Influence of orocaecal transit time on hydrogen excretion after carbohydrate malabsorption

Highly Sensitive and Selective Detection of Hydrogen Using Pd-Coated SnO2 Nanorod Arrays for Breath-Analyzer Applications

We report a breath hydrogen analyzer based on Pd-coated SnO₂ nanorods (Pd-SnO₂ NRs) sensor integrated into a miniaturized gas chromatography (GC) column. The device can measure a wide range of hydrogen (1–100 ppm), within 100 s, using a small volume of human breath (1 mL) without pre-concentration. Especially, the mini-GC integrated with Pd-SnO₂ NRs can detect 1 ppm of H₂, as a lower detection limit, at a low operating temperature of 152 °C. Furthermore, when the breath hydrogen analyzer was exposed to a mixture of interfering gases, such as carbon dioxide, nitrogen, methane, and acetone, it was found to be capable of selectively detecting only H₂. We found that the Pd-SnO₂ NRs were superior to other semiconducting metal oxides that lack selectivity in H₂ detection. Our study reveals that the Pd-SnO₂ NRs integrated into the mini-GC device can be utilized in breath hydrogen analyzers to rapidly and accurately detect hydrogen due to its high selectivity and sensitivity.

Review of paediatric gastrointestinal physiology relevant to the absorption of orally administered medicines

Despite much progress in regulations to improve paediatric drug development, there remains a significant need to develop better medications for children. For the design of oral dosage forms, a detailed understanding of the specific gastrointestinal (GI) conditions in children of different age categories and how they differ from GI conditions in adults is essential. Several review articles have been published addressing the ontogeny of GI characteristics, including luminal conditions in the GI tract of children. However, the data reported in most of these reviews are of limited quality because (1) information was cited from very old publications and sometimes low quality sources, (2) data gaps in the original data were filled with textbook knowledge, (3) data obtained on healthy and sick children were mixed, (4) average data obtained on groups of patients were mixed with data obtained on individual patients, and (5) results obtained using investigative techniques that may have altered the outcome of the respective studies were considered. Consequently, many of these reviews draw conclusions that may be incorrect. The aim of the present review was to provide a comprehensive and updated overview of the available original data on the ontogeny of GI luminal conditions relevant to oral drug absorption in the paediatric population. To this end, the PubMed and Web of Science metadatabases were searched for appropriate studies that examined age-related conditions in the oral cavity, esophagus, stomach, small intestine, and colon. Maturation was observed for several GI parameters, and corresponding data sets were identified for each paediatric age group. However, it also became clear that the ontogeny of several GI traits in the paediatric population is not yet known. The review article provides a robust and valuable data set for the development of paediatric in vitro and in silico biopharmaceutical tools to support the development of age-appropriate dosage forms. In addition, it provides important information on existing data gaps and should provide impetus for further systematic and well-designed in vivo studies on GI physiology in children of specific age groups in order to close existing knowledge gaps and to sustainably improve oral drug therapy in children.

Increase in breath hydrogen concentration was correlated with the main pancreatic duct stenosis

BACKGROUND

Hydrogen is produced from unabsorbed carbohydrates in the intestine through degradation and metabolism by hydrogenase of intestinal bacteria. The hydrogen is then partially diffused into blood flow and released and detected in exhaled breath. Pancreatic juice production is decreased in patients with reduced pancreatic exocrine function, including those with pancreatic cancer, thus decreasing digestion and absorption of nutrients including carbohydrates, which may increase undigested carbohydrates in the intestine and increase breath hydrogen concentration (BHC). The aim of this study was to investigate the association between BHC and pancreatic diseases.

METHODS

A retrospective study was designed and 68 patients underwent morning fasting breath hydrogen test. Since there is no clear standard, normal BHC, the median of the measured values from the subjects (9 ppm) was adopted as the standard. The subjects were classified into those with a value exceeding the median (BHC high group: 32 patients) and a value equal to or below the median (BHC low group: 36 patients). Patients characteristics, blood test results and imaging findings characteristic of pancreatic diseases were compared between the groups.

