Hydrogen breath test wiki
Breath_test_instructions_2016
Green S pring S tation O ut-‐Patient C enter2360 W. J oppa R d. S uite 206, L utherville, M D 21093Kerrie H endren, R N B SN 410-‐583-‐2614HYDROGEN/METHANE B REATH T ESTSWhat is a BREATH TEST? Information for physicians and patients. (H2. Hydrogen and CH4. Methane)Hydrogen and/or Methane gas in the body are produced from intestinal bacteria. Bacteria, normally in the large intestine, produce hydrogen or methane through fermentation of carbohydrates. Substrates containing these carbohydrates, like Lactulose, is given orally to test for small intestinal bacterial presence. Some of the hydrogen or methane produced from the bacterial fermentation causes bloating, abdominal discomfort or diarrhea. The gases are absorbed by the intestinal mucosa and enter the vasculature and transported to the lungs. The gases are then exhaled through normal breathing. These are collected in a bag for immediate analysis.In Small Intestinal Bacterial Overgrowth (SIBO), bacteria exist in the small intestine. Lactulose, when used as the challenge dose, is poorly absorbed in the gastrointestinal tract making it the perfect substrate to test for bacterial overgrowth throughout the length of the small bowel (21 feet).NOTE: If lactose or fructose is given as substrate, bacteria compete with the natural digestive process and metabolize the sugar before it is absorbed and may produce an early rise in breath hydrogen. Dedicated intolerance testing for these sugars are performed separately.In Lactose and Fructose intolerance, the individual has a deficiency in the enzymes needed for its absorption. Normally, it is broken down in the small intestine, absorbed, and very little lactose or fructose reach the large intestine. If it reaches the colon in its raw form, it is metabolized by colonic bacteria producing a large amount of gas which can be measured distally in the breath sample. (Positive Intolerance Test).• Have your physician call Scheduling at 410.933.7495 to order the test.The Guidelines below are to be followed for ALL Hydrogen/Methane Breath Tests**12 HOURS BEFORE YOU START YOUR BREATH TEST, YOU SHOULD FAST. THIS MEANS DO NOT EAT OR DRINK ANYTHING OTHER THAN WATER.•Please wait 28 days to do the test after your last dose after your last dose of antibiotic therapy*, bismuth products, antimicrobial herbals* (i.e. berberine, oregano oil) or probiotics before the test •Please wait 14 days to do the breath test after bowel purgatives (i.e. for colonoscopy) or barium radiography.•Please wait 7 days after your last dose if you are taking Laxatives•Please wait 2 days after your last dose if you are taking Motility agents (i.e. Metoclopromide, Loperamide)•No smoking, including second-hand smoke, for at least 1 hour before or at any time during the breath test.•No sleeping or vigorous exercise for at least 1 hour before or any time during the breath test.•No eating or drinking anything at all during the breath test.* not for small intestine bacterial overgrowth since practitioners often test for efficacy of antibimicrobials during or just after the conclusion of therapyThe day before your test, please limit your diet.A low-residue diet that minimizes nonabsorbable carbohydrates (starches and sugars) is strongly recommended. Here are examples of foods that you CAN eat:•Baked or broiled chicken, fish or turkey. (salt and pepper only)•White bread only.•Plain steamed white rice.•Eggs•Clear chicken or beef broth.•Drink water, non-flavored black coffee, or tea.AVOID foods like:•Pasta, whole grain products, bran, high fiber cereals, granola, ect.•Fruit juices, applesauce, apricots, bananas, cantaloupe, canned fruit cocktail, grapes, honeydew melon, peaches, watermelon. Raw and dried fruits likes raisins and berries.•Vegetable juices, potatoes, alfalfa sprouts, beets, green/yellow beans, carrots, celery, cucumber, eggplant, lettuce, mushrooms, green/red peppers, squash, zucchini, broccoli, cauliflower, brussels sprouts, cabbage, kale, swiss chard, beans, lentils, corn, etc.•All nuts, seeds and beans, as well as foods that may contain seeds•Milk, cheese, ice cream, yogurt, butter• On the day of your study, report to Room 205 30 minutes before to register.This test will take at least 3 hours or longer. We have magazines for your reading enjoyment, or if you prefer, enjoy a movie while the test is in progress. Don’t hesitate to ask questions during the procedure。
