Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus

The North American Consensus group on hydrogen and methane-based breath testing

Research output: Contribution to journalArticle

104 Citations (Scopus)

Abstract

Objectives: Breath tests (BTs) are important for the diagnosis of carbohydrate maldigestion syndromes and small intestinal bacterial overgrowth (SIBO). However, standardization is lacking regarding indications for testing, test methodology and interpretation of results. A consensus meeting of experts was convened to develop guidelines for clinicians and research. Methods: Pre-meeting survey questions encompassing five domains; indications, preparation, performance, interpretation of results, and knowledge gaps, were sent to 17 clinician-scientists, and 10 attended a live meeting. Using an evidence-based approach, 28 statements were finalized and voted on anonymously by a working group of specialists. Results: Consensus was reached on 26 statements encompassing all five domains. Consensus doses for lactulose, glucose, fructose and lactose BT were 10, 75, 25 and 25 g, respectively. Glucose and lactulose BTs remain the least invasive alternatives to diagnose SIBO. BT is useful in the diagnosis of carbohydrate maldigestion, methane-associated constipation, and evaluation of bloating/gas but not in the assessment of oro-cecal transit. A rise in hydrogen of ≥20 p.p.m. by 90 min during glucose or lactulose BT for SIBO was considered positive. Methane levels ≥10 p.p.m. was considered methane-positive. SIBO should be excluded prior to BT for carbohydrate malabsorption to avoid false positives. A rise in hydrogen of ≥20 p.p.m. from baseline during BT was considered positive for maldigestion. Conclusions: BT is a useful, inexpensive, simple and safe diagnostic test in the evaluation of common gastroenterology problems. These consensus statements should help to standardize the indications, preparation, performance and interpretation of BT in clinical practice and research.

Original languageEnglish (US)
Pages (from-to)775-784
Number of pages10
JournalAmerican Journal of Gastroenterology
Volume112
Issue number5
DOIs
StatePublished - May 1 2017

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Breath Tests
Methane
Hydrogen
Lactulose
Carbohydrates
Glucose
Gastroenterology
Constipation
Lactose
Fructose
Research
Routine Diagnostic Tests
Gases
Guidelines

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders : The North American Consensus. / The North American Consensus group on hydrogen and methane-based breath testing.

In: American Journal of Gastroenterology, Vol. 112, No. 5, 01.05.2017, p. 775-784.

Research output: Contribution to journalArticle

The North American Consensus group on hydrogen and methane-based breath testing 2017, 'Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus', American Journal of Gastroenterology, vol. 112, no. 5, pp. 775-784. https://doi.org/10.1038/ajg.2017.46
The North American Consensus group on hydrogen and methane-based breath testing. / Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders : The North American Consensus. In: American Journal of Gastroenterology. 2017 ; Vol. 112, No. 5. pp. 775-784.
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abstract = "Objectives: Breath tests (BTs) are important for the diagnosis of carbohydrate maldigestion syndromes and small intestinal bacterial overgrowth (SIBO). However, standardization is lacking regarding indications for testing, test methodology and interpretation of results. A consensus meeting of experts was convened to develop guidelines for clinicians and research. Methods: Pre-meeting survey questions encompassing five domains; indications, preparation, performance, interpretation of results, and knowledge gaps, were sent to 17 clinician-scientists, and 10 attended a live meeting. Using an evidence-based approach, 28 statements were finalized and voted on anonymously by a working group of specialists. Results: Consensus was reached on 26 statements encompassing all five domains. Consensus doses for lactulose, glucose, fructose and lactose BT were 10, 75, 25 and 25 g, respectively. Glucose and lactulose BTs remain the least invasive alternatives to diagnose SIBO. BT is useful in the diagnosis of carbohydrate maldigestion, methane-associated constipation, and evaluation of bloating/gas but not in the assessment of oro-cecal transit. A rise in hydrogen of ≥20 p.p.m. by 90 min during glucose or lactulose BT for SIBO was considered positive. Methane levels ≥10 p.p.m. was considered methane-positive. SIBO should be excluded prior to BT for carbohydrate malabsorption to avoid false positives. A rise in hydrogen of ≥20 p.p.m. from baseline during BT was considered positive for maldigestion. Conclusions: BT is a useful, inexpensive, simple and safe diagnostic test in the evaluation of common gastroenterology problems. These consensus statements should help to standardize the indications, preparation, performance and interpretation of BT in clinical practice and research.",
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