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Lactose Breath Hydrogen Test

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121. Bacterial Overgrowth Syndrome (Treatment)

of hydrogen breath tests in most patients with Crohn disease. [ ] Norfloxacin, cephalexin, trimethoprim-sulfamethoxazole, and levofloxacin have been recommended for the treatment of bacterial overgrowth syndrome. [ , ] The exact length of therapy is not clearly defined; length of therapy should be tailored to symptom improvement. A single 7-10 day course of antibiotic may improve symptoms in 46-90% of patients with bacterial overgrowth syndrome. [ ] . Recurrence following therapy is not uncommon (...) in Gastroenterology and Hepatology. 1998. Stotzer PO, Kilander AF. Comparison of the 1-gram (14)C-D-xylose breath test and the 50-gram hydrogen glucose breath test for diagnosis of small intestinal bacterial overgrowth. Digestion . 2000. 61(3):165-71. . Peralta S, Cottone C, Doveri T, Almasio PL, Craxi A. Small intestine bacterial overgrowth and irritable bowel syndrome-related symptoms: experience with Rifaximin. World J Gastroenterol . 2009 Jun 7. 15(21):2628-31. . Pimentel M. Review of rifaximin as treatment

2014 eMedicine.com

122. Bacterial Overgrowth Syndrome (Overview)

A,editors. Clinical Application of Breath Tests in Gastroenterology and Hepatology. 1998. Stotzer PO, Kilander AF. Comparison of the 1-gram (14)C-D-xylose breath test and the 50-gram hydrogen glucose breath test for diagnosis of small intestinal bacterial overgrowth. Digestion . 2000. 61(3):165-71. . Peralta S, Cottone C, Doveri T, Almasio PL, Craxi A. Small intestine bacterial overgrowth and irritable bowel syndrome-related symptoms: experience with Rifaximin. World J Gastroenterol . 2009 Jun 7. 15(21 (...) on the population studied and the diagnostic methods used. In healthy people, BOS has been described in 0-12.5% by the glucose breath test, 20-22% by the lactulose breath test, and 0-35% when the 14 C D-xylose breath test is used. [ ] Bacterial overgrowth syndrome is more prevalent in elderly population because of diminished gastric acid secretion and consumption of a large number of medications that can cause hypomotility. BOS has also been described as a cause of occult malabsorption in elderly patients

2014 eMedicine.com

123. Malabsorption (Overview)

Palmitate Test. Clin Chim Acta . 2015 Jan 1. 438:103-6. . Ghoshal UC, Kumar S, Chourasia D, Misra A. Lactose hydrogen breath test versus lactose tolerance test in the tropics: does positive lactose tolerance test reflect more severe lactose malabsorption?. Trop Gastroenterol . 2009 Apr-Jun. 30(2):86-90. . Casterton PL, Verbeke KA, Brouns F, Dammann KW. Evaluation of sucromalt digestion in healthy children using breath hydrogen as a biomarker of carbohydrate malabsorption. Food Funct . 2012 Apr. 3(4):410 (...) of LCT-13910C/T and LCT-22018G/A single nucleotide polymorphisms associated with adult-type hypolactasia/lactase persistence among Israelis of different ethnic groups. Gene . 2013 Apr 25. 519(1):67-70. . Santonocito C, Scapaticci M, Guarino D, et al. Lactose intolerance genetic testing: Is it useful as routine screening? Results on 1426 south-central Italy patients. Clin Chim Acta . 2015 Jan 15. 439:14-7. . Holt PR. Diarrhea and malabsorption in the elderly. Gastroenterol Clin North Am . 2001 Jun. 30

2014 eMedicine.com

124. Irritable Bowel Syndrome (Overview)

pathogens, leukocytes, Clostridium difficile toxin, and possibly Giardia antigen History-specific studies include the following: Hydrogen breath testing to exclude bacterial overgrowth in patients with diarrhea and to screen for lactose and/or fructose intolerance Tissue transglutaminase antibody testing and small bowel biopsy in IBS-D to diagnose celiac disease. Thyroid function tests Serum calcium testing to screen for hyperparathyroidism Erythrocyte sedimentation rate and C-reactive protein (...) , Morch K, Eide GE, Rortveit G. Irritable bowel syndrome and chronic fatigue 3 years after acute giardiasis: historic cohort study. Gut . 2012 Feb. 61 (2):214-9. . Lacy BE. The science, evidence, and practice of dietary interventions in irritable bowel syndrome. Clin Gastroenterol Hepatol . 2015 Nov. 13 (11):1899-906. . Pimentel M, Chow EJ, Lin HC. Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome. a double-blind, randomized, placebo-controlled

