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Lactose Breath Hydrogen Test

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141. Seebri Breezhaler - glycopyrronium bromide

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 Seebri Breezhaler CHMP assessment report EMA/CHMP/508029/2012 Page 4/84 1 (...) , 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 of Commission Regulation

2012 European Medicines Agency - EPARs

142. Enurev Breezhaler - glycopyrronium bromide

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 Enurev Breezhaler CHMP assessment report EMA/CHMP/508338/2012 Page 4/84 1 (...) , 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 of Commission Regulation

2012 European Medicines Agency - EPARs

143. Inlyta - axitinib

(hypromellose, titanium dioxide, lactose monohydrate, triacetin and red iron oxide). All excipients are well-known and commonly used in tablet formulations and meet the corresponding requirement of the European Pharmacopoeia, where appropriate. The compatibility of the active substance with the excipients has been investigated by performing stress studies (high temperature and humidity). The tablet core formulation was tested to confirm Inlyta CHMP assessment report Page 15/92 acceptable chemical stability (...) related gene HPLC High-performance liquid chromatography HUVEC Human umbilical vein endothelial cell IAUC initial area under the curve IC 50 Half maximal inhibitory concentration ICH International Conference on Harmonization ICSR Individual Case Safety Report IEC Independent Ethics Committee IFN-a interferon-alpha IL-2 Interleukin-2 IP Intraperitoneal IIR investigator-initiated research IRC Independent Review Committee IV Intravenous IVRS Interactive Voice Response System LFT Liver function test LOAEL

2012 European Medicines Agency - EPARs

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

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

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2013 Journal of Pediatric Gastroenterology and Nutrition

145. 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

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

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

147. 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

148. 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

149. 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

150. Effect of age on fructose malabsorption in children presenting with gastrointestinal symptoms. (PubMed)

Effect of age on fructose malabsorption in children presenting with gastrointestinal symptoms. Fructose malabsorption can produce symptoms such as chronic diarrhoea and abdominal pain. Here, we retrospectively review breath hydrogen test (BHT) results to determine whether age has an effect on the clinical application of the fructose BHT and compare this with the lactose BHT.Patients were referred to a gastroenterology breath-testing clinic (2003-2008) to investigate carbohydrate malabsorption (...) as a cause of gastrointestinal symptoms. Patients received either 0.5 g/kg body weight of fructose (maximum of 10 g) or 2 g/kg of lactose (maximum of 20 g), in water, and were tested for 2.5 hours.Patient age showed a significant effect on the fructose BHT results (P < 0.001, 0.1-79 years old, n = 1093). The odds of testing positive for fructose malabsorption in paediatric patients (15 years old or younger, n = 760) decreased by a factor of 0.82/year (95% confidence interval 0.79-0.86, P < 0.001

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2011 Journal of Pediatric Gastroenterology and Nutrition

151. Mild CFTR mutations and genetic predisposition to lactase persistence in cystic fibrosis. (PubMed)

, hydrogen-methane breath test (BT) with lactose loading was conducted and clinical symptoms typical for lactose malabsorption were assessed. The percentage of CF patients with C/C was similar to that observed in healthy subjects (HS) (31.5 vs 32.5% ). Eleven out of 52 (24.5%) CF C/C patients had abnormal BT results. The recalculated frequency of lactose malabsorption was similar for the entire CF and HS populations (6.9 vs 7.2%). Similarly as in the control group, few CF patients have identified (...) and linked to lactose consumption clinical symptoms. The frequency of LCT polymorphic variants in CF patients having and not having severe mutations of CFTR gene showed significant differences. The C allele was more frequent in homozygotes of the severe mutations than in patients carrying at least one mild/unknown mutation (P<0.0028) and in patients with at least one mild mutation (P < 0.0377). In conclusion, CF patients carrying mild CFTR mutations seem to have lower genetic predisposition to ATH

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2011 European Journal of Human Genetics

152. Glutamine for the Treatment of Patients With Irritable Bowel Syndrome

ingestion for 2 weeks prior to inclusion into study and throughout the study duration Exclusion Criteria: current participation in another research protocol or unable to give informed consent women with a positive urine pregnancy test or breastfeeding history of inflammatory bowel disease, lactose intolerance, and/or celiac sprue + hydrogen breath test for bacterial overgrowth + antiendomysial antibody titer use of nonsteroidal antinflammatory drug(NSAIDs) 2 weeks before or during the study known (...) using the contacts provided below. For general information, Layout table for eligibility information Ages Eligible for Study: 18 Years to 72 Years (Adult, Older Adult) Sexes Eligible for Study: All Accepts Healthy Volunteers: No Criteria Inclusion Criteria: men and women age 18-72 years old who developed post-infectious diarrhea-predominant IBS (D-IBS) increased intestinal permeability on Lactulose/Mannitol permeability test able and willing to cooperate with the study *absence of alcohol or NSAIDs

2011 Clinical Trials

153. The Effect of Different Macronutrients on Ileal Brake Activation

day ] Gastric emptying by using the C13 stable isotope breath test [ Time Frame: 1 day ] Small bowel transit time by using lactulose hydrogen breath test [ Time Frame: 1 day ] Gallbladder volumes by gallbladder ultrasound [ Time Frame: 1 day ] Measurements in plasma and/or platelet poor plasma Plasma levels of the gut hormone Glucagon Like Peptide-1 (GLP-1) [ Time Frame: 1 day ] Measurements in plasma and/or platelet poor plasma Plasma levels of the gut hormone peptide YY (PYY) [ Time Frame: 1 day (...) (major interference with the execution of the experiment or potential influence on the study outcomes) will be decided by the principal investigator. Use of medication, including vitamin supplementation, except oral contraceptives, within 14 days prior to testing Administration of investigational drugs or participation in any scientific intervention study which may interfere with this study (to be decided by the principle investigator), in the 180 days prior to the study Major abdominal surgery

