수소호기검사와 소장통과 신티그라피의 구강-맹장 통과시간 비교

문정섭,송치욱,최재걸,현진해 大韓消化器病學會 1997 大韓消化器病學會誌 Vol.30 No.5

Delayed Analysis of Hydrogen-Methane Breath Samples

Marjolein Willemsen,Kristel Van De Maele,Yvan Vandenplas 대한소아소화기영양학회 2022 Pediatric gastroenterology, hepatology & nutrition Vol.25 No.1

Purpose: Hydrogen-methane breath tests are used to diagnose carbohydrate malabsorption and small intestinal bacterial overgrowth. The COVID-19 pandemic has driven the modification of procedures as breath tests are potentially aerosol-generating procedures. We assessed the effect of delayed analysis of breath samples, facilitating the at-home performance of breath testing. Methods: Children provided two breath samples at every step of the lactose breath test. The samples were brought back to the clinic, and one set of samples was analyzed immediately. The second set was stored at room temperature and analyzed 1-4 days later. Results: Out of the 73 “double” lactose breath tests performed at home, 33 (45.8%) were positive. The second samples were analyzed 20 to 117 hours after the first samples (41.7±24.3 hours). There was no significant difference in the hydrogen concentration between the first and second sets (Z=0.49, p=0.62). This was not the case for methane, which had a significantly higher concentration in the second breath samples (Z=7.6). Conclusion: Expired hydrogen levels remain stable in plastic syringes if preserved at room temperature for several days. On the other hand, the delayed analysis of methane appeared to be less reliable. Further research is needed to examine the impact of delayed analysis on methane and hydrogen concentrations.

Unclear Abdominal Discomfort: Pivotal Role of Carbohydrate Malabsorption

( Miriam Goebel Stenge ),( Andreas Stenge ),( Marco Schmidtmann ),( Ivo Van Der Voort ),( Peter Kobelt ),( Hubert Monnikes ) 대한소화기기능성질환·운동학회 2014 Journal of Neurogastroenterology and Motility (JNM Vol.20 No.2

Background/AimsCarbohydrate malabsorption is frequent in patients with functional gastrointestinal disorders and in healthy volunteers and cancause gastrointestinal symptoms mimicking irritable bowel syndrome (IBS). The aim of this study was to investigate the prevalence ofsymptomatic lactose and fructose malabsorption in a large population of patients with IBS-like symptoms based on Rome II criteria. MethodsPatients with unclear abdominal discomfort (n = 2,390) underwent lactose (50 g) and fructose (50 g) hydrogen (H2) breathtests and depending on the results further testing with 25 g fructose or 50 g glucose, or upper endoscopy with duodenalbiopsies. Additionally, this population was investigated regarding the prevalence of small intestinal bacterial overgrowth (SIBO)based on glucose breath test and celiac disease. ResultsOf the 2,390 patients with IBS-like symptoms, 848 (35%) were symptomatic lactose malabsorbers and 1,531 (64%) symptomaticfructose malabsorbers. A combined symptomatic carbohydrate malabsorption was found in 587 (25%) patients. Severefructose malabsorbers (pathologic 25 g fructose test) exhaled significantly higher H2 concentrations in the 50 g test than patientswith negative 25 g fructose test (P < 0.001). Out of 460/659 patients with early significant H2 increase in the lactoseand fructose test who underwent a glucose breath test, 88 patients had positive results indicative of SIBO and they were significantlyolder than patients with negative test result (P < 0.01). Celiac disease was found in 1/161 patients by upper endoscopy. ConclusionsCarbohydrate malabsorption is a frequent but underestimated condition in patients with IBS-like symptoms although diagnosiscan be easily confirmed by H2 breath testing.