2014 eMedicine.com

125. Disorders of Carbohydrate Metabolism (Overview)

minutes of oxygen deprivation, it can withstand only about 40-45 minutes without fuel. Most physicians, as medical students or interns, have had experience treating diabetic ketoacidosis. Although the experience tends to cast ketone bodies as toxins, they are not. The acidosis produced by ketone bodies is toxic and is the direct cause of the Kussmaul breathing typical of patients with diabetic ketoacidosis. Patients with diabetes in this state usually have had normal to elevated blood glucose (...) for the previous days or weeks. Enough glucose enters the brain cells during this time to inhibit synthesis of beta-hydroxybutyrate dehydrogenase and acetoacetyl CoA synthetase. Again, the ketone-utilizing enzymes in the brain are not working at effective levels. By the time frank ketoacidosis sets in, too little insulin is left for the blood glucose to be able to sustain the high metabolic activity of the brain. The ketone bodies accumulate but cannot provide energy or carbon for the brain. The hydrogen ion

2014 eMedicine.com

126. Malabsorption (Treatment)

Hepatol . 2012 Feb. 24(2):109-16. . Raman M, Fenton T, Crotty P, Ghosh S, Rioux K, Hundal R. A novel method to identify fat malabsorption: The Serum Retinyl Palmitate Test. Clin Chim Acta . 2015 Jan 1. 438:103-6. . Ghoshal UC, Kumar S, Chourasia D, Misra A. Lactose hydrogen breath test versus lactose tolerance test in the tropics: does positive lactose tolerance test reflect more severe lactose malabsorption?. Trop Gastroenterol . 2009 Apr-Jun. 30(2):86-90. . Casterton PL, Verbeke KA, Brouns F (...) , Dammann KW. Evaluation of sucromalt digestion in healthy children using breath hydrogen as a biomarker of carbohydrate malabsorption. Food Funct . 2012 Apr. 3(4):410-3. . Hope HB, Tveito K, Aase S, et al. Small intestinal malabsorption in chronic alcoholism determined by (13)C-D-xylose breath test and microscopic examination of the duodenal mucosa. Scand J Gastroenterol . 2010. 45(1):39-45. . Dutta AK, Sajith KG, Shah G, et al. Duodenal villous morphology assessed using magnification narrow band

2014 eMedicine.com

127. Disorders of Carbohydrate Metabolism (Treatment)

minutes of oxygen deprivation, it can withstand only about 40-45 minutes without fuel. Most physicians, as medical students or interns, have had experience treating diabetic ketoacidosis. Although the experience tends to cast ketone bodies as toxins, they are not. The acidosis produced by ketone bodies is toxic and is the direct cause of the Kussmaul breathing typical of patients with diabetic ketoacidosis. Patients with diabetes in this state usually have had normal to elevated blood glucose (...) for the previous days or weeks. Enough glucose enters the brain cells during this time to inhibit synthesis of beta-hydroxybutyrate dehydrogenase and acetoacetyl CoA synthetase. Again, the ketone-utilizing enzymes in the brain are not working at effective levels. By the time frank ketoacidosis sets in, too little insulin is left for the blood glucose to be able to sustain the high metabolic activity of the brain. The ketone bodies accumulate but cannot provide energy or carbon for the brain. The hydrogen ion

2014 eMedicine.com

128. Malabsorption (Follow-up)

Hepatol . 2012 Feb. 24(2):109-16. . Raman M, Fenton T, Crotty P, Ghosh S, Rioux K, Hundal R. A novel method to identify fat malabsorption: The Serum Retinyl Palmitate Test. Clin Chim Acta . 2015 Jan 1. 438:103-6. . Ghoshal UC, Kumar S, Chourasia D, Misra A. Lactose hydrogen breath test versus lactose tolerance test in the tropics: does positive lactose tolerance test reflect more severe lactose malabsorption?. Trop Gastroenterol . 2009 Apr-Jun. 30(2):86-90. . Casterton PL, Verbeke KA, Brouns F (...) , Dammann KW. Evaluation of sucromalt digestion in healthy children using breath hydrogen as a biomarker of carbohydrate malabsorption. Food Funct . 2012 Apr. 3(4):410-3. . Hope HB, Tveito K, Aase S, et al. Small intestinal malabsorption in chronic alcoholism determined by (13)C-D-xylose breath test and microscopic examination of the duodenal mucosa. Scand J Gastroenterol . 2010. 45(1):39-45. . Dutta AK, Sajith KG, Shah G, et al. Duodenal villous morphology assessed using magnification narrow band