氢呼气试验 (2)
氢呼气试验（HBT）图1. 氢/甲烷呼气试验基本原理氢呼气试验（hydrogen breath tests）指测定口服某种化合物后呼气中的氢气（hydrogen）浓度变化而诊断胃肠疾病的一类检验方法。
仪器条件许可时，除了氢气还同时作甲烷(methane)浓度测定，故试验有时也称为氢/甲烷呼气试验。
我院目前常规开展的项目有：1.葡萄糖氢呼气试验诊断小肠细菌过生长; 2. 乳果糖氢呼气试验测定口-盲肠通过时间，也可同时诊断小肠细菌过生长。
人和哺乳动物细胞代谢不产生氢气和甲烷，呼气中的氢气和甲烷来源于机体细菌对碳水化合物的发酵。
大肠是身体含细菌最多的地方，而胃和小肠的细菌量是很少的。
所以，餐后一段时间出现的呼气氢和甲烷浓度上升显然就是大肠细菌对食物残渣碳水化合物的发酵的结果。
经过一段时间的禁食，残渣中的可分解碳水化合物耗尽，呼气氢气和甲烷浓度将回复到大气水平。
葡萄糖是一种极易被小肠迅速完全吸收的碳水化合物。
因此，健康人口服一定剂量的葡萄糖后不会出现呼气氢气和甲烷浓度上升的现象，因为几乎没有多余的葡萄糖进入大肠。
相反，小肠细菌过生长的病人，口服的葡萄糖在被小肠吸收的同时也被过量的小肠细菌分解产气。
乳果糖是一种不能消化吸收的人工合成碳水合物。
因此，口服一定剂量的乳果糖后将会出现呼气氢气和甲烷浓度上升的现象，从口服起到呼气氢气和甲烷浓度上升的时间便是药物从口到大肠起点盲肠的运行时间，简称口-盲通过时间，它大致反映了小肠的动力状态。
如果有小肠细菌过生长的存在，口服的乳果糖在到达大肠前就会提前被分解，结果出现两次产气高峰。
基本步骤除白开水外禁食禁饮12h以上采集0时气样口服试验糖餐再次采集气样测定报告注意事项1．严格空腹和饮食控制耗尽食物残渣中碳水化合物，让呼气氢气和甲烷浓度保持在大气水平是氢呼气试验的前提条件。
试验前一天的饮食以清淡易消化为宜，晚餐必须在8点前结束、只能喝白稀饭，餐后禁止白开水以外的一切食物或饮料，空腹时间一定要超过12小时！2．严禁吸烟烟草燃烧产生大量的氢气，吸烟者在试验前至少要禁烟一小时。
Prepare
Regional LaboratoryHYDROGEN BREATH TESTSLACTOSE INTOLERANCE AND BACTERIAL OVERGROWTHPATIENT PREPARATION, PRECONDITIONS,AND COLLECTION PROCEDURESSCHEDULING:The Lactose intolerance and Bacterial overgrowth hydrogen breath tests must be scheduled in advance. Please call (616) 267-2660 to schedule these tests. The Butterworth Hospital Outpatient Laboratory location is the only Spectrum Health site that routinely collects specimens for the hydrogen breath tests. The test is available Monday through Friday with two appointments daily, each lasting up to three hours. PATIENT PREPARATIONS INSTRUCTIONS AND PRECONDITIONS:Only a properly prepared patient should have a hydrogen breath test performed. Incorrectly prepared patients may have conditions present that can affect the outcome of the test. Therefore the following instructions should be followed before testing:1. The patient should be instructed not to eat bran, high fiber cereals or other hard to digest foods likebeans the day before the test.2. The patient should fast for 12 hours prior to the test, with only water to drink.3. The patient should not smoke for at least one hour prior to or during the test.4. The patient should not vigorously exercise, smoke, or sleep for at least one hour prior to testing orduring the test.5. Ask the patient about any recent antibiotic therapy. Antibiotics SHOULD NOT be prescribed for atleast two weeks before testing.SPECIMEN COLLECTION:Improper specimen collection can adversely affect the outcome of the test. Specimen collection should only be performed by staff with experience in proper specimen collection procedures.Hydrogen Breath Test 1。
Hydrogen Breath Test-4patient
How does hydrogen breath testing work?The bacteria in the colon, including the anaerobic bacteria, are able to digest and use sugars and carbohydrates as food. When the anaerobic bacteria digest sugars and carbohydrates, they convert some of the sugars and carbohydrates into gases, most commonly hydrogen. They also mayproduce and release into the colon other substances, for example, chemicals that cause the colon to secrete water and cause diarrhea.As previously discussed, some of the hydrogen gas is absorbed by the colon into the blood and is eliminated in the breath where it can be measured. As long as little sugar or carbohydrate reaches the colon, the small amounts of gas and other substances that are produced do not cause a problem. When larger amounts of sugar or carbohydrate reach the colon because they are not digested and absorbed in the small intestine, larger amounts of gas and substances are formed in the colon.For example, if an individual digests and absorbs the sugar in milk (lactose) normally, then none of the lactose that is given for the lactose hydrogen breath test reaches the colon, and no increase in the concentration of