RESULTS

The age was significantly higher (P = 0.010) and the incidences of pancreatic ductal adenocarcinoma and autoimmune pancreatitis were significantly higher (P = 0.018 and P = 0.004, respectively) in the BHC high group. With respect to the blood test items, the Alb level was significantly lower in the BHC high group (P = 0.005). With respect to the characteristic imaging findings of pancreatic diseases, the proportions of patients with pancreatic enlargement, the main pancreatic duct (MPD) stenosis, and the MPD dilatation were significantly higher in the BHC high group (P = 0.022, P < 0.001, and P = 0.002, respectively). On univariate analysis, only the MPD stenosis was extracted as an independent factor (P = 0.014).

CONCLUSION

It was suggested that the fasting BHC is associated with pancreatic diseases causing stenosis of the MPD, including pancreatic cancer (UMIN000020777).

Effect of raw milk on lactose intolerance: a randomized controlled pilot study

PURPOSE

This pilot study aimed to determine whether raw milk reduces lactose malabsorption and/or lactose intolerance symptoms relative to pasteurized milk.

METHODS

We performed a crossover trial involving 16 adults with self-reported lactose intolerance and lactose malabsorption confirmed by hydrogen (H2) breath testing. Participants underwent 3, 8-day milk phases (raw vs 2 controls: pasteurized, soy) in randomized order separated by 1-week washout periods. On days 1 and 8 of each phase, milk consumption was 473 mL (16 oz); on days 2 to 7, milk dosage increased daily by 118 mL (4 oz), beginning with 118 mL (4 oz) on day 2 and reaching 710 mL (24 oz) on day 7. Outcomes were area under the breath H2 curve (AUC H2) and self-reported symptom severity (visual analog scales: flatulence/gas, audible bowel sounds, abdominal cramping, diarrhea).

RESULTS

AUC H2 (mean ± standard error of the mean) was higher for raw vs pasteurized on day 1 (113 ± 21 vs 71 ± 12 ppm·min·10(-2), respectively, P = .01) but not day 8 (72 ± 14 vs 74 ± 15 ppm·min·10(-2), respectively, P = .9). Symptom severities were not different for raw vs pasteurized on day 7 with the highest dosage (P >.7). AUC H2 and symptom severities were higher for both dairy milks compared with soy milk.

CONCLUSIONS

Raw milk failed to reduce lactose malabsorption or lactose intolerance symptoms compared with pasteurized milk among adults positive for lactose malabsorption. These results do not support widespread anecdotal claims that raw milk reduces the symptoms of lactose intolerance.

Medical applications of breath hydrogen measurements

In this article, technical developments in breath analysis and its applications in the field of clinical diagnosis and the monitoring of various symptoms, particularly molecular hydrogen in breath, are introduced. First, a brief overview of the current uses of the hydrogen breath test is provided. The principles of the test and how hydrogen can be used as a biomarker for various symptoms, and monitoring microbial metabolism, are introduced. Ten case-study applications of breath hydrogen measurements for which hydrogen exhibits beneficial effects for diagnosis, including the contexts of oxidative stress, gastrointestinal disease, and metabolic disorders, are discussed. The technologies and problems involved in breath hydrogen testing, sampling, pretreatment, and detection in exhaled breath are discussed, and research including current analytical systems and new sensors is focused on in the context of hydrogen detection.

Effects of dietary nutrients on volatile breath metabolites

Breath analysis is becoming increasingly established as a means of assessing metabolic, biochemical and physiological function in health and disease. The methods available for these analyses exploit a variety of complex physicochemical principles, but are becoming more easily utilised in the clinical setting. Whilst some of the factors accounting for the biological variation in breath metabolite concentrations have been clarified, there has been relatively little work on the dietary factors that may influence them. In applying breath analysis to the clinical setting, it will be important to consider how these factors may affect the interpretation of endogenous breath composition. Diet may have complex effects on the generation of breath compounds. These effects may either be due to a direct impact on metabolism, or because they alter the gastrointestinal flora. Bacteria are a major source of compounds in breath, and their generation of H₂, hydrogen cyanide, aldehydes and alkanes may be an indicator of the health of their host.

