scholarly journals Hydrogen Breath Tests: Are They Really Useful in the Nutritional Management of Digestive Disease?

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 974
Author(s):  
Paolo Usai-Satta ◽  
Francesco Oppia ◽  
Mariantonia Lai ◽  
Francesco Cabras
Keyword(s):  
Clinical Practice ◽  
Dietary Intervention ◽  
Diagnostic Technique ◽  
Sufficient Evidence ◽  
Nutritional Management ◽  
Noninvasive Technique ◽  
Lactose Malabsorption ◽  
Carbohydrate Malabsorption ◽  
Fodmap Diet ◽  
Hydrogen Breath Tests

Background: Carbohydrate malabsorption is a frequent digestive problem associated with abdominal pain, bloating and diarrhea. Hydrogen breath testing (BT) represents the most reliable and validated diagnostic technique. The aim of this manuscript was to clarify the usefulness of BTs in the nutritional management of these disorders. Methods: A literature search for BT related to carbohydrate malabsorption was carried out using the online databases of Pubmed, Medline and Cochrane. Results: Lactose BT showed good sensitivity and optimal specificity for lactose malabsorption. However, an accurate diagnosis of lactose intolerance should require blind lactose challenge although this method is difficult to utilize in clinical practice. Regarding dose-depending fructose and sorbitol malabsorption, BTs could not add diagnostic advantage compared with a direct dietary intervention. In addition, carbohydrates are fundamental components of fermentable oligo-, di- and monosaccharides and polyols (FODMAPs). Before starting a low FODMAP diet, lactose BT should be suggested in a population with low prevalence of hypolactasia. Conclusions: BTs represent a valid and noninvasive technique in many digestive conditions. Regarding the management of carbohydrate intolerance, lactose BT can be recommended with some limitations. No sufficient evidence is available about the usefulness of BTs for other sugars in clinical practice.

scholarly journals 3185 A Randomized Controlled Trial Comparing the Nonabsorbable Antibiotic Rifaximin vs. Dietary Intervention Low in Fermentable Sugars (FODMAP) in Irritable Bowel Syndrome

2019 ◽  
Vol 3 (s1) ◽  
pp. 31-31
Author(s):  
Allen Lee ◽  
Krishna Rao ◽  
Emily Haller ◽  
Lauren Van Dam ◽  
Jason Baker ◽  
...  
Keyword(s):  
Dietary Intervention ◽  
Controlled Trial ◽  
Gastrointestinal Surgery ◽  
Fecal Microbiota ◽  
Longitudinal Analyses ◽  
Dietary Interventions ◽  
Microbial Composition ◽  
Hydrogen Breath Test ◽  
Fodmap Diet ◽  
Hydrogen Breath Tests

OBJECTIVES/SPECIFIC AIMS: Objectives and goals of this study are to (i) determine whether IBS-D patients randomized to either rifaximin or low FODMAP diet show improvement in IBS-related symptoms; and (2) identify using longitudinal analyses how SIBO status and fecal microbiota features associate with response to either rifaximin or low FODMAP dietary intervention. METHODS/STUDY POPULATION: 42 patients ≥ 18 years of age who meet Rome IV criteria for IBS-D will be randomized to receive either rifaximin or low FODMAP diet intervention. The primary outcome will be the proportion of responders to intervention which is defined as ≥ 30% reduction in mean daily abdominal pain or bloating by visual analog scale compared with baseline. Exclusion criteria will include: (a) history of microscopic colitis, inflammatory bowel disease, celiac disease, or other organic disease that could explain symptoms, (b) prior gastrointestinal surgery, other than appendectomy or cholecystectomy > 6 months prior to study initiation, (c) prior use of rifaximin or formal dietary interventions for IBS-D, (d) use of antibiotics within the past 3 months, or (e) use of probiotics within 1 month of study entry. Glucose hydrogen breath tests will be performed at the beginning and end of the trial to evaluate for SIBO. Fecal samples will be collected at 0, 2, and 6 weeks to determine changes in fecal microbial composition and structure. RESULTS/ANTICIPATED RESULTS: This study seeks to examine whether longitudinal analyses of small intestinal and colonic microbiota can subtype IBS-D subjects into clinically relevant phenotypes. A total of 18 subjects have been enrolled into the study. Clinical variables, hydrogen breath test results, and fecal microbiota data are being collected for ongoing analysis. DISCUSSION/SIGNIFICANCE OF IMPACT: Results from this study may help move treatment of IBS from a purely symptom based approach to a more individualized approach by stratifying IBS-D patients into distinct clinical phenotypes which are amenable to targeted therapeutic approaches.

scholarly journals Roles of Lactose and Fructose Malabsorption and Dietary Outcomes in Children Presenting with Chronic Abdominal Pain

