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Lactose Breath Hydrogen Test

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121. Disorders of Carbohydrate Metabolism (Diagnosis)

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

122. 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

123. 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

124. 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

125. 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

126. 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

127. 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

128. 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

129. 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

130. 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

131. Fructose 1-Phosphate Aldolase Deficiency (Fructose Intolerance) (Diagnosis)

. 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

132. Imaging the Effect of Experimental Stress on Small and Large Bowel Water During Fructose Absorption

hours post prandially. Salivary cortisol will be collected after every MRI scans. Participants will also be asked to blow into the hydrogen breath machine and to fill in symptom questionnaire following each MRI scans. Further breath collections for orocaecal transit time will be collected initially every 10 minutes for the first hour and 15 mins until the end of the study day. Mouthwash will be used before initial breath test collection. This procedure will be repeated again on the 2nd test day (...) consumption of fructose. Condition or disease Intervention/treatment Phase Healthy Drug: CRH Drug: Placebo Phase 4 Detailed Description: A single centre, randomized cross over study consisting a screening visit and 2 test days which will be approximately 7 days apart. The participants will receive 1g unlabelled lactose ureide in a glass of water 3 times a day on the day before the study day to induce the enzyme activity in the colonic bacteria. The participants (20 healthy volunteers) will have a baseline

2013 Clinical Trials

133. The bitterness of Glucose/Galactose: Novel Mutations in the SLC5A1 Gene. (Abstract)

not previously undergo a diagnostic algorithm in full, for instance, one that may consist of a glucose breath hydrogen test and an empiric attempt of a dietary switch to galactomin, we suggest that molecular genotyping of such patients should only follow such appropriate clinical evaluation. (...) The bitterness of Glucose/Galactose: Novel Mutations in the SLC5A1 Gene. Glucose galactose malabsorption (GGM) is a rare autosomal recessive disorder characterized by life-threatening osmotic diarrhea at infancy. When the intake of the offending sugars (namely, glucose, galactose and lactose) is ceased, the diarrhea promptly stops. Mutations in the SLC5A1 gene, encoding the sodium-glucose co-transporter located in the brush border of enterocytes, have been shown to cause the disease. More than

2013 Journal of Pediatric Gastroenterology and Nutrition

134. The low FODMAP diet improves gastrointestinal symptoms in patients with irritable bowel syndrome: a prospective study. (Abstract)

The low FODMAP diet improves gastrointestinal symptoms in patients with irritable bowel syndrome: a prospective study. Current treatment for irritable bowel syndrome (IBS) is suboptimal. Fermentable oligo-, di-, mono-saccharides and polyols (FODMAPs) may trigger gastrointestinal symptoms in IBS patients. Our aim was to determine whether a low FODMAP diet improves symptoms in IBS patients.Irritable bowel syndrome patients, who had performed hydrogen/methane breath testing for fructose (...) (abdominal pain, bloating, flatulence and diarrhoea all significantly associated with adherence, r > 0.27, p < 0.011). Most patients (72.1%) were satisfied with their symptoms.The low FODMAP diet shows efficacy for IBS patients. The current strategy of breath testing and dietary advice provides a good basis to understand and adhere to the diet.© 2013 John Wiley & Sons Ltd.

2013 International journal of clinical practice

135. Flatulence

, Burping) No testing is typically needed, as this is nearly always aerophagia Gastric Bloating (symptoms begin <30 minutes after eating) Upper endoscopy Gastric Emptying Study Bloating (symptoms begin >30 minutes after eating) : IgA Tissue Transglutaminase (TTG) and Total IgA (if low, obtain IgG Gliadin instead of TTG) Hydrogen Breath Test Bloating with Rectal Exam (impaction, pelvic floor dysfunction) (TSH) Colon transit study Anorectal manometry XI. Management ral Avoid discounting patient concerns (...) fruit, honey, fruit juice, high fructose corn syrup) Fructans (fructo-oligosaccharides, inulins, levans - e.g. high fiber bars, onions, leeks, zucchini) Disaccharides (Lactose): Dairy, cheese, milk Polyols: cots, peaches Sugar s (esp. common in sugar-free gum): , xylitol, mannitol, malitol) Galactooligosaccharides or Raffinose (brussel sprouts, cabbage, green beans, lentils, legumes, chick peas) VI. Exam ral examination Focused abdominal exam Rectal exam VII. Findings: Red Flag Symptoms and signs