Effects of a late supper on digestion and the absorption of dietary carbohydrates in the following morning

Background

Our previous experiment showed that the light intensity exposed on the subjects during evening time had no effect in the following morning on the efficiency of the digestion and absorption of dietary carbohydrates ingested at a usual suppertime. People who keep late hours usually have a late suppertime; thus, we examined the effects of a late suppertime on gastrointestinal activity in the following morning in comparison to that of a usual suppertime.

Methods

Twelve female university students volunteered as paid participants. The breath hydrogen test was carried out to estimate the amount of unabsorbed dietary carbohydrates and the percentage of the total amount of dietary carbohydrates in the breakfast that were unabsorbed, as well as to estimate oro-cecal transit time. The respiratory quotient was also measured to find the ratio of carbohydrates/lipid metabolism in the post-breakfast state. Subjects’ peripheral blood glucose concentration was measured by a blood glucose meter. The subjects participated under two different experimental conditions: with a usual suppertime (having supper at 18:00) and a late suppertime (having supper at 23:00).

Results

The efficiency of the digestion and absorption of dietary carbohydrates in the breakfast under late suppertime conditions was higher than that under usual suppertime conditions. Usual or late suppertime had no effect on the ratio of carbohydrates to lipids oxidized after the subjects had breakfast. There were significant differences in the blood glucose level between the two conditions at 30, 60, 120, 150, and 180 minutes after having breakfast, whereas the mean blood glucose level under late suppertime conditions was significantly higher than under usual suppertime conditions.

Conclusions

Having a late supper showed a worse effect on postprandial serum glucose profiles the following morning. This study confirmed that keeping our usual meal timing is important for our health.

Seasonal variation in amount of unabsorbed dietary carbohydrate from the intestine after breakfast in young female Thai subjects: comparison with that of Japanese subjects

Previously, using the breath hydrogen test, we investigated seasonal variations in the amount of unabsorbed dietary carbohydrate from the intestine after breakfast in female Japanese university students and young Polish subjects. In the study we found that there were significant seasonal variations in both countries with the smallest unabsorbed dietary carbohydrate in autumn and the biggest in winter. Considering the theory of human adaptation to living environments, we suggested a hypothesis that this seasonal variation in the efficiency of carbohydrate absorption in the intestine may reflect human adaptation and/or a response to seasonal change in the living environment. In order to prove this hypothesis, we carried out the same examination in Chiang Mai, Thailand, where there is different seasonal change in the living environment from that of Japan and of Poland. In this examination, we measured the amount of unabsorbed dietary carbohydrate (UDC) from the intestine after breakfast and the oro-cecal transit time (OCTT) of the breakfast in female Thai university students using the same method and experimental protocol as previously carried out with Japanese subjects. We conducted the examination in April (the hot season), in August-September (the rainy season), and in November-December (the dry season) of 2008, at the Medical School of Chiang Mai University, Chiang Mai. The results are summarized as follows: (1) there were no significant seasonal variations in the amounts of unabsorbed dietary carbohydrate from breakfast in Thai subjects; (2) there were no significant seasonal variations in the oro-cecal transit times of breakfast or a soluble indigestible trisaccharide (lactosucrose) solution in Thai subjects; (3) there were no significant differences in the oro-cecal transit times of breakfast between the two countries in any season; (4) the UDC of Thai subjects was significantly less than that of the Japanese subjects in the three seasons. These results suggest that differences in seasonal change in a living environment have different effects on seasonal variations in the efficiency of carbohydrate absorption in the intestine after breakfast.