정상인에서 반고형식 Lactulose 수소호기검사법을 이용한 구강맹장 통과시간의 측정

강영우(Young Woo Kang),박승국(Soong Kook Park) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.4

N/A Lactulose hydrogen breath test has been used for rneasurement of orocecal transit time (OCTT) because of its non invasiveness and simplicity. Recently, the lack of reproducibility of OCTT which measured by hydrogen breath test using water diluted lactulose resulted in the need to develop a new semisolid or solid meal combined lactulose hydrogen breath test. We measured OCTT in 47 norrnal subjects(male 17, female 30, age 24 69 years, average 35.5 years) after ingestion of semisolid meal including potato soup and lactulose syrup 20g. OCTT was defined as the time from test meal ingestion to a sustained increase of more than 10pprn above the baseline in end expiratory hydrogen concentration with 10 minutes interval for 3 hours. OCTT was 79.2+11.9(mean+SD) minutes in male, 81.5+15.2 minutes in female, and average 81.9+13.3 minutes. Although there was no significant difference according t,o sex, OCTT in sixth and seventh decades were delayed compared to third decades(P<0.05). These results will be useful for comparison of OCTT in different group of patients.(Korean J Gastro- enterol 1994; 26: 619 624)

Obesity Is Inversely Related to Hydrogen-Producing Small Intestinal Bacterial Overgrowth in Non-Constipation Irritable Bowel Syndrome

정승은,주남석,한경선,김규남 대한의학회 2017 Journal of Korean medical science Vol.32 No.6

There have been inconsistent findings on the association of obesity and non-constipation irritable bowel syndrome (IBS). Small intestinal bacterial overgrowth (SIBO) with hydrogen (H2) gas forming-microflora causes non-constipation IBS. But, the effect of H2 producing SIBO on obesity in non-constipation IBS patients has not been studied yet. The aim of this study was to investigate the association between obesity and SIBO in non-constipation IBS patients. We reviewed the charts of patients who showed IBS symptoms along with the documented results of their lactulose hydrogen breath test (LHBT) for SIBO. Multivariate models were used to assess the association between obesity and SIBO. Four-hundred fifty-eight patients were retrospectively included in the study. Of the 485 IBS patients, 158 (30.7%) subjects had positive results for LHBT. Subjects without SIBO showed significantly higher levels of body mass index (24.8 vs. 23.3; P < 0.001) and waist circumference (86.5 vs. 82.7; P < 0.001) as compared to subjects with SIBO. In multivariate analysis, the odds ratios of SIBO were 0.396 (P = 0.018) for obesity and 0.482 (P = 0.021) for abdominal obesity. This is the first human study to demonstrate that obesity is inversely related to SIBO with H2 gas production in non-constipation IBS patients.

How to Interpret Hydrogen Breath Tests

( Uday C Ghoshal ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2011 Journal of Neurogastroenterology and Motility (JNM Vol.17 No.3

Hydrogen breath tests using various substrates like glucose, lactulose, lactose and fructose are being used more and more to diagnose small intestinal bacterial overgrowth (SIBO) and lactose or fructose malabsorption. Though quantitative culture of je-junal aspirate is considered as gold standard for the diagnosis of SIBO, hydrogen breath tests, in spite of their low sensitivity, are popular for their non-invasiveness. Glucose hydrogen breath test is more acceptable for the diagnosis of SIBO as conventionally accepted double-peak criterion on lactulose hydrogen breath test is very insensitive and recently described early-peak criterion is often false positive. Hydrogen breath test is useful to diagnose various types of sugar malabsorption. Technique and interpretation of different hydrogen breath tests are outlined in this review.

Nutrient Challenge Testing Is Not Equivalent to Scintigraphy-Lactulose Hydrogen Breath Testing in Diagnosing Small Intestinal Bacterial Overgrowth

( Valeria Schindler ),( Martin Huellner ),( Fritz Murray ),( Larissa Schnurre ),( Anton S Becker ),( Valentine Bordier ),( Daniel Pohl ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2020 Journal of Neurogastroenterology and Motility (JNM Vol.26 No.4

