Breath tests and irritable bowel syndrome

World J Gastroenterol. 2014 Jun 28;20(24):7587-601. doi: 10.3748/wjg.v20.i24.7587.

Abstract

Breath tests are non-invasive tests and can detect H₂ and CH₄ gases which are produced by bacterial fermentation of unabsorbed intestinal carbohydrate and are excreted in the breath. These tests are used in the diagnosis of carbohydrate malabsorption, small intestinal bacterial overgrowth, and for measuring the orocecal transit time. Malabsorption of carbohydrates is a key trigger of irritable bowel syndrome (IBS)-type symptoms such as diarrhea and/or constipation, bloating, excess flatulence, headaches and lack of energy. Abdominal bloating is a common nonspecific symptom which can negatively impact quality of life. It may reflect dietary imbalance, such as excess fiber intake, or may be a manifestation of IBS. However, bloating may also represent small intestinal bacterial overgrowth. Patients with persistent symptoms of abdominal bloating and distension despite dietary interventions should be referred for H₂ breath testing to determine the presence or absence of bacterial overgrowth. If bacterial overgrowth is identified, patients are typically treated with antibiotics. Evaluation of IBS generally includes testing of other disorders that cause similar symptoms. Carbohydrate malabsorption (lactose, fructose, sorbitol) can cause abdominal fullness, bloating, nausea, abdominal pain, flatulence, and diarrhea, which are similar to the symptoms of IBS. However, it is unclear if these digestive disorders contribute to or cause the symptoms of IBS. Research studies show that a proper diagnosis and effective dietary intervention significantly reduces the severity and frequency of gastrointestinal symptoms in IBS. Thus, diagnosis of malabsorption of these carbohydrates in IBS using a breath test is very important to guide the clinician in the proper treatment of IBS patients.

Keywords: Bacterial overgrowth; Breath test; Carbohydrate malabsorption; Irritable bowel syndrome; Lactulose breath test; Small intestine; Sorbitol breath test.

Publication types

  • Review

MeSH terms

  • Bacteria / metabolism*
  • Biomarkers / metabolism
  • Breath Tests*
  • Dietary Carbohydrates / metabolism*
  • Fermentation*
  • Gases
  • Humans
  • Intestines / microbiology*
  • Irritable Bowel Syndrome / complications
  • Irritable Bowel Syndrome / diagnosis*
  • Irritable Bowel Syndrome / diet therapy
  • Irritable Bowel Syndrome / microbiology
  • Lactose Intolerance / diagnosis
  • Lactose Intolerance / microbiology
  • Predictive Value of Tests
  • Prognosis

Substances

  • Biomarkers
  • Dietary Carbohydrates
  • Gases