Effect of evening exposure to bright or dim light after daytime bright light on absorption of dietary carbohydrates the following morning

We had previously reported on the effect of exposure to light on the human digestive system: daytime bright light exposure has a positive effect, whereas, evening bright light exposure has a negative effect on the efficiency of dietary carbohydrate absorption from the evening meal. These results prompted us to examine whether the light intensity to which subjects are exposed in the evening affects the efficiency of dietary carbohydrate absorption the following morning. In this study, subjects were exposed to either 50 lux (dim light conditions) or 2,000 lux (bright light conditions) in the evening for 9 h (from 15:00 to 24:00) after staying under bright light in the daytime (under 2,000 lux from 07:00 to 15:00). We measured unabsorbed dietary carbohydrates using the breath-hydrogen test the morning after exposure to either bright light or dim light the previous evening. Results showed that there was no significant difference between the two conditions in the amount of breath hydrogen. This indicates that evening exposure to bright or dim light after bright light exposure in the daytime has no varying effect on digestion or absorption of dietary carbohydrates in the following morning's breakfast.

Seasonal Variation in the Amount of Dietary Carbohydrate Not Absorbed from the Intestine after Breakfast in Elderly Japanese Females

It was previously shown that there is seasonality in the amount of dietary carbohydrate not absorbed from the intestine after breakfast, the amount of carbohydrate in winter being significantly larger than that in autumn in young Japanese subjects. In order to investigate this phenomenon further, the experiment was repeated on 22 elderly Japanese female subjects (61-78 yrs of age) during the four seasons of the year. The amount of unabsorbed dietary carbohydrate by the breath hydrogen test, which measures the amount of hydrogen in exhaled air, was then estimated. A 6 g solution of lactosucrose, an indigestible trisaccharide, was used for comparison. Two groups of subjects, 16 subjects in Osaka and 6 subjects in Nagano, were studied in the summer (July to August) and autumn (October to November) of 2005 and the winter (January to February) and spring (April to May) of 2006. The following results were found using the pooled data of the total of 22 subjects. With regard to the amount of breath hydrogen excretion of the lactosucrose solution, there was no significant difference between the four seasons. There was a significant seasonal change in the efficiency of dietary carbohydrate absorption from the intestine after breakfast. The percentage of total carbohydrate that was not absorbed was lowest in the spring and highest in the winter. A comparison of the results from studies on the elderly and young subjects revealed the percentage of total carbohydrate that was not absorbed in the elderly was significantly lower than in the young in the winter, spring, and summer. These results indicate that there is seasonal variation in the efficiency of dietary carbohydrate absorption from the intestine among elderly female Japanese subjects as well as young female Japanese subjects. They also suggest that the efficiency of dietary carbohydrate absorption from the intestine after breakfast is retained in these naturally active and healthy elderly subjects.

Seasonal variation in amount of unabsorbed dietary carbohydrate from the intestine after breakfast in Japanese subjects

We previously showed that daytime dim-light exposure has a negative effect on the efficiency of dietary carbohydrate absorption in the evening, whereas evening-time dim-light exposure has a beneficial effect. These results suggest that seasonal changes in the environmental light may affect gastrointestinal activity, and that there might, therefore, be seasonal variation in the efficiency of dietary carbohydrate absorption from the intestine. In order to prove this hypothesis, we measured the amount of dietary carbohydrate unabsorbed from the intestine after a breakfast in healthy female Japanese subjects during the four seasons of the year. We estimated the amount of unabsorbed dietary carbohydrate by the breath hydrogen test, which measures the amount of hydrogen in exhaled air. A 6 g solution of lactosucrose, an indigestible trisaccharide, was used for comparison. Two groups of subjects, 12 subjects in Osaka and 14 subjects in Nagano, were studied in the winter (January to February), spring (April to May), summer (July to August), and autumn (October to November) of 2004. We found the following results: (1) In no season were there any significant differences between the two subgroups in the orocecal transit time of the breakfast and the lactosucrose solution. Nor were there any significant differences in the amount of unabsorbed dietary carbohydrate from the breakfast. (2) Using the pooled data of the total of 26 subjects, there was no significant seasonal variation in the orocecal transit time of the breakfast or the lactosucrose solution. (3) There was a significant seasonal variation in the amount of unabsorbed dietary carbohydrate from the breakfast. (4) The amount of unabsorbed dietary carbohydrate from the breakfast was largest in winter and smallest in autumn. Results in spring and in summer were similar and intermediate between those in winter and autumn. Post hoc multiple comparison tests showed that the amount of unabsorbed dietary carbohydrate in winter was significantly larger than in autumn. (5) In winter, the average ratio of the amount of unabsorbed dietary carbohydrate to the total amount of carbohydrate in the breakfast was about 12%; in autumn it was about 6%. These results clearly show that there is seasonal variation in the efficiency of intestinal dietary carbohydrate absorption among young female Japanese subjects.

