Breath Hydrogen Gas Concentration Linked to Intestinal Gas Distribution and Malabsorption in Patients with Small-bowel Pseudo-obstruction

Background: The patient with colonic obstruction may frequently have bacterial overgrowth and increased breath hydrogen (H2) levels because the bacterium can contact with food residues for longer time. We experienced two cases with intestinal obstruction whose breath H2 concentrations were measured continuously.Case 1: A 70-year-old woman with small bowel obstruction was treated with a gastric tube. When small bowel gas decreased and colonic gas was demonstrated on the plain abdominal radiograph, the breath H2 concentration increased to 6 ppm and reduced again shortly.Case 2: A 41-year-old man with functional small bowel obstruction after surgical treatment was treated with intravenous administration of erythromycin. Although the plain abdominal radiograph demonstrated a decrease of small-bowel gas, the breath H2 gas kept the low level. After a clear-liquid meal was supplied, fasting breath H2 concentration increased rapidly to 22 ppm and gradually decreased to 9 ppm despite the fact that the intestinal gas was unchanged on X-ray. A rapid increase of breath H2 concentration may reflect the movement of small bowel contents to the colon in patients with small-bowel pseudo-obstruction or malabsorption following diet progression.Conclusions: Change in breath H2 concentration had a close association with distribution and movement of intestinal gas

Extensive Atrophic Gastritis Increases Intraduodenal Hydrogen Gas

Objective. Gastric acid plays an important part in the prevention of bacterial colonization of the gastrointestinal tract. If these bacteria have an ability of hydrogen (H2) fermentation, intraluminal H2 gas might be detected. We attempted to measure the intraluminal H2 concentrations to determine the bacterial overgrowth in the gastrointestinal tract. Patients and methods. Studies were performed in 647 consecutive patients undergoing upper endoscopy. At the time of endoscopic examination, we intubated the stomach and the descending part of the duodenum without inflation by air, and 20 mL of intraluminal gas samples of both sites was collected through the biopsy channel. Intraluminal H2 concentrations were measured by gas chromatography. Results. Intragastric and intraduodenal H2 gas was detected in 566 (87.5%) and 524 (81.0%) patients, respectively. The mean values of intragastric and intraduodenal H2 gas were 8.5 ± 15.9 and 13.2 ± 58.0 ppm, respectively. The intraduodenal H2 level was increased with the progression of atrophic gastritis, whereas the intragastric H2 level was the highest in patients without atrophic gastritis. Conclusions. The intraduodenal hydrogen levels were increased with the progression of atrophic gastritis. It is likely that the influence of hypochlorhydria on bacterial overgrowth in the proximal small intestine is more pronounced, compared to that in the stomach

The Association of H. pylori Infection and Patterns of Erythematous Gastric Mucosa

It has been uncertain what types of erythematous gastric mucosa are produced by Helicobacter pylori (H. pylori)-infection. We therefore design the present study to identify the type of erythematous mucosa associated with H. pylori-infection. A total of 590 consecutive Japanese patients (mean age 58.7 years, 185 men and 405 women) referred to our hospital for diagnostic upper gastrointestinal endoscopy were recruited in this study. We assessed endoscopically the type of gastric mucosal erythema, including spotty erythema, haemorrhagic erosion, reddish streaks, and raised erosion. H. pylori infection was diagnosed by a positive endoscopic 13C-urea breath test (e-UBT). Of the 402 H. pylori-positive subjects, spotty erythemas in the corpus were found in 177 (44.0%), haemorrhagic erosions in 26 (6.5%), reddish streaks in the antrum in 21 (5.2%) and in the corpus in 10 (2.5%), and raised erosions in the antrum in 58 (14.4%) and in the corpus in 4 (1.0%). For spotty erythema in the upper body, sensitivity was 44.0%, specificity was 92.6% for H. pylori infection. Seventy-two (86.7%) of 83 patients with antral reddish streaks and 65 (52.8%) of 123 patients with antral raised erosions had H. pylori-negative e-UBT. Spotty erythema in the corpus was one of most frequent endoscopic findings reflecting H. pylori infection. In contrast, antral reddish streaks and raised erosions were likely to indicate the absence of H. pylori

Clinical Study Extensive Atrophic Gastritis Increases Intraduodenal Hydrogen Gas

Recommended by Maria Eugenicos Objective. Gastric acid plays an important part in the prevention of bacterial colonization of the gastrointestinal tract. If these bacteria have an ability of hydrogen (H2) fermentation, intraluminal H2 gas might be detected. We attempted to measure the intraluminal H2 concentrations to determine the bacterial overgrowth in the gastrointestinal tract. Patients and methods. Studies were performed in 647 consecutive patients undergoing upper endoscopy. At the time of endoscopic examination, we intubated the stomach and the descending part of the duodenum without inflation by air, and 20 mL of intraluminal gas samples of both sites was collected through the biopsy channel. Intraluminal H2 concentrations were measured by gas chromatography. Results. Intragastric and intraduodenal H2 gas was detected in 566 (87.5%) and 524 (81.0%) patients, respectively. The mean values of intragastric and intraduodenal H2 gas were 8.5 ± 15.9 and 13.2 ± 58.0 ppm, respectively. The intraduodenal H2 level was increased with the progression of atrophic gastritis, whereas the intragastric H2 level was the highest in patients without atrophic gastritis. Conclusions. The intraduodenal hydrogen levels were increased with the progression of atrophic gastritis. It is likely that the influence of hypochlorhydria on bacterial overgrowth in the proximal small intestine is more pronounced, compared to that in the stomach