An Improvisation in Fixation of Stamm Gastrostomy in Neonates

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Hereditary Multiple Gastrointestinal Atresia associated with Choledochal Cyst: A Rare Entity with Management Dilemma

Multiple intestinal atresias are rare and its treatment is challenging. Here, we present a case of multiple gastrointestinal atresia associated with choledochal cyst posing us a surgical challenge.

Energy Sources in Neonatal Surgery: Principles and Practice

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N-acetyltransferase 2, cytochrome P4502E1 and glutathione S-transferase genotypes in antitubercular treatment-induced hepatotoxicity in North Indians

WHAT IS KNOWN AND OBJECTIVE

Tuberculosis (TB) is a major cause of illness and death in developing countries. Hepatotoxicity is a serious side effect of antituberculosis treatment (ATT). NAT2, CYP2E1 and glutathione S-transferase (GST) gene polymorphisms may play an important role in ATT-induced hepatotoxicity. So, elucidating the genetics involved in anti-TB drug-induced hepatotoxicity in patients would be of utmost clinical significance. Therefore, the objective of the study was to elucidate the role of NAT2, CYP2E1 and GST gene polymorphisms in ATT-induced hepatotoxicity in North Indian patients.

METHODS

Three hundred patients with pulmonary and extra-pulmonary TB were enrolled. Total genomic DNA was isolated from each patient's peripheral lymphocytes using phenol-chloroform method, and genetic polymorphic analysis for N-acetyltransferase 2 (NAT2), cytochrome P4502E1 (CYP2E1) and GST was performed by polymerase chain reaction (PCR) with restriction fragment length polymorphism (RFLP).

RESULTS AND DISCUSSION

Of the 300 patients, 185 were males and 115 females. Among them, 33 males and 22 females developed ATT-induced hepatotoxicity. There were significant increases in alanine aminotransferase, aspartate aminotransferase and bilirubin levels in patients with ATT-induced hepatotoxicity at 1 month of treatment. NAT2 5/7 and 6/7 were significantly higher in hepatotoxicity patients as compared to the non-hepatotoxicity group. c1/c1 allele of CYP2E1 gene was lower (50·9%) in ATT-induced hepatotoxicity patients as compared to non-hepatotoxicity patients (61·2%), whereas c1/c2 and c2/c2 alleles were higher, but not statistically significant. GSTM1 was significantly higher in hepatotoxicity patients as compared to non-hepatotoxicity patients, whereas GSTT1 and GSTT1/M1 were lower, but not statistically significant.

WHAT IS NEW AND CONCLUSION

This study indicates that patients with slow-acetylator genotypes (NAT2 5/7, 6/7) and GSTM1 allele of GST enzyme were at higher risk of ATT-induced hepatotoxicity.

Pedicled omental onlay flap for post-traumatic intrahepatic major ductal injury

We report a 5-year-old girl who presented with post traumatic biliary leakage that failed to respond to conservative management for two weeks. Surgical exploration in the third week revealed a partially healed 5 cm long hepatic laceration in the right lobe of the liver. Bile was found leaking through a rent in the major right intra-hepatic duct at the apex of liver laceration. A pedicled onlay omental flap was used to buttress this rent as direct closure was not possible due to friable tissue. The child recovered uneventfully.

Dextran Carrier Macromolecules for Colon-specific Delivery of 5-Aminosalicylic Acid

Present manuscript describes the sustained and targeted delivery of 5-aminosalicylic acid to the distal ileum and proximal colon, using dextran (40 kDa) as a carrier for targeting 5-aminosalicylic acid at the colonic site by attaching p-aminobenzoic acid and benzoic acid as linkers. Prepared conjugate were characterized by UV, HPLC, FT-IR, and ¹H NMR. The degree of substitution was estimated by complete hydrolysis of conjugates in borate buffer and in vitro hydrolysis study of conjugates was performed in different biological media. It was observed that 5-aminosalicylic acid alone have produced high incidence of gastric ulcer with high ulcer index whereas lower ulcer index was found for the dextran conjugates of 5-aminosalicylic acid. The release pattern of conjugates in 3% w/v rat caecal content was confirmed the colon specificity of 5-aminosalicylic acid conjugates.