Effect of nonabsorbed amounts of a fructose-sorbitol mixture on small intestinal transit in healthy volunteers

Although malabsorption of small amounts of fructose-sorbitol mixtures occurs frequently in healthy humans, insights into their effects on gastrointestinal motility are poor. The present study addresses the hypothesis that malabsorption of a fructose-sorbitol challenge changes the small intestinal transit rate. Eleven healthy volunteers participated in a double-blind crossover investigation. In random order, the subjects ingested 30 g glucose or a mixture of 25 g fructose and 5 g sorbitol as 10% solutions. As a radiolabeled marker, (99m)Tc-diethylenetriaminepentaacetic acid was added to each test solution. Breath hydrogen and methane concentrations and gastrointestinal progress of the radiolabeled marker were followed for the next 6-hr period. Malabsorption of small amounts of the fructose-sorbitol mixture was evident in all subjects. The area under the gastric radioactivity-time curve after ingestion of glucose did not differ from that after ingestion of the fructose-sorbitol mixture (P = 0.7897). However, the mouth-to-cecum transit of the radiolabeled marker was faster (P = 0.0033) and the percentage content of the marker in colon was higher after ingestion of the fructose-sorbitol mixture than after ingestion of glucose (P = 0.0128). In healthy humans, malabsorption of small amounts of a fructose-sorbitol mixture accelerates small bowel transit.

Comparison of carbohydrate digestion between Japanese and Polish healthy subjects

We have revealed that light environment affects digestion and absorption of dietary carbohydrates in the gastrointestinal tract. This experimental result supposes that the efficiency of carbohydrate absorption may differ among people who live in different latitudes, such as Japanese and Polish people, at the same calendar season. In order to prove this hypothesis, we have been comparing the efficiency of carbohydrate absorption using the breath hydrogen test in Japan and Poland. Here, we report the comparison of the result obtained in the summer of 2004 as the following; (1) Orocecal transit time (OCTT) for indigestible trisaccharide of Japanese subjects was significantly longer than that in Poland (p = 0.043). (2) On the ingestion of minestrone, the amount of unabsorbed carbohydrate of Japanese subjects (which was estimated as trisaccharide equivalent) was significantly larger than that of Polish subjects (p = 0.006).

Effect of evening exposure to dim or bright light on the digestion of carbohydrate in the supper meal

In a previous study we found that daytime exposure to bright as compared to dim light exerted a beneficial effect on the digestion of the evening meal. This finding prompted us to examine whether the digestion of the evening meal is also affected by evening light intensity. Subjects lived in light of 200 lux during the daytime (08:00-17:00 h) and took their evening meal at 17:00 h under 20 lux (evening dim-light condition: 17:00-02:00 h) or 2000 lux (evening bright-light condition: 17:00-02:00 h) until retiring at 02:00 h. Assessment of carbohydrate digestion of the evening meal was accomplished by a breath hydrogen test that is indicative of the malabsorption of dietary carbohydrate. Hydrogen excretion in the breath in the evening under the dim-light condition was significantly less than under the bright-light condition (p < 0.05). This finding is the opposite to that obtained in previous experiments in which subjects were exposed to the different intensities of light during the daytime, and indicates that the exposure to dim light in the evening exerts a better effect on carbohydrate digestion in the evening meal than does the exposure to bright light.