Background/Aims Small intestinal bacterial overgrowth (SIBO) is a common condition in disorders of gut-brain interaction (DGBI). Recently, a combined scintigraphy-lactulose hydrogen breath test (ScLHBT) was described as an accurate tool diagnosing SIBO. We aim to analyze whether a lactulose nutrient challenge test (NCT), previously shown to separate DGBI from healthy volunteers, is equivalent to ScLHBT in diagnosing SIBO. Methods We studied data of 81 DGBI patients undergoing ScLHBT with 30 g lactulose and 300 mL water as well as NCT with 30 g lactulose and a 400 mL liquid test meal. Differences in proportion of positive SIBO diagnoses according to specified cecal load and time criteria for NCT and ScLHBT, respectively, were tested in an equivalence trial. An odds ratio (OR) range of 0.80-1.25 was considered equivalent. Results Diagnosis of SIBO during NCT was not equivalent to SIBO diagnosis in ScLHBT, considering a hydrogen increase before cecal load of 5.0%, 7.5%, or 10.0%, respectively ([OR, 3.76; 90% CI, 1.99-7.09], [OR, 1.87; 90% CI, 1.06-3.27], and [OR, 1.11; 90% CI, 0.65- 1.89]). Considering only time to hydrogen increase as criterion, the odds of a positive SIBO diagnosis in the NCT (0.65) was lower than in ScLHBT (1.70) (OR, 0.38; 90% CI, 0.23-0.65). Conclusions This study could not show an equivalence of NCT and ScLHBT in diagnosing SIBO. A possible explanation might be the different transit times owing to unequal testing substances. The effect of this deviation in relation to consecutive therapy regimens should be tested in further prospective studies. (J Neurogastroenterol Motil 2020;26:514-520)

Unreliability of Breath Methane as a Candidate Indicator of Functional Bowel Disorders

( Krzysztof Jonderko ),( Agata Gabriel Jasniok ),( Malgorzata Szymszal ),( Anna Kasicka Jonderko ),( Barbara Blonska Fajfrowska ) 대한소화기학회 2008 Gut and Liver Vol.2 No.3

Background/Aims: The aim of this study was to examine the reproducibility of methane and hydrogen in exhaled air breath after a per-oral load of lactulose. Methods: Methane was present in the exhaled breath of 21 of 50 healthy subjects recruited by advertisement. Three methane breath tests were performed in 12 women (aged 23.6±0.5 years, mean±SEM) after they consumed 10 g of lactulose dissolved in 300 ml of water. Short- and medium-term reproducibilities were assessed by paired examinations taken 3 and 17 days (median) apart, respectively. Results: High values of coefficients of variation for paired examinations (CVp) indicated a poor short-term reproducibility of parameters characterizing either the methane or hydrogen excretion in breath air: CVp values of the maximum net increments over baseline in methane (max CH4_net), and in hydrogen (max H2_net), were 34% and 41%, respectively. Moreover, the reproducibility consistently deteriorated with increasing time gap between repeat measurements (CVp: 60% for max CH4_net and 64% for max H2_net). Conclusions: The low reproducibility of parameters characterizing quantitative methane breath excretion suggests that caution is necessary when judging the clinical usefulness of the methane breath test after a per-oral lactulose load for the purpose of diagnosing and classifying functional bowel disorders. (Gut and Liver 2008;2:180-185)

Association between Symptoms of Irritable Bowel Syndrome and Methane and Hydrogen on Lactulose Breath Test

이강녕,고동희,이오영,손원,이상표,전대원,이항락,윤병철,최호순,함준수 대한의학회 2013 Journal of Korean medical science Vol.28 No.6

Whether hydrogen and methane gas produced during lactulose breath test (LBT) are associated with symptoms of irritable bowel syndrome (IBS) is not determined. We aimed to investigate whether hydrogen and methane on LBT are associated with IBS symptoms. Sixty-eight IBS patients meeting the Rome III criteria for IBS, and 55 healthy controls,underwent LBT. The IBS subjects recorded their customary gastrointestinal symptoms on a questionnaire using visual analogue scales. LBT positivity was defined to be above 20 ppm rise of hydrogen or 10 ppm rise of methane within 90 min. Gas amounts produced during LBT were determined by calculating area under the curve of hydrogen and methane excretion. Symptom severity scores were not different between the LBT (+) IBS and LBT (-)IBS subjects and also between methane producers and non-methane producers. Gas amounts produced during LBT were not associated with IBS symptoms, except a weak correlation between total gas amounts and a few IBS symptoms such as bloating (r = 0.324, P = 0.039), flatulence (r = 0.314, P = 0.046) and abdominal pain (r = 0.364,P = 0.018) only in LBT (+) IBS. In conclusion, hydrogen and methane gas on LBT are not useful for predicting the customary symptoms and subtypes of IBS.

