Breath Test.pdfVIP

Veronica Ojetti, Antonio Gasbarrini Organizzazione e gestione di un ambulatorio di fisiopatologia digestiva: BREATH TESTS Medicina Interna e Gastroenterologia Policlinico Gemelli Universita’ Cattolica - Roma 6° Corso Nazionale GASTRO-CARE Avellino, 19-20 novembre 2010 Azpiroz et al, Gastroenteology 2005 Intestinal gas volume 100-400 ml Gas production ?Swallow ?Chemical ?Diffusion ?Fermentation Gas elimination ?Belching ?Diffusion ?Consumption ?Flatus GI Bacteria Intestinal gases 103 CFU/mL 102-109 CFU/mL 104-1012 CFU/mL COMMENSAL BACTERIAL FLORA COLONIZES THE WHOLE GI TRACT ? Gas production could be associated to clinical symptoms (ie bloating) and/or be an expression of pathologies (ie small bowel bacterial overgrowth) ? Assessment of gas production could be of great value in the clinical practice ? Breath testing seems to be a good non invasive diagnostic procedure to assess gas production ? Up to now, there is not consensus as regards: Indications, methodology, analysis and interpretation of data produced by H-breath testing Intestinal gas evaluation H2-breath testing in the clinical practice ? Non-invasive, easy and reproducible ? Low-costs ? Different clinical applications Carbohydrates Malabsorption (BT lactose-sorbitole-fructose) Small Bowel Bacterial Overgrowth (BT glucose-lactulose) Orocecal transit time (BT lactulose) H2 breath test - Background CHO bacteria H2 CH4 H2S NH3 H2 CO2 b lo o d Diffusion 14-20% H2 H2 BREATH TEST METHODOLOGY a Instruments for intestinal gases dasage Non-dedicated Gascromatogra ph Dedicated Gascromatograph Stationary Portable Gold Standard No data about reproducibility and long term stability Accetable accuracy for all dedicated gascromatographs A Double-bag system Bag Syringe system Breath samples collected systems Hydrogen values acquired through two different systems are similar Breath samples collection and