specific for diagnosis of lactose malabsorption. Techniques and interpretation of various hydrogen breath tests are reviewed in this chapter.
KeywordsBreath tests Functional bowel disease Irritable bowel syndrome Lactose intolerance Small intestinal bacterial overgrowth