hydrogen in the breath is seen during the breath test. On the other hand, if the individual does not digest and absorb the lactose completely, that is, he or she is lactose intolerant, the lactose travels through the small intestine and enters the colon where the bacteria digest it and produce hydrogen. An increase in hydrogen in the breath then is seen. Other sugars for which poor digestion can be diagnosed by breath testing include sucrose and fructose (found in corn syrup), and sorbitol (a sugar that is used as a low-calorie sweetener).There are ways other than abnormal digestion of dietary sugars by which the bacteria can cause problems. Unlike in the colon, the number of hydrogen-producing, anaerobic bacteria in the small intestine is small. If, however, large numbers of hydrogen-producing bacteria move into the small intestine from the colon, a condition called bacterial overgrowth of the small bowel, the bacteria may digest the sugars and carbohydrates before the small bowel has had a chance to digest and absorb them and produce large amounts of hydrogen.Finally, if individuals have abnormally rapid passage of food through the small intestine, there may not be enough time for the small intestine to digest and absorb sugars and carbohydrates. This results in the entry of larger amounts of sugar and carbohydrate into the colon where the bacteria can digest and convert them to gas.To diagnose bacterial overgrowth and rapid transit through the small intestine, a sugar that is not digested and absorbed by man, such as lactulose, usually is used for the test. In the case of rapid passage through the small intestine, the sugar passes quickly through the small intestine and intothe colon so that hydrogen is found in the breath very soon after ingestion of the sugar. In the caseof bacterial overgrowth, production of hydrogen occurs twice during the test. Once as the sugar passes the bacteria in the small intestine and again when the sugar enters the colon.How is hydrogen breath testing performed?Prior to hydrogen breath testing, the patient fasts for at least 12 hours. At the start of the test, the patient blows into and fills a balloon with a breath of air. The concentration of hydrogen is measured in a sample of breath removed from the balloon. The patient then ingests a small amount of the testsugar (lactose, sucrose, sorbitol, fructose, lactulose, etc. depending on the purpose of the test). Additional samples of breath are collected and analyzed for hydrogen every 15 minutes for three and up to five hours.How are the results of hydrogen breath testing interpreted?The interpretation of the results of hydrogen breath testing depends on the sugar that is used for testing, and the pattern of hydrogen production after the sugar is ingested.After ingestion of test doses of the dietary sugars lactose, sucrose, fructose or sorbitol, any production of hydrogen means that there has been a problem with digestion or absorption of the test sugar and that some of the sugar has reached the colon.When rapid intestinal transit is present, the test dose of non-digestible lactulose reaches the colon more quickly than normally, and, therefore, hydrogen is produced by the colonic bacteria soon after the sugar is ingested.When bacterial overgrowth of the small bowel is present, ingestion of lactulose results in two separate periods during the test in which hydrogen is produced, an earlier period caused by the bacteria in the small intestine and a later one caused by the bacteria in the colon.What are the limitations of hydrogen breath testing?There are several limitations to hydrogen breath testing. For unclear reasons, testing for bacterial overgrowth of the small bowel with lactulose can diagnose only 60% of cases. (This insensitivity of the test may be due in part to the strict criteria that are used for interpreting a test as abnormal. Less strict criteria may diagnose overgrowth more often.) In addition, with bacterial overgrowth there may be an overlap of the early and later periods of hydrogen production that can be misinterpreted as a