Pro-inflammatory and anti-inflammatory cytokine response in diarrhoea-predominant irritable bowel syndrome patients

BACKGROUND AND AIM

Irritable bowel syndrome (IBS) is referred to as a functional bowel disorder which is diagnosed by a number of characteristic symptoms (Rome II criteria) in the absence of detectable structural abnormalities. Low-grade inflammation of the intestine may be one of the reasons for development of diarrhoea-predominant IBS (IBS-D). We undertook this study to estimate the serum levels of pro-inflammatory (IL-6, TNF-alpha) and anti-inflammatory (IL-10) cytokines in IBS-D patients.

METHODS

A total of 108 diarrhoea patients were screened. Out of these only 63 adult IBS-D patients were enrolled. Age and sex matched 62 apparently healthy controls with no GI symptoms were also recruited. Out of 63 IBS-D patients, 37 were males while there were 32 males among the controls. The patients with IBS-D were diagnosed according to the Rome II criteria. Levels of serum IL-6, TNF-alpha and IL-10 were measured in all subjects using ELISA.

RESULTS

Mean (+/- SD) age of IBS-D patients (42.6 +/- 19.5 years) was comparable (p = 0.64) to that of controls (43.5 +/- 18.7 years). The mean (+/- SD) levels of IL-6 in IBS-D patients (32.2 +/- 12.01 pg/ml) was significantly higher (p < 0.001) than in controls (7.48 +/- 2.55 pg/ml). The levels of TNF-alpha in IBS-D patients (16.3 +/- 5.2 pg/ml) were also significantly higher (p < 0.05) than in controls (7.94 +/- 2.19 pg/ml). There was no significant difference in the serum levels of IL-10 (p = 0.23) between IBS-D patients (5.75 +/- 2.1 pg/ml) and controls (5.84 +/- 1.9 pg/ml).

CONCLUSION

Our results indicate that mild inflammation is involved in IBS-D patients as proinflammatory cytokines were increased although no difference in anti-inflammatory cytokine was observed.

Small intestinal bacterial overgrowth and orocecal transit time in patients of inflammatory bowel disease

BACKGROUND

Inflammatory bowel disease (IBD) consists of Ulcerative colitis (UC) and Crohn's disease (CD). These two conditions share many common features-diarrhea, bloody stools, weight loss, abdominal pain, fever and fatigue. Small intestinal bacterial overgrowth (SIBO) is frequent in patients with CD but it has not been studied in UC Indian patients.

AIM

The study was planned to measure orocecal transit time (OCTT) and SIBO in UC and CD patients.

METHODS

One hundred thirty-seven patients of IBD (95 UC and 42 CD) and 115 healthy controls were enrolled. OCTT and SIBO were measured by lactulose and glucose hydrogen breath test respectively. Concentration of hydrogen and methane were measured by SC microlyser from Quintron, USA.

RESULTS

Mean±standard deviation (SD) of OCTT in patients of IBD was significantly higher as compared to controls. Furthermore, OCTT was significantly higher in CD patients as compared to UC patients. It was also observed that occurrence of SIBO was significantly higher in IBD patients as compared to controls. The occurrence of SIBO in CD (45.2%) was significantly higher as compared to patients in UC (17.8%) group. Percentage of methane positive IBD patients (2.9%) was significantly lower as compared to methane positive controls (24.4%).

CONCLUSION

OCTT was significantly delayed in IBD patients as compared to controls and in CD patients as compared to UC patients. OCTT was significantly higher in SIBO positive IBD patients as compared to SIBO negative patients. Thus, we can suggest that delayed OCTT would have been the cause of increased SIBO in these patients.

Jamming behavior of domains in a spiral antiferromagnetic system

Using resonant magnetic x-ray photon correlation spectroscopy, we show that the domains of a spiral antiferromagnet enter a jammed state at the onset of long-range order. We find that the slow thermal fluctuations of the domain walls exhibit a compressed exponential relaxation with an exponent of 1.5 found in a wide variety of solidlike jammed systems and can be qualitatively explained in terms of stress release in a stressed network. As the temperature decreases, the energy barrier for fluctuations becomes large enough to arrest further domain wall fluctuations, and the domains freeze into a spatial configuration within 10 K of the Néel temperature. The relaxation times can be fitted with the Vogel-Fulcher law as observed in polymers, glasses, and colloids, thereby indicating that the dynamics of domain walls in an ordered antiferromagnet exhibit some of the universal features associated with jamming behavior.

