Breath Hydrogen Test in Lactose Malabsorption

Main Article Content

Badriul Hegar
Hans A. Buller

Abstract

Lactose is the most important source in mammalian milk. In normal children, Lactose is hydrolyzed by lactase, and directly absorbed into bloodstream by an active transport mechanism. The term of lactose malabsorption is reserved to patients in whom impaired intestinal lactose hydrolysis and uptake has been proven by an appropriate test. The severity of lactose malabsorption and the extent of symptoms vary widely and are the results of several factors such as the amount of ingested lactose, gastric emptying time, intestinal transit time, and colonic flora. The diagnosis of lactose malabsorption is based on clinical findings and the results of appropriate tests. The breath hydrogen test has obvious advantages for pediatric population because it is painless, non-invasive, sensitive and specific. In the absence of bacterial colonization in the small intestine, the elevation of the concentration of hydrogen in the expired air implies the arrival of lactose in the colon. The increasing respiratory excretion of hydrogen is indicative of a deficit of lactase in enterocyte brush border. This test can also be used to show the existence of bacterial growth. Dietary fiber, some drugs, preparation for colonoscopy, colonic pH, and diarrhea can influence the result of breath hydrogen test.

Article Details

How to Cite
1.
Hegar B, Buller H. Breath Hydrogen Test in Lactose Malabsorption. PI [Internet]. 8Oct.2018 [cited 18Nov.2019];35(7-8):161-1. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/1981
Section
Review Article
Received 2018-10-08
Published 2018-10-08