single period characteristic of rapid intestinal transit. Finally, some normal individuals may have slow transit through the small intestine making prolonged testing - up to 5 hours - necessary, and many individuals are unwilling to undergo such prolonged testing.Some individuals do not have bacteria that produce hydrogen, and in these individuals hydrogen breath testing is not possible. Most of these individuals have bacteria that produce a different gas, methane. (There also are individuals who produce both hydrogen and methane.) Methane can be measured in the breath just like hydrogen, and the production of methane can be used for diagnosis in the same way as hydrogen. There is much less experience with methane, however, and the production of methane is more complex than the production of hydrogen. Therefore, it is not clear if the pattern of methane production after ingestion of sugars can be interpreted in the same way as hydrogen production, particularly for the diagnosis of bacterial overgrowth.A pattern of hydrogen production that is typical for bacterial overgrowth does not necessarily mean that an individual's symptoms are caused by the overgrowth. For example, there may be anatomic abnormalities of the small intestine such as narrowing or functional abnormalities in the waythe muscle of the small intestine works. These abnormalities can cause symptoms of bloating, distention, pain, and diarrhea themselves, but they also can lead to bacterial overgrowth with its similar symptoms. Therefore, it may be an underlying abnormality that is responsible for the symptoms and not the bacterial overgrowth. The only way to differentiate between the two causes of symptoms-an underlying problem or bacterial overgrowth - is to treat and eradicate the bacteria. If the symptoms disappear, then it is more likely that it is the overgrowth rather than the underlying abnormality that is responsible for the symptoms.Any condition that results in the delivery of undigested or unabsorbed food to the colon may result in abnormal breath tests when dietary sugars are used for testing. Both pancreatic insufficiencyand celiac sprue can cause abnormal breath tests, in the former instance becausepancreatic enzymes that are necessary for the digestion of carbohydrates are missing, and in the latter instance because the lining of the small intestine is destroyed, and digested food cannot be absorbed. It may be necessary to exclude these causes of abnormal breath tests by additional tests-pancreatic function tests and small intestinal biopsy.Are there other ways in which hydrogen breath testing can be used?Antibiotics are used for treating bacterial overgrowth of the small bowel; however, anyone antibiotic may be effective at eliminating the overgrowing bacteria only 50%-60% of the time. Therefore, if symptoms do not disappear in an individual following treatment with antibiotics, it may be useful to repeat the breath test to determine if the antibiotics have eliminated the bacteria. If not, a different antibiotic or non-antibiotic treatment can be tried.What are the side effects of hydrogen breath testing?The side effects of hydrogen breath testing are exactly what one would expect to see in individuals who poorly digest and absorb sugars and carbohydrates, for example, bloating, distention, pain, and diarrhea. When lactulose is used these symptoms are unlikely to occur or are mild because the dose of lactulose used for testing is small.What are the alternatives to hydrogen breath testing?For diagnosing lactose intolerance, an alternative procedure to breath testing requires blood samples to be taken after the ingestion of lactose. If the digestion and absorption of lactose is normal, the levels of glucose in the blood should rise. The elevation of blood glucose occurs because the lactose is broken down into its two component sugars, galactose and glucose, as it is absorbed into the blood. A second alternative is to give a dose of lactose (or other dietary sugar) and observe an individual for symptoms. If the individual is intolerant, bloating, distention, pain, flatulence,。