Comparison of lactulose and glucose breath test for diagnosis of small intestinal bacterial overgrowth in patients with irritable bowel syndrome

BACKGROUND AND AIMS

Validity of the lactulose breath test (LBT) to diagnose small intestinal bacterial overgrowth (SIBO) has been questioned. Therefore, a study was planned to compare LBT with glucose breath test (GBT) to diagnose SIBO in irritable bowel syndrome (IBS) patients and controls.

METHODS

175 diarrhea-predominant IBS patients and 150 apparently healthy controls were enrolled. IBS was diagnosed according to Rome II criteria. Breath samples were collected every 10 min up to 180 min. Breath H₂ and CH₄ were measured using an SC MicroLyzer. SIBO was positive with a sustained increase in breath H₂ or CH₄ or both ≥10 ppm over a baseline value within <90 min in case of LBT and within <120 min in GBT.

RESULTS

SIBO was positive in 60/175 (34.3%) patients by lactulose and in 11/175 (6.2%) patients by GBT. In controls, LBT was positive for SIBO in 45/150 (30%) patients and in 1/150 (0.66%) patients by GBT. Positive LBT for SIBO was not significantly different in patients and controls; while using GBT, SIBO was significantly higher (p < 0.01) in patients as compared to controls. By using GBT as gold standard for SIBO, sensitivity, specificity, positive predictive value and negative predictive value of LBT in IBS patients was 63.6, 67.7, 11.7 and 96.6% respectively.

CONCLUSION

LBT is not a good test to discriminate SIBO in IBS patients from controls.

Neural tube defect repair and ventriculoperitoneal shunting: indications and outcome

Neural tube defect with its global involvement of nervous system has lot of implications. There is cotroversy in terms of timing of repair, simultaneous or metachronous ventriculoperitoneal shunt and criteria for shunt surgery in neonatal age. We are reporting our approach and results of management of this disease in neonatal period.

Integration of tobacco cessation in general medical practice: need of the hour

Tobacco use is the single most preventable cause of death and disability. Tobacco use causes almost one million deaths annually in India, which is much more than the combined mortality due to malaria/TB and HIV/AIDS. It is estimated to cause one billion deaths in the 21st century, eighty per cent of which will occur in the developing countries like India. Tobacco use is increasing in the country. Global Adult Tobacco Survey, 2010, estimated that more than one-third of adults (35%) in the country use tobacco, out of which 21% use smokeless tobacco, 9% smoke and 5% use both. The prevalence of overall tobacco use among men was 47.9% and among women was 20.2%. Global Youth Tobacco Survey, India, 2009, estimate 14.6% of 13-15 years school going children use tobacco. There is urgent need for addressing the tobacco epidemic in India. Though effective interventions for tobacco cessation such as brief counselling, nicotine replacement therapy, non-nicotine pharmacotherapy are available, their use by general practitioners is restricted due to lack of adequate dissemination of information in their use. Use of these simple assessment tools and practice of these effective interventions by general medical and healthcare practitioners will go a long way in addressing the rising tobacco epidemic in India and making general healthcare more comprehensive.

Impact of an irreversibly adsorbed layer on local viscosity of nanoconfined polymer melts

We report the origin of the effect of nanoscale confinement on the local viscosity of entangled polystyrene (PS) films at temperatures far above the glass transition temperature. By using marker x-ray photon correlation spectroscopy with gold nanoparticles embedded in the PS films prepared on solid substrates, we have determined the local viscosity as a function of the distance from the polymer-substrate interface. The results show the impact of a very thin adsorbed layer (~7 nm in thickness) even without specific interactions of the polymer with the substrate, overcoming the effect of a surface mobile layer at the air-polymer interface and thereby resulting in a significant increase in the local viscosity as approaching the substrate interface.

Comparison between acetylator phenotype and genotype polymorphism of n-acetyltransferase-2 in tuberculosis patients

BACKGROUND

Isoniazid (INH) is one of the most important drugs of antitubercular treatment regime, and in some cases it causes hepatotoxicity. It is metabolized by hepatic N-acetyltransferase-2 (NAT2).

AIM

To compare whether both methods, i.e., genotype NAT2 and phenotype test of measuring serum INH levels, are useful to identify acetylator status of patients on antitubercular treatment (ATT).

METHODS

A total of 251 tuberculosis (TB) patients on standard treatment were followed up to 6 months for this study. NAT2 genotype was assessed by PCR with restriction fragment length polymorphism (RFLP) whereas serum INH levels were measured by fluorometry.