2011 Clinical Trials

154. Effects of FODMAPs on Small Bowel Water Content: an MRI Study

- 315 minutes of ascending colon, colonic motility, symptoms questionnaires, small bowel transit time, breath hydrogen concentrations and tryptase faecal content. Previous work using mannitol and glucose indicates that mean (SD) SBWC at 40 minutes postprandial after ingesting 300ml glucose was 47 (SD 15) and using n=12 the investigators calculate the investigators can detect an increase of 20 ml in excess of this with 90% power which is very much less than the investigators are predicting (...) Intervention/treatment Phase Healthy Dietary Supplement: Glucose Dietary Supplement: Fructose Dietary Supplement: Fructan Dietary Supplement: Fructose and glucose Not Applicable Detailed Description: Title: Effects of FODMAPs (Fermentable Oligo-, Di-, and Mono-saccharides, And Polyols) on small bowel water content: an MRI study Background. FODMAPs consist of fructose, lactose, fructo- and galacto-oligosaccharides such as fructans and galactans, and polyols such as sorbitol and mannitol. These carbohydrates

2011 Clinical Trials

155. 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)

156. 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)

157. Chronic and Recurrent Abdominal Pain

Sometimes regurgitation of gastric contents into mouth Barium swallow Endoscopy Chronic nonspecific pain Sometimes palpable RLQ mass Fever, diarrhea, weight loss Tuberculin test Endoscopy for biopsy CT with oral contrast Chest x-ray Bloating and cramps after ingesting milk products Hydrogen breath test Trial of elimination of lactose-containing foods Severe upper abdominal pain that Often radiates to the back Occurs late in disease, when weight loss is often present May cause obstructive jaundice CT (...) MRCP or ERCP Parasitic infestation (particularly ) History of travel or exposure Cramps, flatulence, diarrhea Stool examination for ova or parasites Stool enzyme immunoassay (for Giardia ) Upper abdominal pain relieved by food and antacids May awaken patient at night Endoscopy and biopsy for Helicobacter pylori H. pylori breath test Evaluation of NSAID use Stool examination for occult blood Postoperative adhesive bands Previous abdominal surgery Colicky discomfort accompanied by nausea

2013 Merck Manual (19th Edition)

158. Overview of Malabsorption

carbohydrates in the colon, increasing exhaled hydrogen. The lactose-hydrogen breath test is useful only to confirm and is not used as an initial diagnostic test in the evaluation of malabsorption. The 14 C-xylose and hydrogen breath tests have replaced bacterial cultures of aspirates taken during endoscopy for diagnosis of . The Schilling test assesses malabsorption of vitamin B 12 . Its 4 stages determine whether the deficiency results from pernicious anemia, pancreatic exocrine insufficiency, bacterial (...) is suggestive but are not sensitive for mild pancreatic disease. The 14 C-xylose breath test helps diagnose bacterial overgrowth. 14 C-xylose is given orally, and the exhaled 14 CO 2 concentration is measured. Catabolism of ingested xylose by the overgrowth of flora causes 14 CO 2 to appear in exhaled breath. The hydrogen (H 2 ) breath test measures the exhaled hydrogen produced by the bacterial degradation of carbohydrates. In patients with disaccharidase deficiencies, enteric bacteria degrade nonabsorbed

2013 Merck Manual (19th Edition)

159. Carbohydrate Intolerance

amounts may suggest another diagnosis. Diagnosis Clinical diagnosis Hydrogen breath test for confirmation Lactose intolerance can usually be diagnosed with a careful history supported by dietary challenge. Patients usually have a history of diarrhea and/or gas after ingestion of milk and dairy foods; other symptoms, such as rash, wheezing, or other anaphylactic symptoms (particularly in infants and children), suggest a cow's milk allergy . Milk allergy is rare in adults and also may cause vomiting (...) and symptoms of esophageal reflux, which are not manifestations of carbohydrate intolerance. The diagnosis is also suggested if the stool from chronic or intermittent diarrhea is acidic (pH < 6) and can be confirmed by an H 2 breath test or a lactose tolerance test. In the hydrogen breath test, 50 g of lactose is given orally and the hydrogen produced by bacterial metabolism of undigested lactose is measured with a breath meter at 2, 3, and 4 h postingestion. Most affected patients have an increase

2013 Merck Manual (19th Edition)

160. Diarrhea in Children

evaluation Sometimes hydrogen breath test Sometimes test for reducing substances in stool (to check for carbohydrates) and stool pH ( 6.0 indicates carbohydrates in stool) Cow's milk protein intolerance (milk protein allergy) Vomiting Diarrhea or constipation Hematochezia Anal fissures Failure to thrive Symptom resolution when cow's milk protein is eliminated Sometimes endoscopy or colonoscopy Excessive juice intake History of excessive juice or sugary drink intake (4–6 oz/day) Clinical evaluation (...) ) or reptiles ( Salmonella ) History of eating undercooked food ( Salmonella ) Recent ( 2 mo) antibiotic use ( C. difficile ) Day care center outbreak Stool culture Fecal leukocytes If patients appear ill, CBC, renal function tests, and blood culture If patient has recently been given antibiotics, stool testing for C. difficile toxin or food poisoning Allergy: Urticarial rash, lip swelling, abdominal pain, vomiting, diarrhea, difficulty breathing within minutes to several hours after eating Poisoning

2013 Merck Manual (19th Edition)

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