Hydrogen_Breath_Test
Hydrogen Breath TestWhat is a hydrogen breath test?This is a test for bacterial overgrowth, or intolerances to lactose, fructose, or sucrose. Glucose is a sugar that will be broken down by bacteria if present in the small bowel with hydrogen or methane gas as a by-product. The breath sample will be analyzed for hydrogen or methane content to determine if you are able to properly break down the lactose, fructose, or sucrose, or if you have bacterial overgrowth.What can I expect from a hydrogen breath test?This test requires that you drink a solution of lactose, fructose, sucrose, or glucose in water. Lactose is the sugar found in milk and is normally broken down in the small bowel. Glucose is a sugar that will be broken down by bacteria if present in the small bowel with hydrogen as a by-product. Sucrose is a common sugar found in foods such as candy. After drinking the solution, you will be asked to breathe into a plastic bag. Breath samples are obtained every 15 minutes for adults, and every 30 minutes for children. The breath sample will be analyzed for hydrogen content to determine if you are able to properly break down the lactose or sucrose, or if you have bacterial overgrowth.The test is performed in the Gastrointestinal Physiology Laboratory of the Medical Procedures Unit.How do I prepare for a hydrogen breath test?Please follow these instructions to ensure a successful test.Two weeks before your test:o You must be off antibiotics and Pepto-Bismol™ for two (2) weeks.Two days before your test:o Eat a . The purpose of this diet is to avoid foods that may produce gas in the intestinal tract for two daysbefore your test, as this could cause inaccurate test results.milk/yogurt/icecream, rice milk; any aged orSample Menus:2 scrambled eggs and 1 bananasalad with grilled chicken, tomato, cucumber, carrots, feta, balsamic vinegar + olive oil dressing1 cup fruit (such as blueberries and strawberries), small handful ofpeanuts or almondsGrilled chicken, baked potato, ½ cup steamed broccoli1 cup popcornplain cheerios with lactose-free milk (such as Lactaid brand) or oatmeal with cinnamon and blueberriessandwich with turkey, cheese, lettuce, and tomato on gluten-free bread;plain potato chips or 1 orangebaby carrots and 1 cheese stickgrilled salmon with lemon, brown rice or quinoa, sautéed zucchini and yellow squash1 cup grapes∙The day before your test:o You should have .o, or until your examination is completed.o This includes any type of or∙ breath tests can be done anytime a colonoscopy prep;but not for four (4) weeks a colonoscopy prep, or any test thatrequires a bowel prep.∙Before starting the test you will be asked to rinse your mouth with mouthwash. This limits the effect of bacteria in your mouth on theresults.Can I take my medicine before a hydrogen breath test?Noncritical medicines, including over-the-counter medicines andsupplements should not be taken, unless your physician or nurse has advised you otherwise.If you are unable to keep your appointment, please call the Medical Procedures Unit at (734) 936-9250, option 1.Websites affiliated with the University of Michigan Health System: Your Digestive System and How it WorksDirections to the Medical Procedures Unit– Look for number 24 on the floor plan.Instructions for Patients with Diabetes Having Outpatient Tests (on insulin) Instructions for Patients with Diabetes Having Outpatient Tests (no insulin)Other related Websites:National Digestive Diseases Information Clearing House – Lactose Intolerance。
甲烷和氢呼气使用手册
甲烷和氢呼气使用手册屮烷和氢呼气试验解决了很多其它试验难以检查的项LI以及一些无法完成的检测盲区，譬如胰腺功能检查、小肠细菌过增长、肠道通过时间以及乳糖酶缺乏症, 都是其它检查方法都不能完成的“盲区”。
呼气检测方法是一种无创、无痛、准确、环保、快捷技术，具有广泛的临床应用价值。
检测询需要做好准备工作。
,禁食12小时,头天晚餐不吃不易消化的食物。
，晚饭后至测试前不喝含糖的饮料。
，清晨清洁口腔。
,不吸烟、不喝酒。
,避免剧烈运动。
空腹基础值的解释：H2 <10ppm:正常H2 10-20ppm:禁食不充分或晚餐进食不宜消化食物。
H2 >20ppm:考虑小肠细菌过度生长检测名称检测指标和LI的检测方法适应症乳糖呼气试验乳糖酶缺乏症1、先测空腹基础值乳糖酶缺乏症或不耐症小肠细菌过度生长2、口服乳糖，lg/Kg体重，各种功能性肠病总量不超过25呂慢性腹泻或慢性肠炎口盲通过时间3、每30分钟至60分钟采气肠道预激综合症的诊断一次胃肠或肝胆外科手术后肠道功能恢复的（如不考虑小肠细菌过度生评估。