Effects of dim or bright-light exposure during the daytime on human gastrointestinal activity

On the basis of our previous findings that bright-light exposure during the daytime has profound influence on physiological parameters such as melatonin secretion and tympanic temperature in humans, we proposed the hypothesis that bright vs. dim light-exposure during the daytime has a different influence on the activity of the digestive system via the endocrine and/or autonomic nervous system. To examine this hypothesis, we conducted a series of counterbalanced experiments in which subjects stayed the daytime (7:00 to 15:00h) under either a dim (80 lux) or bright (5,000 lux) light condition. We measured gastrointestinal activity using a breath hydrogen (indicative of carbohydrate malabsorption) and an electrogastrography (EGG, indicative of gastric myoelectric activity) test. The results showed the postprandial breath hydrogen excretion during the following nighttime period after daytime exposure to the dim-light condition was significantly higher than under the bright-light condition (p < 0.05). In addition, the spectrum total power of the EGG recorded after taking the evening meal was significantly lower for the dim than bright-light condition (p < 0.05). These results support our hypothesis and indicate that dim-light exposure during the daytime suppresses the digestion of the evening meal, resulting in malabsorption of dietary carbohydrates in it.

Short duration exercise increases breath hydrogen excretion after lactulose ingestion: description of a new phenomenon

OBJECTIVE

There is limited information on the effect of exercise on colonic function. Beneficial effects have been described, including prevention of colon cancer. In the present study, we demonstrate that short duration exercise results in enhancement of breath hydrogen excretion after consumption of lactulose.

METHODS

Twelve normal volunteers who performed regular exercise were recruited. Each study subject underwent four study sessions (two resting and two exercise) after consumption of 10 g of crystalline lactulose. Colonic hydrogen production was measured in mid-expiratory breath samples obtained at baseline and frequent intervals to 420 min. Exercise sessions consisted of 5 min on a treadmill at a 20% incline at 10 km/h. This was performed 180 min after lactulose ingestion in the two exercise sessions.

RESULTS

A characteristic pattern in the hydrogen concentration versus time curves was seen after exercises, consisting of an initial decrease then an increase in concentration above baseline for up to 3 h. Mean area under the curve from 0 to 420 min for resting studies was 5,156 +/- 2,621 ppm/min and was 7,051 +/- 2,447 ppm/min for exercise studies, p < 0.05 (37% increase). Mean area under the curve from 180 to 420 min was 2,808 +/- 1,592 ppm/min for resting studies and 4,543 +/- 1,729 for exercise studies, p < 0.005 (62% increase).

CONCLUSION

This study demonstrates that exercise potentially enhances the metabolism of lactulose by colonic bacteria. The authors postulate that this effect is due to stirring of the colonic contents. The described phenomenon may explain, in part, the beneficial effects of exercise on colonic mucosa.

Carbohydrate malabsorption: quantification by methane and hydrogen breath tests

BACKGROUND

Previous studies in small series of healthy adults have suggested that parallel measurement of hydrogen and methane resulting from gut fermentation may improve the precision of quantitative estimates of carbohydrate malabsorption. Systematic, controlled studies of the role of simultaneous hydrogen and methane measurements using end-expiratory breath test techniques are not available.

METHODS

We studied seven healthy, adult methane and hydrogen producers and seven methane non-producers by means of end-expiratory breath test techniques. Breath gas concentrations and gastrointestinal symptoms were recorded at intervals for 12h after ingestion of 10, 20 and 30 g lactulose.

RESULTS

In the seven methane producers the excretion pattern was highly variable; the integrated methane responses were disproportional and not reliably reproducible. However, quantitative estimates of carbohydrate malabsorption on the basis of individual areas under the methane and hydrogen excretion curves (AUCs) tended to improve in methane producers after ingestion of 20 g lactulose by simple addition of AUCs of methane to the AUCs of the hydrogen curves. Estimates were no more precise in methane producers than similar estimates in non-producers. Gastrointestinal symptoms increased significantly with increasing lactulose dose; correlation with total hydrogen and methane excretion was weak.