2014 eMedicine.com

129. Disorders of Carbohydrate Metabolism (Follow-up)

minutes of oxygen deprivation, it can withstand only about 40-45 minutes without fuel. Most physicians, as medical students or interns, have had experience treating diabetic ketoacidosis. Although the experience tends to cast ketone bodies as toxins, they are not. The acidosis produced by ketone bodies is toxic and is the direct cause of the Kussmaul breathing typical of patients with diabetic ketoacidosis. Patients with diabetes in this state usually have had normal to elevated blood glucose (...) for the previous days or weeks. Enough glucose enters the brain cells during this time to inhibit synthesis of beta-hydroxybutyrate dehydrogenase and acetoacetyl CoA synthetase. Again, the ketone-utilizing enzymes in the brain are not working at effective levels. By the time frank ketoacidosis sets in, too little insulin is left for the blood glucose to be able to sustain the high metabolic activity of the brain. The ketone bodies accumulate but cannot provide energy or carbon for the brain. The hydrogen ion

2014 eMedicine.com

130. Necrotizing Enterocolitis (Diagnosis)

in serum sodium (< 130 mEq/dL) is alarming Low serum bicarbonate (< 20) may be seen in babies with poor tissue perfusion, sepsis, and bowel necrosis Reducing substances may be identified in the stool of formula-fed infants A breath hydrogen test may be positive Arterial blood gas levels may indicate the infant's need for respiratory support and can provide information on the acid-base status Abdominal radiography The mainstay of diagnostic imaging An AP and a left lateral decubitus view are essential (...) decreases the incidence of NEC. The protective effect of breast milk is thought, in part, to be related to delivery of Lactobacillus species that somehow repair the intestinal milieu. Work by Blackwood, et al suggests that the mechanism is more elegant: Both in vitro and in vivo models showed improved intestinal integrity in rat pups fed L rhamnosus and L plantarum probiotics. [ ] By increasing capillary tight junctions, tested animals experienced less intestinal injury compared to control animals when

2014 eMedicine Pediatrics

131. Necrotizing Enterocolitis: Surgical Perspective (Diagnosis)

in serum sodium (< 130 mEq/dL) is alarming Low serum bicarbonate (< 20) may be seen in babies with poor tissue perfusion, sepsis, and bowel necrosis Reducing substances may be identified in the stool of formula-fed infants A breath hydrogen test may be positive Arterial blood gas levels may indicate the infant's need for respiratory support and can provide information on the acid-base status Abdominal radiography The mainstay of diagnostic imaging An AP and a left lateral decubitus view are essential (...) decreases the incidence of NEC. The protective effect of breast milk is thought, in part, to be related to delivery of Lactobacillus species that somehow repair the intestinal milieu. Work by Blackwood, et al suggests that the mechanism is more elegant: Both in vitro and in vivo models showed improved intestinal integrity in rat pups fed L rhamnosus and L plantarum probiotics. [ ] By increasing capillary tight junctions, tested animals experienced less intestinal injury compared to control animals when

2014 eMedicine Pediatrics

132. Malabsorption Syndromes (Diagnosis)

, Tuck CJ. The clinical value of breath hydrogen testing. J Gastroenterol Hepatol . 2017 Mar. 32 Suppl 1:20-22. . Gabrielli M, D'angelo G, Di Rienzo T, Scarpellini E, Ojetti V. Diagnosis of small intestinal bacterial overgrowth in the clinical practice. Eur Rev Med Pharmacol Sci . 2013 Dec. 17 Suppl 2:30-5. . Rizzello CG, De Angelis M, Di Cagno R, et al. Highly efficient gluten degradation by lactobacilli and fungal proteases during food processing: new perspectives for celiac disease. Appl Environ (...) in patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther . 2009 Oct. 30(7):707-17. . Mokrowiecka A, Daniel P, Slomka M, Majak P, Malecka-Panas E. Clinical utility of serological markers in inflammatory bowel disease. Hepatogastroenterology . 2009 Jan-Feb. 56(89):162-6. . Ritchie BK, Brewster DR, Davidson GP, Tran CD, McNeil Y, Hawkes JS. 13C-sucrose breath test: novel use of a noninvasive biomarker of environmental gut health. Pediatrics . 2009 Aug. 124(2):620-6. . Yao CK