References

1. Buller HA. Lactase phlorizin hydrolase: A review of the literature. Dissertation. University of Amsterdam 1990;2-25.
2. Newcomer AD, Me Gill DB, Thomas PJ, Hofmann AF. Prospective comparison of indirect methods for detecting lactase deficiency. N Engl J Med 1975; 293: 1232-5.
3. Rings E, Grand RJ. Buller HA. Lactose in tolerance and lactase deficiency in children. Curr Opin Pediatr 1994; 6:562-7.
4 . Perman JA. Breath analysis. In: Walker, Durie, Hamilton, Smith W, Watkins eds. Pediatric gastrointestinal disease, 2nd ed. Philadelphia: BC Decker 199; 1354-8.
5. Kretchmer N. Memorial lecture: Lactose and lactase - a historical perspective. Gastroenterology 1971;.61:805-12.
6. Boyle JT, Celano P, ·Koldovsky 0. Demonstration of a difference in expression of maximal lactase and sucrase activity along the villus in adult rat jejunum. Gastroenterology 1980; 79:503-7.
7. Caspary WF. Diarrhoea associated with carbohydrate malabsroption . In: Krejs GJ, ed. Clinics in gastroenterology. Toronto: WB Saunders, 1986;631.
8. Levitt MD. Production and excretion of hydrogen gas in man. New Eng! J Med 1969; 281:122-7.
9. Nose O, Iida Y, Kai H, Harada T, Ogawa M, Yabuuchi H. Breath hydrogen test for detection lactose malabsorption in infants and children. Arch Dis Child 1979;54: 436-40.
10. Wolin MJ. Fermentation in the rumen and human large intestine. Science 1981; 2 13: 1463-8.
11 . Martini MC, Kukielka D, Savaiano DA. Lactose digestion from yogurt: influence of a meal and additional lactose. Am J Clin Nutr 1991; 53:1253-8.
12. Solomons NW, Ibanez RG, Viteri FE. Reduced rate of breath hydrogen excretion with lactose tolerance test in young children using whole milk. Am J Clin Nutr 1979; 32:783-6.
13. Kerzner B. Breath tests. In: Wyllie R, Hyams JS, eds. Pedia llic gastrointestinal disease pathophysiology, diagnosis, management; 9th ed. Philadelphia: WB Saunders, 1993;1027-37.
14. Welle AR. Carbohydrate intolerance. In: Roy CC, Silverman A, Alagil!e D, eds. Pediatric clinical gastroenterology; 4th ed. StLouis: Mosby, 1994;287 -98.
15. Koruda MJ, Rolandelli RH, Bliss DZ, Hastings J, Rambeau JL, Settle RG. Parenteral nullition supplemented with short -chain fatty acids: effect on the small-bowel mucosa in normal rats. Am J Clin Nutr 1990; 51:685-9.
16. Grand RJ, Montgomery RJ(, Buller HA. Lactose intolerance. In: Snape WJ ed. Consultations in gasuuenterology; 1st ed. Philadelphia: WB Saundres 1996; 362-7.
17. Sunoto, Suhruyono, Boediarso A, Sutejo. Lactose malabsorption in healthy Indonesian preschool children. Paediatr lndones 1971;11:251-4.
18. Beers EH, Buller HA, Grand R,J, Eincrhand AWC, Dekker J . In testinal brush border Glycohydrolase: Structure, function, and development. Crit Rev Biochcm Mol Bioi 1995;30:235.
19. Newcomer AD. Screening test for carbohydrate malabsorption. J Pediatr Gastroenterol Nutr 1984; 3:6-8.
20. Hepner GW. Breath analysis: Gast.rocnterological applications. Gastroenterology 1974; 67:1250-6.
21. Rosado JL, Solomons NW. Sensitivity and specificity of the hydrogen breath hydrogen test for detecting malabsorption of physiological doses of lactose. Clin Chern 1983; 29:545-8.
22. Hoek Loos Medical Technology. Lactometer H2 breathtester usersmanual. 1995: 1-6.
23. Gracey M. The breath hydrogen test. In: Anderson CM, Burke V, Gracey M, eds. Paediatric gastroenterology, 2nd ed. Palo Alto: Blackwell Scientific, 1987; 878-9.
24. Osu·ander CR, Cohen RS, Hopper AO, Sha bin SM, Kerner JA, Johnson JD, Stevenson DK. Breath hydrogen analysis: A review of methodologies and clinical applications. J Pediatr Gastroenterol Nutr 1983; 2:525-32.
25. Abramowilz A, Grannot E, Tamir I, Deckelbaum J. Two-hour lactose breath hydrogen test. J Pediatr Gastroenterol Nutr 1986;5: 130-2.
26. Barr RG, Watkins JB, Perman JA. Mucosal function and breath hydrogen excreation: Comparative studies in the clinical cvalution of children with nonspecific abdominal complain ts. Pediatrics
1981; 68:526-32.
27. Solomon NW, Bruillas C. The cut-off criterion for positive hydrogen breath hydrogen test in children: a reappraisal. J Pediatr Gastroenterol Nutr 1986; 5: 920-3.
28. Hyams JS, Stafford RJ, Grand RJ, Watkins JB. Correlation of lactose breath hydrogen test, intestinal morphology, and lactase activity in young children. J Pediatr 1980;97:609-11.
29. Douwes AC, Fernandes J, Degenhart HJ. Improved accuracy of lactose tolerance test in children, using expired H2 measurement. Arch .Dis Child 1978; 53: 939-42.
30. Veligati LN, Treem WR, Sullivan B, Burke G, Hyams JS. A 10 ppm versus A20 ppm: a reappraisal of diagnostic criteria for breath hydrogen testing in children. Am J Gastrocnterol 1994; 89: 758-61.
31. Joseph F, Rosenberg A. Breath hydrogen testing: Diseased versus normal patien ts. J Pediatr Gastroenterol Nutr 1988; 7 : 787-8.
32. Murphy EL, Calloway DH. The effect or antibiotic drugs on Lhc valume and composition of intestinal gas from bean. Dig Dis 1972; 17: 639-42.
33. Flatz G, 1-lwa Lie G. Effect of acetylsali cylic acid on symptoms and hydrogen excretion in the disaccharide tolerance test with lactose or lactulose. Am J Clin Nutr 1982; 35:273-6.
34. Gilat T, Hur HB, Malachi EG, Terdiman R, Peled Y. Alteration or the colonic flora and their effect on the hydrogen breath test. Gut 1978; 19:602-5.
35. Perman JA, Modler S, Olson AC. Role of pH in production of hydrogen rrom carbohydrates by colonic bacterial nora. J Clin lnvest.;67:643-50.
36. Perman JA, Modlers S, Olson AC. Interpretation of H2 breath test may be affects by colonic pH. Gastroenterology 1981; 8 1:629-30.
37. Metz G, Gassull MA, Drasar BS, Jenkins DJA. Breath hydrogen test for small intestinal bacterial colonisation. Lancet 1976: 27:668-9.
38. Thompson DG, O'brien JD, Hardie JM. Influence of the oropharyngeal microflora on the measurement of exhaled breath hydrogen. Gastroenterology 1986; 91: 853-60.
39. Thompson DG, Bin field P, De Seider A, O'brien J, Waren S, Wilson M. Exna intestinal influences on exhaled breath hydrogen measurement during the investigation of gastrointestinal disease. Gut 1985; 26: 1349-52.
40. Shinnick FL, Hess RL, Fischer MH, Marlett JA. Apparent nutrient absorption and upper gastrointestinal transit with fiber-containing enteral feedings. Am J Clin Nutr 1989; 49:471-5.
41. Penny ME, Paredes P, Brown KH. Clinical and nutrition consequences of lactose feeding during persistent postenteritis diarrhea. Pediatrics 1989; 84:835
42. Gardiner AJ, Tarlow MJ, Sutherland IT, Sammons HG. Lactose malabsorption duting gastroenteritis, asscscd by the hydrogen breath test. Arch Dis Child 1981; 56:364-7.
43. Perman JA, Modler S, Barr RG. Fasting breath hydrogen concentration: Normal values and clinical application. Gastroenterology 1984; 87: 1358-63.