CONCLUSIONS

Our study suggests that in methane producers, simple addition of methane and hydrogen excretion improves the precision of semiquantitative measurements of carbohydrate malabsorption. The status of methane production should, therefore, be known to interpret breath tests semiquantitatively. The weak correlation between hydrogen and methane excretion and gas-related abdominal complaints suggests that other factors than net production of these gases may be responsible for the symptoms.

Potential usefulness of hydrogen breath test with D-xylose in clinical management of intestinal malabsorption

Hydrogen breath tests (H2 BT) have been used extensively to investigate intestinal disaccharidase deficiencies. A potentially useful test for assessing intestinal absorptive function, the H2 BT with D-xylose (H2 BT-D-xylose), has received scant attention. We report here the results of our investigation of this test in 45 patients. Fifteen patients had proved malabsorption that was due to nontropical sprue in nine, and to lymphoma, Whipple's disease, or giardiasis in the remainder. Nine patients had small-bowel bacterial overgrowth secondary to either postsurgical sequelae or intestinal dysmotility. Twenty-one patients with irritable bowel syndrome and 21 healthy individuals served as control groups. All participants ingested 25 g of D-xylose, and alveolar breath samples were obtained thereafter at 30 min intervals for 5 hr. Breath H2 was measured by chromatography. Basal H2 production, peak change (delta) and area under the curve (AUC) were calculated. Simultaneously, 5-hr urinary excretion of D-xylose was measured by colorimetry and served as the reference test. In healthy individuals, D-xylose ingestion increased H2 production (delta = 5.8 +/- 1.4 ppm, P < 0.001). Changes were similar in patients with the irritable bowel syndrome. In contrast, the increase was of a much greater magnitude in the malabsorption group (delta = 49.9 +/- 7.2 ppm, P < 0.001 vs healthy controls). AUC analysis yielded comparable results. Test performance analysis showed that, in malabsorption the H2 BT-D-xylose had a sensitivity index of 0.86, which was identical to that of the urinary D-xylose test. Specificity was 1 and 0.95, respectively; and predictability 1 and 0.93, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Fructose and related food carbohydrates. Sources, intake, absorption, and clinical implications

It is possible to point out subjects consuming considerable quantities of fructose and sorbitol, and the intake seems to be increasing both from added and natural sources. Studies of the absorption of fructose in animals are inconsistent, and the mechanisms of fructose uptake seem to vary in accordance with the species. In most species fructose absorption takes place by a specific carrier (facilitated transport), but it may be active in the rat. In vitro studies of human intestine are very scarce; there is no evidence of active intestinal fructose transport in the human intestine. By means of hydrogen breath tests, a very low absorption capacity for fructose given as the free monosaccharide has been found in humans. Fructose given as sucrose or in equimolar combinations with glucose is well absorbed, and only fructose in excess of glucose is malabsorbed. On this basis it is hypothesized that two different uptake mechanisms for fructose are present in the human intestine. One of these may be a disaccharidase-related uptake system. Sorbitol ingestion may aggravate malabsorption of fructose given as the monosaccharide; it is not known whether a specific mechanism is involved. In children and adults with functional bowel distress the absorption capacities for fructose may not differ from those of healthy individuals, but malabsorption of fructose and/or sorbitol may be the cause of or aggravate abdominal symptoms. Fructose polymers (fructans) are also subject to increasing nutritional interest. Fructans are not absorbed in the small intestine but are strongly fermented in the large bowel. Fructans may be of potential benefit for large-bowel function and blood glucose regulation.