소아에서 호기내 수소검사를 이용한 유당 흡수장애 유병률

정주영,배선환,최광해,고재성,서정기,Chung, Ju-Young,Bae, Sun-Hwan,Choi, Kwang-Hae,Ko, Jae-Sung,Seo, Jeong-Kee 대한소아소화기영양학회 2002 Pediatric gastroenterology, hepatology & nutrition Vol.5 No.1

목적: 국내 소아에서 유당 흡수장애 유병률이 변화하는 연령을 파악하고 생리적 용량의 db당부하 호기 수소검사 시 유병률을 알아보고자 본 연구를 시행하였다. 방법: 1998년 5월부터 1998년 8월까지 서울의 초등학교 및 유치원 한 곳, 어린이집 두 곳의 건강한 소아를 대상으로 표준 유당부하 호기내 수소검사는 생후 25개월에서 96개월까지 총 129명(남아 75명, 여아 52명), 생리적 용량의 유당부하 호기내 수소검사는 생후 25개월에서 84개월까지 총 126명(남아 72명, 여아 51명)에서 시행하였다. 호기 검체는 공복시 기저치, 유당부하 60분, 120분 후에 각각 수집하여 Model 12i Microlyzer (Quintron, USA)를 이용하여 분석하였다. 결과: 1) 표준 유당부하 호기내 수소검사에서 유당 흡수장애의 유병률은 생후 25~36개월에서 7%, 생후 37~48개월에서 19%, 생후 49~60개월에서 35%, 생후 61~72개월에서 55%, 생후 73~84개월에서 82%, 생후 84~96개월에서 80%였다. 2) 표준 유당부하 호기내 수소검사에서 유당불 내성의 유병률은 생후 25~36개월에서 0%, 생후 37~48개월에서 9%, 생후 49~60개월에서 17%, 생후 61~72개월에서 22%, 생후 73~84개월에서 41%, 생후 84~96개월에서 70%였다. 3) 생리적 용량의 유당부하 호기내 수소검사에서 생후 25개월부터 84개월까지 총 126명의 소아중 한 명에서만 유당 흡수장애를 보였으며 유당불 내성은 한명도 없었다. 결론: 한국인 소아의 유당 흡수장애 유병률은 생후 37개월부터 60 개월에 증가하며 생후 72개월 이후에는 성인의 유병률에 도달하게 된다. 유당 흡수장애군에서도 생리적 용량의 유당을 포함한 우유의 섭취는 임상적으로 문제가 되지 않음을 확인할 수 있었다. Purpose: The aim of this study was to investigate the age of onset and the prevalence of lactose malabsorption in early childhood in Korea. Methods: We conducted a study of lactose malabsorption by breath hydrogen test in healthy children aged between 25~96 months old. Standard lactose loading (2 g lactose/kg, maximum 40g) test was done in 129 children and cow's milk (10 mL/kg) loading in 126 children followed by breath sampling of 60 and 120 minutes after the loading. An increase above baseline of 20 ppm or more was used as a criteria for positive responses. Results: The prevalence of lactose malabsorption was 7% in 25~36 months old, 19% in 37~48 months old, 35% in 49~60 months old, 55% in 61~72 months old, 82% in 72~84 months old, 80% in 85~96 months old children. Only 1% of the children showed positive result in breath hydrogen test after the cow's milk challenge. Conclusion: The prevalence of lactose malabsorption was increased between 37 months and 60 months of age, reached to adult level of prevalence after 72 months of age. When physiological dose of lactose was used as the challenge, the number of lactose malabsorbers become clinically insignificant.