RESULTS

Of the 251 patients, 50 (19.9%) developed ATT-induced hepatotoxicity. By phenotypic estimation, in the hepatotoxicity group, 17/50 (34%) were slow acetylators whereas 33/50 (66%) were fast acetylators. Genotypically, 19/50 (38%) were slow acetylators and 31/50 (62%) fast acetylators. By phenotypic analysis, in non-hepatotoxicity group, 46/201 (22.9%) were slow acetylators and 155/201 (77.1%) fast acetylators. By genotypic analysis, 30/201 (14.9%) were slow acetylators and 171/201 (85%) fast acetylators. Overall, slow acetylators (25.1%) measured phenotypically were not significantly different from slow acetylators (19.5%) measured genotypically.

CONCLUSION

This study suggests that the acetylator status of TB patients can be detected by phenotypic method as efficaciously as by genotypic method. Therefore, phenotypic method can replace genotypic method to determine acetylating status as phenotypic method is simple and inexpensive.

Evaluation of the effectiveness of ophthalmic assistants as screeners for glaucoma in North India

AIM

To assess whether ophthalmic assistants are effective in screening people for glaucoma in India.

METHODOLOGY

The study subjects were examined by both trained ophthalmic assistants and an ophthalmologist in both hospital and community settings. Specific tests for the diagnosis of glaucoma suspects included visual field examination using frequency doubling technology perimetry, intraocular pressure measurement (Tonopen), A-scan central anterior chamber depth measurement and dilated optic disc examination. The findings recorded by the ophthalmic assistants were masked to the ophthalmologist to avoid measurement bias.

RESULTS

In the hospital setting, there was a substantial level of agreement between the ophthalmic assistants and the ophthalmologist in the diagnosis of glaucoma suspects (89.29%, k=0.7, 95% confidence interval (CI)=0.54-0.86). The diagnostic accuracy of the ophthalmic assistants in detecting glaucoma suspects was high for sensitivity (95.2%, 95% CI=91.4-97.7%) but lower for specificity at 71.4% (95% CI=60.0-78.7%).In the community setting, there was a moderate level of agreement between the ophthalmic assistants and the ophthalmologist in the diagnosis of glaucoma suspects (78.23%, k=0.50, 95% CI=0.37-0.64). The diagnostic accuracy of the ophthalmic assistants in detecting glaucoma suspects was moderate for sensitivity (82.9, 95% CI=69.7-91.5%) but lower for specificity at 76.8% (95% CI=72.7-79.5%).

CONCLUSION

Ophthalmic assistants can be used for opportunistic case detection of glaucoma suspects in the community. Structured training of the ophthalmic assistants together with enhanced clinical experience would improve their performance in detecting glaucoma suspects in the community.

Pseudothrombocytopenia -- a caveat

Pseudothrombocytopenia is an ex vivo thrombocytopenia, counted by an automated cell counter, but not configured by microscopic examination of a well prepared blood smear. Incidences of pseudothrombocytopenia reported in different studies range from 0.09-0.21%, which could account for 15-30% of all cases of thrombocytopenla. Failure to identify pseudothrombocytopenia has led to a lot of clinical problems like unnecessary platelet transfusion, glucocorticoid therapy and so on. Haematological cell counters count platelets as particles with volume between 2 and 20fl. Thus platelet clumps are counted as leucocytes while fragmented RBCs as platelets. This study found pseudothrombocytopenia due to causes like EDTA blood stored at less than 32 degrees C for more than 2 hours (35%), excess EDTA in sample (10.7%), hyperlipidaemia, auto-immune disease, pregnancy, etc. No apparent cause could be found in 52% of cases. Hence it is emphasised that direct microscopic examination of a well stained blood smear from EDTA-venous blood (within 1hour) and or direct counting under Neubauer chamber with 1% ammonium oxalate (in special cases) is almost mandatory before releasing a report of platelet count. Also factors related to ratio and storage of EDTA-blood, calibration of instruments, proper selection of reagents, supervision of laboratory staff are essential to rule out any error of report including pseudothrombocytopenia.

Traumatic strictures of the posterior urethra in boys with special reference to recurrent strictures

PURPOSE

We report 18 years' experience of traumatic urethral strictures in boys with emphasis on recurrent strictures.

