Hydrogen Breath Tests: Are They Really Useful in the Nutritional Management of Digestive Disease?
FODMAP
fructose and sorbitol malabsorption
hydrogen breath testing
lactose malabsorption and intolerance
nutritional management
Journal
Nutrients
ISSN: 2072-6643
Titre abrégé: Nutrients
Pays: Switzerland
ID NLM: 101521595
Informations de publication
Date de publication:
17 Mar 2021
17 Mar 2021
Historique:
received:
27
02
2021
revised:
13
03
2021
accepted:
15
03
2021
entrez:
3
4
2021
pubmed:
4
4
2021
medline:
21
5
2021
Statut:
epublish
Résumé
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. A literature search for BT related to carbohydrate malabsorption was carried out using the online databases of Pubmed, Medline and Cochrane. 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. 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.
Sections du résumé
BACKGROUND
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
METHODS
A literature search for BT related to carbohydrate malabsorption was carried out using the online databases of Pubmed, Medline and Cochrane.
RESULTS
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
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.
Identifiants
pubmed: 33802839
pii: nu13030974
doi: 10.3390/nu13030974
pmc: PMC8002624
pii:
doi:
Substances chimiques
Hydrogen
7YNJ3PO35Z
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Références
Gut. 2004 Nov;53(11):1571-6
pubmed: 15479673
Gut. 2008 Jan;57(1):137-8; author reply 138
pubmed: 18094206
World J Gastrointest Pharmacol Ther. 2012 Jun 6;3(3):29-33
pubmed: 22966480
N Engl J Med. 1975 Dec 11;293(24):1232-6
pubmed: 1186802
Aliment Pharmacol Ther. 2009 Mar 30;29 Suppl 1:1-49
pubmed: 19344474
Gastroenterol Clin North Am. 2012 Sep;41(3):611-27
pubmed: 22917167
Clin Gastroenterol Hepatol. 2018 Oct;16(10):1673-1676
pubmed: 29408290
Gut. 1974 Apr;15(4):308-23
pubmed: 4600336
Am J Gastroenterol. 2017 May;112(5):775-784
pubmed: 28323273
Int J Environ Res Public Health. 2020 Jul 20;17(14):
pubmed: 32698373
Curr Opin Clin Nutr Metab Care. 2013 Jul;16(4):473-7
pubmed: 23739630
Clin Pediatr (Phila). 2020 Nov;59(13):1191-1194
pubmed: 32686473
Nutrients. 2017 Aug 26;9(9):
pubmed: 28846594
Clin Gastroenterol Hepatol. 2007 Aug;5(8):959-63
pubmed: 17625977
Am J Hum Genet. 2006 Feb;78(2):339-44
pubmed: 16400612
Aliment Pharmacol Ther. 2014 Apr;39(8):900-1
pubmed: 24635316
Evid Rep Technol Assess (Full Rep). 2010 Feb;(192):1-410
pubmed: 20629478
Aliment Pharmacol Ther. 2013 Jun;37(11):1074-83
pubmed: 23574302
Aliment Pharmacol Ther. 2008 Jan 15;27(2):93-103
pubmed: 17956597
J Support Oncol. 2013 Jun;11(2):61-7
pubmed: 23158908
Mol Cell Pediatr. 2016 Dec;3(1):10
pubmed: 26883354
Aliment Pharmacol Ther. 2012 Oct;36(7):660-9
pubmed: 22860690
Dig Liver Dis. 2002 Dec;34(12):846-50
pubmed: 12643292
Lancet. 1975 May 24;1(7917):1155-7
pubmed: 48774
Curr Gastroenterol Rep. 2009 Oct;11(5):368-74
pubmed: 19765364
Scand J Gastroenterol. 1999 Sep;34(9):898-903
pubmed: 10522609
United European Gastroenterol J. 2017 Mar;5(2):284-292
pubmed: 28344797
Am J Gastroenterol. 2002 May;97(5):1113-26
pubmed: 12014715
Nutrients. 2018 Nov 01;10(11):
pubmed: 30388735
J Nutr. 1998 Mar;128(3):587-92
pubmed: 9482768
Clin Chem. 1983 Nov;29(11):1980-1
pubmed: 6627640
Nutrients. 2020 Aug 07;12(8):
pubmed: 32784614
J Am Coll Nutr. 1996 Oct;15(5 Suppl):12S-17S
pubmed: 8892178
Am J Clin Nutr. 1988 Dec;48(6):1424-30
pubmed: 3202090
Eur Rev Med Pharmacol Sci. 2013;17 Suppl 2:26-9
pubmed: 24443064
Digestion. 2019;99(2):140-147
pubmed: 30179874
Gut. 2017 Aug;66(8):1517-1527
pubmed: 28592442
Arch Dis Child. 1983 Aug;58(8):595-7
pubmed: 6614973
Gut. 1988 Jan;29(1):44-8
pubmed: 3343011
J Pediatr Gastroenterol Nutr. 2007 Oct;45(4):503-6
pubmed: 18030226
Aliment Pharmacol Ther. 2012 Feb;35(4):429-40
pubmed: 22211845
Aliment Pharmacol Ther. 2017 Apr;45(8):1094-1106
pubmed: 28233394
United European Gastroenterol J. 2013 Jun;1(3):151-9
pubmed: 24917953
Scand J Gastroenterol. 2001 Nov;36(11):1170-2
pubmed: 11686216
Gut. 2019 Nov;68(11):2080-2091
pubmed: 31427404
Am J Clin Nutr. 1997 May;65(5):1502-6
pubmed: 9129483
Gut. 2018 Feb;67(2):263-270
pubmed: 27872184
Nat Genet. 2002 Feb;30(2):233-7
pubmed: 11788828
J Gastroenterol Hepatol. 2010 Feb;25(2):252-8
pubmed: 20136989
N Engl J Med. 1969 Jul 17;281(3):122-7
pubmed: 5790483
Eur J Clin Nutr. 2007 Oct;61(10):1220-5
pubmed: 17311063
Curr Clin Pharmacol. 2018;13(3):164-172
pubmed: 30084333
PLoS One. 2018 Jul 26;13(7):e0201410
pubmed: 30048547