2015 FP Notebook

136. Lactase Deficiency

eating foods with lactose in them, you may feel sick to your stomach. You may also have Gas Diarrhea Swelling in your stomach Your doctor may do a blood, breath or stool test to find out if your problems are due to lactose intolerance. Lactose intolerance is not serious. Eating less food with lactose, or using pills or drops to help you digest lactose usually helps. You may need to take a calcium supplement if you don't get enough of it from your diet, since milk and foods made with milk are the most (...) ) Bloating or gas Cramping Foul smelling stools Large dairy intake or severe intolerance More significant symptoms of those listed above VI. Signs No weight loss associated with malabsorption VII. Differential Diagnosis (See secondary causes above) sis VIII. Evaluation Consider empiric trial off dairy products Also Consider (replaced by hydrogen test) IX. Management See Do not completely eliminate dairy products Risk of Lactase enzyme replacement (e.g. Lactaid, Dairy Ease) X. References Melrad in Goldman

2015 FP Notebook

137. Chronic Watery Diarrhea

. Causes: Functional Diarrhea Findings: Small volume (<350 ml/day) watery stools, better at night and with g V. Labs Fecal electrolytes (fecal , fecal ) Electrolytes increased in Secretory Diarrhea Electrolytes negligible in Osmotic Diarrhea Small osmotic gap <50 mOsm/kg in Secretory Diarrhea pH pH <6 in carbohydrate malabsorption VI. Evaluation Osmotic Diarrhea: Fecal osmotic gap >125 mOsm/kg If g improves , consider breath hydrogen test for (or empiric avoidance) Secretory Diarrhea: Fecal osmotic gap (...) Diarrhea Aka: Chronic Watery Diarrhea , Secretory Diarrhea , Osmotic Diarrhea From Related Chapters II. Causes: Osmotic Diarrhea Findings: fecal osmotic gap >125 mOsm/kg Malabsorption Lactose malabsorption ( ) Fructose malabsorption malabsorption Galactose malabsorption Gluten-sensitive ( ) ( s) s s Excessive High sugar juice intake Apple juice Pear juice Sugar s Mannitol ingestion ingestion (chewing gum ) Xylitol s phosphate citrate therapy Sulfate (Glauber's Salt) III. Causes: Secretory Diarrhea

2015 FP Notebook

138. Safety of Probiotics to Reduce Risk and Prevent or Treat Disease

, Streptococcus, Enterococcus, and Bacillus differ by product and delivery characteristics? The lack of detail in the description of administered probiotic organisms in most studies hindered evaluations of the safety. Many studies did not specify which probiotic strains were investigated, nor was there indication that intervention preparations were tested for identity of the included organisms, quantity, viability, or contaminants. Stratified analyses by probiotic genus showed no increased risk of adverse (...) are safe in the short term? Long term? a. What safety parameters are collected in clinical studies (Phases I-IV)? b. What harms are reported in clinical studies (Phases I-IV)? c. What harms are reported in case reports? d. What safety parameters are collected in population surveillance studies and other observational studies, and do these include only standard clinical safety parameters (e.g., standard blood chemistry profiles) or also expanded laboratory or clinical testing unique to the use

2011 EvidenceUpdates

139. Diarrhea

is secretory or osmotic. An osmotic gap < 50 mEq/L indicates secretory diarrhea; a larger gap suggests osmotic diarrhea. Patients with osmotic diarrhea may have covert magnesium laxative ingestion (detectable by stool magnesium levels) or carbohydrate malabsorption (diagnosed by hydrogen breath test, lactase assay, and dietary review). Undiagnosed secretory diarrhea requires testing (eg, plasma gastrin, calcitonin , vasoactive intestinal peptide levels, histamine, urinary 5-hydroxyindole acetic acid [5 (...) Diarrhea Diarrhea - Gastrointestinal Disorders - MSD Manual Professional Edition Brought to you by The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases / / / / IN THIS TOPIC OTHER TOPICS IN THIS CHAPTER Test your knowledge Helicobacter pylori Infection People

2013 Merck Manual (19th Edition)

140. Gas-Related Complaints

unless other symptoms suggest a particular disorder. Testing for carbohydrate intolerance (eg, lactose, fructose) with breath tests should be considered particularly when the history suggests significant consumption of these sugars. Testing for small-bowel bacterial overgrowth should also be considered, particularly in patients who also have diarrhea, weight loss, or both, preferably by aerobic and anaerobic culture of small-bowel aspirates obtained during upper GI endoscopy. Testing for bacterial (...) overgrowth with hydrogen breath tests, generally glucose-hydrogen breath tests, is prone to false-positive (ie, with rapid transit) and false-negative (ie, when there are no hydrogen-producing bacteria) results. New, persistent bloating in middle-aged or older women (or those with an abnormal pelvic examination) should prompt pelvic ultrasonography to rule out ovarian cancer. Treatment Belching and bloating are difficult to relieve because they are usually caused by unconscious aerophagia or increased

2013 Merck Manual (19th Edition)

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