Nutrients ◽  
2019 ◽  
Vol 11 (12) ◽  
pp. 3063 ◽  
Author(s):  
Carsten Posovszky ◽  
Vreni Roesler ◽  
Sebastian Becker ◽  
Enno Iven ◽  
Christian Hudert ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Incidental Finding ◽  
Elimination Diet ◽  
Chronic Abdominal Pain ◽  
Functional Abdominal Pain ◽  
Lactose Malabsorption ◽  
Carbohydrate Malabsorption ◽  
Fructose Malabsorption ◽  
Hydrogen Breath Tests ◽  
Carbohydrate Intolerance

Intolerance to lactose or fructose is frequently diagnosed in children with chronic abdominal pain (CAP). However, the causal relationship remains a matter of discussion. A cohort of 253 patients, aged 7–12 years, presenting with unexplained CAP received standardized diagnostics. Additional diagnostic tests were performed based on their medical history and physical and laboratory investigations. Fructose and lactose hydrogen breath tests (H2BT) as well as empiric diagnostic elimination diets were performed in 135 patients reporting abdominal pain related to the consumption of lactose or fructose to evaluate carbohydrate intolerance as a potential cause of CAP. Carbohydrate malabsorption by H2BT was found in 55 (41%) out of 135 patients. An abnormal increase in H2BT was revealed in 30% (35/118) of patients after fructose consumption and in 18% (20/114) of patients after lactose administration. Forty-six percent (25/54) reported pain relief during a diagnostic elimination diet. In total, 17 patients had lactose malabsorption, 29 fructose malabsorption, and nine combined carbohydrate malabsorption. Carbohydrate intolerance as a cause of CAP was diagnosed at follow-up in only 18% (10/55) of patients with malabsorption after the elimination of the respective carbohydrate. Thus, carbohydrate malabsorption appears to be an incidental finding in children with functional abdominal pain disorders, rather than its cause. Therefore, testing of carbohydrate intolerance should only be considered in children with a strong clinical suspicion and with the goal to prevent long-term unnecessary dietary restrictions in children suffering from CAP.

scholarly journals Controversies in the Use of MIGS

2020 ◽  
pp. 133-145
Author(s):  
Georges M. Durr ◽  
Paola Marolo ◽  
Antonio Fea ◽  
Iqbal Ike K. Ahmed
Keyword(s):  
Clinical Practice ◽  
Endothelial Cell ◽  
Cataract Surgery ◽  
New Technologies ◽  
Unmet Need ◽  
Glaucoma Surgery ◽  
Cell Loss ◽  
Sufficient Evidence ◽  
Controversial Issues ◽  
Trabecular Bypass

Abstract Minimally invasive glaucoma surgery (MIGS) has fulfilled an unmet need in the management of glaucoma. This chapter highlights some controversial issues regarding the use of MIGS in clinical practice, including (1) whether there is sufficient evidence to advocate combining MIGS with cataract surgery over cataract surgery alone, (2) the merits and drawbacks of different approaches to trabecular bypass and canal-based MIGS procedures, (3) the effect of MIGS on endothelial cell loss, (4) suprachoroidal MIGS devices and whether there is still a role for these procedures, and (5) a comparison between subconjunctival MIGS and trabeculectomy. Several questions are still left unanswered and hopefully, further research and more clinical experience with these new technologies will help improve surgical outcomes for patients.

Applying a Low-FODMAP Dietary Intervention to a Female Ultraendurance Runner With Irritable Bowel Syndrome During a Multistage Ultramarathon

2019 ◽  
Vol 29 (1) ◽  
pp. 61-67 ◽  
Author(s):  
Stephanie K. Gaskell ◽  
Ricardo J.S. Costa
Keyword(s):  
Irritable Bowel Syndrome ◽  
Dietary Intervention ◽  
Gastrointestinal Symptoms ◽  
Irritable Bowel Syndrome Symptom ◽  
Carbohydrate Intake ◽  
Severe Nausea ◽  
Dietary Analysis ◽  
Irritable Bowel ◽  
Fodmap Diet ◽  
The Impact