2014 eMedicine Pediatrics

133. Malabsorption Syndromes (Overview)

, Tuck CJ. The clinical value of breath hydrogen testing. J Gastroenterol Hepatol . 2017 Mar. 32 Suppl 1:20-22. . Gabrielli M, D'angelo G, Di Rienzo T, Scarpellini E, Ojetti V. Diagnosis of small intestinal bacterial overgrowth in the clinical practice. Eur Rev Med Pharmacol Sci . 2013 Dec. 17 Suppl 2:30-5. . Rizzello CG, De Angelis M, Di Cagno R, et al. Highly efficient gluten degradation by lactobacilli and fungal proteases during food processing: new perspectives for celiac disease. Appl Environ (...) in patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther . 2009 Oct. 30(7):707-17. . Mokrowiecka A, Daniel P, Slomka M, Majak P, Malecka-Panas E. Clinical utility of serological markers in inflammatory bowel disease. Hepatogastroenterology . 2009 Jan-Feb. 56(89):162-6. . Ritchie BK, Brewster DR, Davidson GP, Tran CD, McNeil Y, Hawkes JS. 13C-sucrose breath test: novel use of a noninvasive biomarker of environmental gut health. Pediatrics . 2009 Aug. 124(2):620-6. . Yao CK

2014 eMedicine Pediatrics

134. Malabsorption Syndromes (Treatment)

of a noninvasive biomarker of environmental gut health. Pediatrics . 2009 Aug. 124(2):620-6. . Yao CK, Tuck CJ. The clinical value of breath hydrogen testing. J Gastroenterol Hepatol . 2017 Mar. 32 Suppl 1:20-22. . Gabrielli M, D'angelo G, Di Rienzo T, Scarpellini E, Ojetti V. Diagnosis of small intestinal bacterial overgrowth in the clinical practice. Eur Rev Med Pharmacol Sci . 2013 Dec. 17 Suppl 2:30-5. . Rizzello CG, De Angelis M, Di Cagno R, et al. Highly efficient gluten degradation by lactobacilli (...) review: the prevalence of idiopathic bile acid malabsorption as diagnosed by SeHCAT scanning in patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther . 2009 Oct. 30(7):707-17. . Mokrowiecka A, Daniel P, Slomka M, Majak P, Malecka-Panas E. Clinical utility of serological markers in inflammatory bowel disease. Hepatogastroenterology . 2009 Jan-Feb. 56(89):162-6. . Ritchie BK, Brewster DR, Davidson GP, Tran CD, McNeil Y, Hawkes JS. 13C-sucrose breath test: novel use

2014 eMedicine Pediatrics

135. Fructose 1-Phosphate Aldolase Deficiency (Fructose Intolerance) (Overview)

. An inborn defect of hepatic fructose-1-phosphate splitting aldolase. Am J Med . 1963 Feb. 34:151-67. . Levin B, Oberholzer VG, Snodgrass GJAI, Stimmler L, Wilmers MJ. Fructosaemia. An inborn error of fructose metabolism. Arch Dis Child . 1963 Jun. 38:220-30. . Mass RE, Smith WR, Walsh JR. The association of hereditary fructose intolerance and renal tubular acidosis. Am J Med Sci . 1966 May. 251(5):516-23. . Muller P, Meier C, Bohme HJ. Fructose breath hydrogen test - is it really a harmless diagnostic (...) , jaundice, coagulopathy, coma, renal , and severe (in part due to lactic acidosis). See the image below. Pathophysiologic classification of lactic acidosis. Next: Pathophysiology Affected individuals are completely asymptomatic until they ingest fructose. Thus, homozygous neonates remain clinically well until confronted with dietary sources of fructose. Although lactose is the carbohydrate base in most infant formulas, some (eg, soy formulas) contain sucrose, a fructose-glucose disaccharide that may

2014 eMedicine Pediatrics

136. Necrotizing Enterocolitis: Surgical Perspective (Overview)

in serum sodium (< 130 mEq/dL) is alarming Low serum bicarbonate (< 20) may be seen in babies with poor tissue perfusion, sepsis, and bowel necrosis Reducing substances may be identified in the stool of formula-fed infants A breath hydrogen test may be positive Arterial blood gas levels may indicate the infant's need for respiratory support and can provide information on the acid-base status Abdominal radiography The mainstay of diagnostic imaging An AP and a left lateral decubitus view are essential (...) decreases the incidence of NEC. The protective effect of breast milk is thought, in part, to be related to delivery of Lactobacillus species that somehow repair the intestinal milieu. Work by Blackwood, et al suggests that the mechanism is more elegant: Both in vitro and in vivo models showed improved intestinal integrity in rat pups fed L rhamnosus and L plantarum probiotics. [ ] By increasing capillary tight junctions, tested animals experienced less intestinal injury compared to control animals when

