Original Article

Carbohydrate Challenge Tests: Do You Need to Measure Methane?

Authors: Christopher D. Knudsen, DO, Jack A. Di Palma, MD, FACG

Abstract

Objective: Breath tests that measure hydrogen (H2) have been judged reliable for the detection of lactose maldigestion (LM) and fructose malabsorption (FM). Recently, methane (CH4) testing has been advocated and measurement of CH4 in addition to H2 has been shown to increase the diagnostic accuracy for LM.


Purpose: This study was designed to consider the additional yield from CH4 measurement in patients tested for LM and FM.


Methods: Patients reported for testing after an overnight fast, not smoking and with their prior evening meal carbohydrate restricted. After challenge with 50 g lactose or 25 g fructose in water, end-alveolar breath samples collected over a 4-hour duration were analyzed for H2 and CH4. Diagnostic positivity was compared using a cutoff level of 20 ppm increase above fasting baseline for H2 alone, which is consistent with consensus guidelines, versus H2 plus twice CH4, which recognizes that CH4 consumes twice the hydrogen.


Results: There were 406 LM performed in 93 men and 313 women. Of those tested, 124 (30%) had a positive test for H2 and 139 (34%) had a positive test for H2 + CH4 ×2. There were 178 FM tests performed in 31 men and 147 women. Of those tested, 17 (9%) had a positive test for H2 and 42 (23%) had a positive test for H2 + CH4 ×2.


Conclusion: If H2 alone was measured without additional CH4 analysis, 4% of patients with LM and 14% patients with FM would not have been identified.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Gasbarrini A, Corazza GR, Gasbarrini G, et al. Methodology and indications of H2-breath testing in gastrointestinal diseases: the Rome Consensus Conference. Aliment Pharmacol Ther 2009; 29: 1–3.
 
2. Satta PU, Anania C, Astegiano M, et al. H2-breath testing for carbohydrate malabsorption. Aliment Pharmacol Ther 2009; 29: 14–17.
 
3. Di Stefano M, Certo M, Colecchia A, et al. H2-breath tests: methodological audits in adults and children. Aliment Pharmacol Ther 2009; 29: 8–13.
 
4. Beyerlein L, Pohl D, Delco F, et al. Correlation between symptoms developed after the oral ingestion of 50 g lactose and results of hydrogen breath testing for lactose intolerance. Aliment Pharmacol Ther 2008; 27: 659–665.
 
5. Corlew-Roath M, DiPalma JA. Clinical impact of identifying lactose maldigestion or fructose malabsorption in irritable bowel syndrome or other conditions. South Med J 2009; 102: 1010–1012.
 
6. Law D, Conklin J, Pimentel M. Lactose intolerance and the role of the lactose breath test. Am J Gastroenterol 2010; 105: 1726–1728.
 
7. Kyaw MH, Mayberry JF. Fructose malabsorption true condition or a variance from normality. J Clin Gastroenterol 2011; 45: 16–21.
 
8. Choi YK, Kraft N, Zimmerman B, et al. Fructose intolerance in IBS and utility of fructose-restricted diet. J Clin Gastroenterol 2008; 42: 233–238.
 
9. Barrett JS, Irving PM, Shepherd SJ, et al. Comparison of the prevalence of fructose and lactose malabsorption across chronic intestinal disorders. Aliment Pharmacol Ther 2009; 30: 165–174.
 
10. Shepherd SJ, Parker FC, Muir JG, et al. Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence. Clin Gastroenterol Hepatol 2008; 6: 765–771.
 
11. Narvaez RM, DiPalma JA. Prediction of lactose malabsorption in referral patients. Dig Dis Sci 1988; 33: 303–307.
 
12. Hovde O, Farup PG. A comparison of diagnostic tests for lactose malabsorption—which one is the best? BMC Gastroenterol 2009; 9: 82.
 
13. Roccarina D, Lauritano EC, Gabrielli M, et al. The role of methane in intestinal diseases. Am J Gastroenterol 2010; 105: 1250–1256.
 
14. Cloarec D, Bornet F, Gouilloud S, et al. Breath hydrogen response to lactulose in healthy subjects: relationship to methane producing status. Gut 1990; 31: 300–304.
 
15. Brummer RJM, Karibe M, Stockbrügger RW. Lactose malabsorption. Optimalization of investigational methods. Scand J Gastroenterol Suppl 1993; 200: 65–69.
 
16. Newcomer AD, McGill DB, Thomas PJ, et al. Prospective comparison of indirect methods for detecting lactase deficiency. N Engl J Med 1975; 293: 1232–1236.
 
17. Rao SC, Attaluri A, Anderson L, et al. The ability of the normal human small intestine to absorb fructose: evaluation by breath testing. Clin Gastroenterol Hepatol 2007; 5: 959–963.
 
18. Corazza GR, Strocchi A, Sorge M, et al. Prevalence and consistency of low breath H2 excretion following lactulose ingestion. Possible implications for the clinical use of H2 breath test. Dig Dis Sci 1993; 38: 2010–2016.