Malabsorption of fermentable oligo-, di-, mono-saccharides and polyols (FODMAPs) in response to prolonged exercise may increase incidence of upper and lower gastrointestinal symptoms (GIS), which are known to impair exercise performance. This case study aimed to explore the impact of a low-FODMAP diet on exercise-associated GIS in a female ultraendurance runner diagnosed with irritable bowel syndrome, competing in a 6-day 186.7-km mountainous multistage ultramarathon (MSUM). Irritable bowel syndrome symptom severity score at diagnosis was 410 and following a low-FODMAP diet (3.9 g FODMAPs/day) it reduced to 70. The diet was applied 6 days before (i.e., lead-in diet), and maintained during (5.1 g FODMAPs/day) the MSUM. Nutrition intake was analyzed through dietary analysis software. A validated 100-mm visual analog scale quantified GIS incidence and severity. GIS were modest during the MSUM (overall mean ± SD: bloating 27 ± 5 mm and flatulence 23 ± 8 mm), except severe nausea (67 ± 14 mm) experienced throughout. Total daily energy (11.7 ± 1.6 MJ/day) intake did not meet estimated energy requirements (range: 13.9–17.9 MJ/day). Total daily protein [1.4 ± 0.3 g·kg body weight (BW)−1·day−1], carbohydrate (9.1 ± 1.3 g·kg BW−1·day−1), fat (1.1 ± 0.2 g·kg BW−1·day−1), and water (78.7 ± 6.4 ml·kg BW−1·day−1) intakes satisfied current consensus guidelines, except for carbohydrates. Carbohydrate intake during running failed to meet recommendations (43 ± 9 g/hr). The runner successfully implemented a low-FODMAP diet and completed the MSUM with minimal GIS. However, suboptimal energy and carbohydrate intake occurred, potentially exacerbated by nausea associated with running at altitude.

scholarly journals Rational investigations in irritable bowel syndrome

2019 ◽  
Vol 11 (2) ◽  
pp. 140-147 ◽  
Author(s):  
Christopher J Black ◽  
Alexander C Ford
Keyword(s):  
Irritable Bowel Syndrome ◽  
Bacterial Overgrowth ◽  
Gastrointestinal Disorder ◽  
Small Intestinal Bacterial Overgrowth ◽  
Routine Practice ◽  
Faecal Calprotectin ◽  
Lactose Malabsorption ◽  
Alarm Features ◽  
Irritable Bowel ◽  
Hydrogen Breath Tests

Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder which accounts for a substantial proportion of a gastroenterologist’s time in the outpatient clinic. However, there is variability in approaches to diagnosis and investigation between physicians, dependent on expertise. Many patients express disappointment over the lack of a patient-centred approach. Consequently, there have been calls for the care of patients with IBS to be standardised, a process which aims to promote high-quality and high-value care. Making an early diagnosis, based on a clinical assessment of symptoms, while limiting use of investigations, are key tenets of this process. Exhaustive investigation to exclude all organic pathology is unnecessary, and may be counterproductive. Routine blood tests in suspected IBS have low yield, but are an acceptable part of routine practice. All patients should have coeliac serology tested, regardless of their predominant stool form. Patients with diarrhoea should have a faecal calprotectin measured, and should proceed to colonoscopy to exclude inflammatory bowel disease (IBD) if this is positive. Beyond this, the need for investigations should be made on a case-by-case basis, contingent on the reporting of known risk factors for organic pathology. Colonoscopy should be considered in any patient with alarm features for colorectal cancer, and in those whose clinical features are suggestive of microscopic colitis. A 23-seleno-25-homotaurocholic acid (SeHCAT) scan should be considered in patients with IBS-D, a third of whom may actually have bile acid diarrhoea. There is no role for routine hydrogen breath tests for lactose malabsorption or small intestinal bacterial overgrowth.

Carbohydrate Malabsorption: Quantification by Methane and Hydrogen Breath Tests

1994 ◽  
Vol 29 (9) ◽  
pp. 826-832 ◽  
Author(s):  
J. J. Rumessen ◽  
I. Nordgaard-Andersen ◽  
E. Gudmand-Høyer
Keyword(s):  
Breath Tests ◽  
Carbohydrate Malabsorption ◽  
Hydrogen Breath Tests

scholarly journals Controlled Attenuation Parameter for Quantification of Steatosis: Which Cut-Offs to Use?

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Roxana Sirli ◽  
Ioan Sporea
Keyword(s):  
Clinical Practice ◽  
Liver Disease ◽  
Public Health Problem ◽  
Diagnostic Techniques ◽  
Chronic Viral Hepatitis ◽  
Controlled Attenuation Parameter ◽  
Noninvasive Technique ◽  
Nonalcoholic Fatty Liver ◽  
Attenuation Parameter ◽  
The Us

Chronic liver diseases (CLDs) are a public health problem, even if frequently they are underdiagnosed. Hepatic steatosis (HS), encountered not only in nonalcoholic fatty liver disease (NAFLD) but also in chronic viral hepatitis, alcoholic liver disease, etc., plays an important role in fibrosis progression, regardless of CLD etiology; thus, detection and quantification of HS are imperative. Controlled attenuation parameter (CAP) feature, implemented in the FibroScan® device, measures the attenuation of the US beam as it passes through the liver. It is a noninvasive technique, feasible and well accepted by patients, with lower costs than other diagnostic techniques, with acceptable accuracy for HS quantification. Multiple studies have been published regarding CAP performance to quantify steatosis, but due to the heterogeneity of CLD etiologies, of steatosis prevalence, etc., it had widely variable calculated cut-off values, which in turn limited the day-to-day utility of CAP measurements in clinical practice. This paper reviews published studies trying to suggest cut-off values usable in clinical practice.

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