MATERIALS AND METHODS

Thirty-four boys with pelvic fracture urethral strictures underwent 35 repairs: 23 in the primary group (initial suprapubic cystostomy, but no urethral repair) and 12 in the re-do group (previously failed attempt(s) at urethroplasty elsewhere). The median age at operation and stricture length was 8.4 years and 3 cm in the primary and 9 years and 5.4 cm in the re-do group, respectively. Anastomotic urethroplasty was performed wherever possible, or failing this a substitution urethroplasty. Median follow up was 9 years for primary group and 8 years for re-do group.

RESULTS

Primary group: urethroplasty was successful in 22/23, with 10 by perineal and 13 by additional transpubic approach. Two have stress incontinence. Erectile function is unchanged in all and upper tracts are maintained. One had recurrent stricture. Re-do group (12 including 1 recurrence from primary group): anastomotic urethroplasty was done in 5 and substitution urethroplasty in 7. Patients needing substitution had long stricture (>5 cm), stricture extending to distal bulb, or high riding bladder neck. All patients are voiding urethrally. Two patients with substitution required dilatation for early re-stenosis. One appendix substitution required delayed revision. Two have stress incontinence. Erectile function was unaffected. Upper tracts are maintained.

CONCLUSIONS

Anastomotic urethroplasty was successful in over 95% of primary cases. In re-do cases it was viable in only 41% of cases; the rest required substitution urethroplasty. Urethral substitution also gave acceptable results.

Molecular simulation of the frictional behavior of polymer-on-polymer sliding

Molecular simulations of the sliding processes of polymer-on-polymer systems were performed to investigate the surface and subsurface deformations and how these affect tribological characteristics of nanometer-scale polymer films. It is shown that a very severe deformation is localized to a band of material about 2.5 nm thick at the interface of the polymer surfaces. Outside of this band, the polymer films experience a uniform shear strain that reaches a finite steady-state value of close to 100%. Only after the polymer films have achieved this steady-state shear strain do the contacting surfaces of the films show significant relative slippage over each other. Because severe deformation is limited to a localized band much thinner than the polymeric films, the thickness of the deformation band is envisaged to be independent of the film thickness and hence frictional forces are expected to be independent of the thickness of the polymer films. A strong dependency of friction on interfacial adhesion, surface roughness, and the shear modulus of the sliding system was observed. Although the simulations showed that frictional forces increase linearly with contact pressure, adhesive forces contribute significantly to the overall friction and must therefore be accounted for in nanometer-scale friction. It is also shown that the coefficient of friction is lower for lower-density polymers as well as for polymers with higher molecular weights.

Measurement of the interior structure of thin polymer films using grazing incidence diffuse x-ray scattering

A method is developed for calculating the small-angle x-ray scattering originating from within the interior of a thin film under grazing incidence illumination. This offers the possibility of using x-ray scattering to probe how the structure of polymers is modified by confinement. When the diffuse scattering from a thin film is measured over a range of incident angles, it is possible to separate the contributions to scattering from the interfaces and the contribution from the film interior. Using the distorted-wave Born approximation the structure factor, S(q), of the film interior can then be obtained. We apply this method to analyze density fluctuations from within the interior of a silicon supported molten polystyrene (PS) film. Measurements were made as a function of film thickness ranging from one to ten times the polymer radius of gyration (Rg). The compressibility, calculated by extrapolating the measured S(q) to q=0, agrees well with that of bulk PS for thick films, but thinner films exhibit a peak in S(q) near q=0. This peak, which grows with decreasing thickness, is attributed to a decreased interpenetration of chains and a consequent enhanced compressibility.

Reduced viscosity of the free surface in entangled polymer melt films

By embedding "dilute" gold nanoparticles in single polystyrene thin films as "markers", we probe the local viscosity of the free surface at temperatures far above the glass transition temperature (T(g)). The technique used was x-ray photon correlation spectroscopy with resonance-enhanced x-ray scattering. The results clearly showed the surface viscosity is about 30% lower than the rest of the film. We found that this reduction is strongly associated with chain entanglements at the free surface rather than the reduction in T(g).

Long term follow-up of very low birthweight infants from a neonatal volume versus pressure mechanical ventilation trial

BACKGROUND

A previous randomised trial showed volume controlled ventilation (VCV) was efficacious in ventilating very preterm and extremely low birthweight babies.

OBJECTIVE

To compare long term survival, pulmonary morbidities and gross neurodevelopmental outcomes of babies randomised to either VCV or pressure limited ventilation (PLV) for treatment of respiratory distress syndrome.