2014 eMedicine Pediatrics

137. Necrotizing Enterocolitis (Overview)

in serum sodium (< 130 mEq/dL) is alarming Low serum bicarbonate (< 20) may be seen in babies with poor tissue perfusion, sepsis, and bowel necrosis Reducing substances may be identified in the stool of formula-fed infants A breath hydrogen test may be positive Arterial blood gas levels may indicate the infant's need for respiratory support and can provide information on the acid-base status Abdominal radiography The mainstay of diagnostic imaging An AP and a left lateral decubitus view are essential (...) decreases the incidence of NEC. The protective effect of breast milk is thought, in part, to be related to delivery of Lactobacillus species that somehow repair the intestinal milieu. Work by Blackwood, et al suggests that the mechanism is more elegant: Both in vitro and in vivo models showed improved intestinal integrity in rat pups fed L rhamnosus and L plantarum probiotics. [ ] By increasing capillary tight junctions, tested animals experienced less intestinal injury compared to control animals when

2014 eMedicine Pediatrics

138. Irritable Bowel Syndrome (Diagnosis)

pathogens, leukocytes, Clostridium difficile toxin, and possibly Giardia antigen History-specific studies include the following: Hydrogen breath testing to exclude bacterial overgrowth in patients with diarrhea and to screen for lactose and/or fructose intolerance Tissue transglutaminase antibody testing and small bowel biopsy in IBS-D to diagnose celiac disease. Thyroid function tests Serum calcium testing to screen for hyperparathyroidism Erythrocyte sedimentation rate and C-reactive protein (...) , Morch K, Eide GE, Rortveit G. Irritable bowel syndrome and chronic fatigue 3 years after acute giardiasis: historic cohort study. Gut . 2012 Feb. 61 (2):214-9. . Lacy BE. The science, evidence, and practice of dietary interventions in irritable bowel syndrome. Clin Gastroenterol Hepatol . 2015 Nov. 13 (11):1899-906. . Pimentel M, Chow EJ, Lin HC. Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome. a double-blind, randomized, placebo-controlled

2014 eMedicine.com

139. Malabsorption Syndromes (Follow-up)

JS. 13C-sucrose breath test: novel use of a noninvasive biomarker of environmental gut health. Pediatrics . 2009 Aug. 124(2):620-6. . Yao CK, Tuck CJ. The clinical value of breath hydrogen testing. J Gastroenterol Hepatol . 2017 Mar. 32 Suppl 1:20-22. . Gabrielli M, D'angelo G, Di Rienzo T, Scarpellini E, Ojetti V. Diagnosis of small intestinal bacterial overgrowth in the clinical practice. Eur Rev Med Pharmacol Sci . 2013 Dec. 17 Suppl 2:30-5. . Rizzello CG, De Angelis M, Di Cagno R, et al (...) or malnutrition, admit the patient to a medical care facility and immediately initiate treatment with parenteral fluid and nutrition supplements. Treatment for severe acquired carbohydrate malabsorption requires admission to a medical care facility for enteral nutrition with a low-carbohydrate formula and administration of parenteral dextrose. Previous Next: Deterrence/Prevention The availability of sensitive and specific serological testing for celiac disease, namely the antitissue transglutaminase

2014 eMedicine Pediatrics

140. Tovanor Breezhaler - glycopyrronium bromide

inhaler SLC Solute carrier uptake transporters SMQ Standardized MedDRA query SOC System organ class SGRQ St Gorge Respiratory Questionnaire SMETT Sub-max constant-load cycle ergometry test ss Steady state T½ Apparent elimination half-life TDI Transition dyspnea index Tg Transgenic Tmax Time to reach maximum concentration Tio Tiotropium ULN Upper limit normal URTI Upper respiratory tract infection V Volume of distribution WBC White blood cell Tovanor Breezhaler CHMP assessment report EMA/CHMP/508244 (...) of administrative information, complete quality data, non- clinical and clinical data based on applicants’ own tests and studies and bibliographic literature supporting certain tests or studies. Information on Paediatric requirements Pursuant to Article 7 of Regulation (EC) No 1901/2006, the application included an EMA Decision P/4/2008 on the granting of a product-specific waiver. Information relating to orphan market exclusivity Similarity Pursuant to Article 8 of Regulation (EC) No. 141/2000 and Article 3

2012 European Medicines Agency - EPARs

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