Relationship between breath test and gas volume

Office Uno Column: Yoshiharu Uno, M.D., Ph.D.

I verify the relationship between the gas volume of the small intestine or large intestine that were measured by MRI and hydrogen breath test from three articles.

●Relationship between the gas volume of the small intestine and Lacturose hydrogen breath test (LHBT)

Savarino E, Savarino V, Fox M, Di Leo G, Furnari M, Marabotto E, Gemignani L, Bruzzone L, Moscatelli A, De Cassan C, Sardanelli F,Sconfienza LM.

Measurement of oro-caecal transit time by magnetic resonance imaging.

Eur Radiol. 2015 Jun; 25(6):1579-87.

This study population comprised 28 healthy volunteers.

Increase of H2 breath test, was slightly delayed to an increase in the small intestine of the gas.

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●Relationship between the colon gas volume and hydrogen breath test

Murray K, Wilkinson-Smith V, Hoad C, Costigan C, Cox E, Lam C, Marciani L, Gowland P, Spiller RC. Differential effects of FODMAPs (fermentable oligo-, di-, mono-saccharides and polyols) on small and large intestinal contents in healthy subjects shown by MRI.

Am J Gastroenterol. 2014 Jan;109(1):110-9.

17 healthy subjects with no history of gastrointestinal disorders were investigated.

 Drinks consisted of 500 ml of water containing 40 g fructose.

Peak formation of H2 and SBWC (small bowel water content) was about the same time.

Colon gas was increased slowly, and was increased at the last of observation time. Namely, colon gas had increased after the SBCW has decreased.

Fructan experiments were performed in the test water mixed with inulin of 40g of water 500ml.

After inulin drinking, the amount of H2 was paralleled to the volume of colon gas.  However, like fructan, SBWC decreases gradually, and colon gas volume was increased.

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●Geboes KP, Luypaerts A, Rutgeerts P, Verbeke K.

Inulin is an ideal substrate for a hydrogen breath test to measure the orocaecal transit time.

Aliment Pharmacol Ther. 2003 Oct 1;18(7):721-9.

The study was conducted in healthy subjects. The purpose of the study was to measure the transit time from mouth to caecum.

A rise in 13 CO 2 excretion in the breath can therefore be considered as a measure of the orocaecal transit time. Due to the structural conformation of its linkages, inulin resists hydrolysis in the human small intestine and is almost completely fermented by the colonic microflora with the production of hydrogen. 

Lactulose appeared to shorten the orocaecal transit time significantly, whereas no difference in the orocaecal transit time was seen between the two doses of inulin [orocaecal transit time: 510 min (420–510 min) after the administration of 5 g Raftilin HP, 480 min (420–570 min) after the administration of 10 g Raftilin HP and 308 min (225–330 min) after the administration of 10 g lactulose] .

This study, inulin breath test suggest that it is possible to estimate the volume of colon gas.

And, lactulose fermentation in the colon occurs after 240-300 minutes (4-5 hours) of ingestion of lactulose.　Namely, common LHBT (within 180 min) may be not enough to estimate for colonic fermentation.

<Summary>

●H2 in the breath test of Fructan (inulin) is an indicator of the increase of colon gas.

●Fructose breath test is indicative of liquid volume in the small intestine.

●Colon gas increases according to the decrease of the liquid in the small intestine.

●Lactulose fermentation in the colon occurs after 240-300 minutes (4-5 hours) of ingestion of lactulose.

●To evaluate the colon gas by LHBT is required observation period of 4-5 hours.

< Additional evidence>

Show evidence that it does not make sense to evaluate the colon after lactulose ingestion.

●Undseth R, Berstad A, Kløw NE, Arnljot K, Moi KS, Valeur J.

Abnormal accumulation of intestinal fluid following ingestion of an unabsorbable carbohydrate in patients with irritable bowel syndrome: an MRI study.

Neurogastroenterol Motil. 2014 Dec;26(12):1686-93.

This Figure is Maximum diameters of intestinal segments as measured by MRI at 1 h after ingestion of 10g lactulose.

The difference in the pattern between IBS and healthy subjects (HS) was not observed.

In the course of just one hour, site of the intestinal tract has been extended was only terminal ileum.

This result is evidence that it is not possible to inflate the colon after ingestion 1 hour of lactulose 10g.
 

In the same research methods, if measured 4-5 hours after lactulose ingestion, it will be very surprise results are obtained.