Effects of alpha-glucosidase inhibitors on mouth to caecum transit time in humans

The alpha-glucosidase inhibitors acarbose and miglitol have been successfully used to control postprandial hyperglycaemia in diabetics. They probably work by slowing carbohydrate digestion and absorption, but their effect on mouth to caecum transit time has not been studied. The effect acarbose (100 mg), miglitol (100 mg), and placebo on mouth to caecum transit time (380 kcal breakfast with 20 g of lactulose) was investigated in 18 normal volunteers using breath hydrogen analysis. Both miglitol and acarbose significantly increased breath hydrogen excretion (F2,34 = 6.31, p = 0.005) and shortened the mouth to caecum transit time (F2,34 = 3.49, p = 0.04) after breakfast compared with placebo. There was a significant negative correlation between breath hydrogen excretion and mouth to caecum transit time suggesting that with shorter transit times significantly more carbohydrates were spilled into the colon. These results indicate that alpha-glucosidase inhibitors accelerate mouth to caecum transit time by inducing carbohydrate malabsorption.

The influence of gastrointestinal transit on drug absorption in healthy volunteers

1. The effect of variability of gastric emptying and oro-caecal transit on the absorption of a multicomponent solution of frusemide, atenolol, hydrochlorthiazide and salicylic acid has been studied in six healthy subjects. Each subject was studied on five separate occasions: three times under basal conditions, once following metoclopramide and once following codeine pretreatment in an attempt to speed and slow transit respectively. 2. Inter-subject variability of gastric emptying, oro-caecal transit and the rate and extent of drug absorption was considerable. 3. The absorption of salicylic acid appeared rate-limited by gastric emptying but the rate and extent of frusemide, atenolol and hydrochlorthiazide absorption were unrelated to measures of gastric emptying or oro-caecal transit. 4. Codeine phosphate caused a two-fold delay in oro-caecal transit but did not influence gastric emptying while metoclopramide had no significant effect on either function. 5. Metoclopramide and codeine had no significant effect on the rate or extent of absorption of any of the study drugs. 6. Within the limits of this experiment, oro-caecal transit time did not appear to be an important determinant of frusemide, atenolol, hydrochlorothiazide or salicylic acid absorption. Other factors must account for the observed variability in drug absorption.

Assimilation of wheat starch in patients with chronic pancreatitis. Positive effect of enzyme replacement

Pancreatic insufficiency due to chronic pancreatitis may lead to symptomatic malabsorption of both starch and fat. The absorption capacity of wheat starch has not been studied previously in patients with chronic pancreatitis, although this carbohydrate is a quantitatively important component of the Western diet. We studied the absorption of wheat starch and the effect of pancreatic enzyme substitution in seven patients with chronic pancreatitis and steathorrea. The malabsorption was determined from hydrogen breath tests with lactulose standards as reference. Without enzyme substitution, wheat starch (50 g) was absorbed to a lesser extent than in healthy controls (p less than 0.05). The mouth-to-cecum transit time was prolonged and correlated positively to the fat excretion before substitution with pancreatic enzymes (sigma = 1). The enzyme substitution increased the absorption of wheat starch to values seen in healthy controls (p less than 0.05) and reduced the mouth-to-cecum transit time by 19.8%.

Interval sampling of end-expiratory hydrogen (H2) concentrations to quantify carbohydrate malabsorption by means of lactulose standards

Lactulose H2 breath tests are widely used for quantifying carbohydrate malabsorption, but the validity of the commonly used technique (interval sampling of H2 concentrations) has not been systematically investigated. In eight healthy adults we studied the reproducibility of the technique and the accuracy with which 5 g and 20 g doses of lactulose could be calculated from the H2 excretion after their ingestion by means of a 10 g lactulose standard. The influence of different lengths of the test period, different definitions of the baseline and the significance of standard meals and peak H2 concentrations was also studied. Regardless of baseline definition, estimates of malabsorption were most precise, if areas under the H2 concentration v time curves for four hours or more from the start of the excess H2 excretion were used. The median deviations from the expected values were 20-30% (5-60%, interquartile range). This corresponded to the deviation in reproducibility of the standard dose. We suggest that individual estimates of carbohydrate malabsorption by means of H2 breath tests should be interpreted with caution if tests of reproducibility are not incorporated. Both areas under curves and peak H2 concentrations seem valid for comparison of groups.