DESIGN/METHODS

Masked evaluation of health status, including frequency of respiratory illness, use of medications, hospital admissions, and gross neurodevelopmental status were obtained using a structured parental questionnaire and verification from medical records.

RESULTS

94 of 109 children (86%) survived to discharge. Three died after discharge (2 VCV, 1 PLV). Modality of ventilation did not affect overall mortality; seven VCV children died (12%) versus 11 PLV (21%) (OR 0.5 (95% CI 0.1 to 1.4), p = 0.13). Respiratory abnormalities were present in 32 (37%), and 26 (30%) required hospital readmission. There was no significant difference in readmission rates between the two groups: VC 13/45 (29%) and PLV 19/40 (47%) (OR 0.4 (0.1 to 1.1), p = 0.07). Modality of ventilation did not affect frequency of respiratory illness: VC 12 (27%) and PLV 14 (35%) (OR 0.46 (0.1 to 1.1), p = 0.09). However, significantly fewer VCV children (13%, n = 6) compared to PLV children (32%, n = 13) required treatment with inhaled steroids/bronchodilators (OR 0.3 (0.1 to 0.9), p = 0.04). Nine children had severe neurodevelopmental disability (cerebral palsy, blindness, deafness) (9.8%; 3 VCV, 6 PLV 6) (OR 0.4 (0.09 to 1.7)).

CONCLUSIONS

The efficacy of VCV in very preterm and low birth babies appears to be maintained on longer term evaluation.

Effect of predominant methanogenic flora on outcome of lactose hydrogen breath test in controls and irritable bowel syndrome patients of north India

The relationship between methanogenic flora and hydrogen (H(2)) production is considered to be a possible confounding factor in the interpretation of hydrogen breath tests (H(2)BT). Therefore, the present study was conducted prospectively and included 154 IBS patients (fulfilling Rome II criteria) and 286 age-and-sex-matched apparently healthy controls. Each subject underwent H(2)BT after overnight fasting using 25 g lactose. Methane and H(2) were measured using an SC Microlyser from Quintron, USA, at baseline and every 30 min for a total of 4 h. Subjects with fasting methane concentration <10 ppm were labeled as low methane producers (LMP) and >10 ppm as predominant methane producers (PMP). A rise >20 ppm over base line in hydrogen concentration was taken as +ve hydrogen breath test. IBS and control groups included 66.78% and 67.53% males, respectively. Mean age in the two groups were 48.52 +/- 30.54 years (range 15-68 years) and 45.67 +/- 30.54 years (range 15-78 years), respectively. Hydrogen breath test was +ve in 77/154 (50%) IBS patients and in 142/286 (49.65%) in controls (P > 0.05). It was also observed that the hydrogen breath test was -ve due to PMP in 5/77 (6.49%) of IBS patients and in 29/154 (20.14%) in controls. PMP affected lactose hydrogen breath tests in 6.49-20.14% subjects. This effect is more apparent in apparently healthy subjects as compared to patients with IBS.

Influence of previously ingested wheat on fasting breath hydrogen in celiac patients

The excretion of hydrogen in breath commonly persists, despite an overnight fast. Although the elevation of hydrogen concentration above the fasting value after the administration of a test sugar is evidence of malabsorption, the level of the fasting value itself in untreated celiac patients is unknown. Therefore, we studied the fasting breath hydrogen (FBH(2)) concentration in 40 healthy controls, 35 subjects with functional bowel disorders, and 30 patients of untreated celiac disease with and without bread or wheat diet one day before the test. The fasting level of hydrogen concentration in untreated celiac patients (28.7 +/- 19.5 ppm) was significantly higher than those in healthy volunteers (9.5 +/- 3.4 ppm) and subjects with functional bowel disorders (10.6 +/- 4.5 ppm). The percentage of patients with elevated H(2) fasting levels in untreated celiac disease (82.5%) was significantly higher than that in healthy controls (10%) and subjects with functional bowel disorders (17.1%). In 30 celiac patients, studied with and without wheat-free diet one day before the test, the fasting hydrogen levels decreased from 28.7 +/- 19.5 ppm to 10.6 +/- 3.5 ppm, and becoming normal in all patients of celiac disease. Our results show that the patients of untreated celiac disease should be instructed not to eat things made up of wheat one day before hydrogen breath testing so that the normal fasting hydrogen concentration can be obtained and false-negative hydrogen breath test results can be avoided.