长，可以每60分钟取气一次）检测名称检测指标和LI的检测方法适应症乳果糖呼气试验小肠细菌过度生长1、先测空腹基础值慢性腹泻或慢性结肠炎2、口服乳果糖0. 5g/Kg体口盲通过时间功能性肠病重，总量不超过10g回盲瓣功能不良消化不良综合症溶于180-250ml水慢性肝病或肝硬化3、每20分钟至30分钟采气糖尿病患者的胃肠动力异常一次慢性便秘阳性:2小时内H2上亚健康状态升〉12ppm乳糖酶缺乏症或不耐症各种功能性肠病慢性腹泻或慢性肠炎肠道预激综合症的诊断胃肠或肝胆外科手术后肠道功能恢复的评估。
检测名称检测指标和LI的检测方法适应症葡萄糖呼气试验小肠细菌过度生长1、先测空腹基础值2、口服葡萄糖，lg/Kg体重，总量不超过100g溶于250ml水3、每20分钟至30分钟采气一次阳性:2小时内H2上升＞12ppm检测名称检测指标和II的检测方法适应症果糖呼气试验果糖不耐受检测名称检测指标和LI的检测方法适应症蔗糖呼气试验蔗糖不耐受检测名称检测指标和LI的检测方法适应症山梨醇呼气试验山梨醇不耐受检测名称检测指标和□的检测方法适应症支链淀粉呼气试胰腺外分泌功能评估胰腺炎后胰腺功能损伤验糖尿病患者的病因和预后检测名称检测指标和LI的检测方法适应症金属镁呼气试验胃酸含量该技术的应用范围涵盖40%-60%的胃肠疾病，消化科、儿科、体检中心、内分泌科、胃肠及肝胆外科等临床科室都可开展。
呼吸注水试验操作流程
呼吸注水试验操作流程英文回答：To conduct the water immersion test, also known as the breath-holding test, the following steps can be followed:1. Preparation: Fill a container with water, ensuring there is enough water to completely submerge the subject's face. Make sure the water is at a comfortable temperature, neither too hot nor too cold.2. Explanation: Explain the procedure to the subject, ensuring they understand the purpose of the test and what is expected of them. Assure them that they can stop the test at any time if they feel uncomfortable or unable to continue.3. Demonstration: Show the subject how to perform the test correctly. Take a deep breath, close your mouth and eyes, and submerge your face into the water. Hold yourbreath for as long as you can, and then resurface when you need to breathe.4. Test: Ask the subject to take a deep breath and hold it. Then, instruct them to submerge their face into the water, making sure their mouth and nose are completely covered by the water. Start a timer to record the durationof the breath-holding.5. Monitoring: Observe the subject closely during the test. Look for signs of distress, discomfort, or any irregularities in their breathing pattern. If the subject experiences any difficulties, immediately instruct them to resurface and breathe normally.6. Recording: Note down the duration of the breath-holding, as well as any observations or remarks about the subject's performance during the test. This informationwill be helpful for analysis and comparison in future tests.7. Repeat: If necessary, repeat the test multiple times to obtain consistent results. Allow sufficient rest periodsbetween each trial to prevent fatigue and ensure accurate measurements.8. Debriefing: After the test, discuss the results with the subject. Provide feedback on their performance andoffer any suggestions or recommendations for improvement if needed.中文回答：进行呼吸注水试验，也称为憋气试验，可以按照以下步骤进行：1. 准备，准备一个容器，装满水，确保水足够多，能够完全浸没被试者的脸部。
methane-breath-testing
Glucose Hydrogen/Methane Breath TestingEndoscopy SuitePatient InformationWhat is a breath test?A glucose hydrogen breath test is used to make several diagnoses including lactose intolerance, carbohydrate malabsorption and small bowel bacterial overgrowth.After giving you a sugary-tasting drink, we will ask you to blow (exhale) into a small bag and measure the gases in your breath every 20 minutes until the test has been completed. Please allow 3 hours to be at the hospital.Why am I having a breath test?If the working of your digestive tract has been changed by surgery, chemotherapy, radiotherapy or other conditions, you may have symptoms such as watery loose stool, a need to rush to the lavatory, wind and bloating.If certain gases (hydrogen and methane) in your breath are abnormally high, it will help us to establish whether your symptoms are due to specifi c foods in your diet or whether you have germs in the small bowel where there should not be any.In small bowel bacterial overgrowth, the test is used to try and detect the presence of germs in the small bowel.What preparation will I need for my breath test?You will be asked to change your diet (as outlined in this leafl et) so that any breath test measurements recorded are accurate.It is important that you follow the instructions below very carefully. If these are not followed, your procedure may have to be cancelled.If any of the following apply to you, please contact the endoscopy suite a few days prior to your appointment (contact details on last page):•You have any concerns/queries•You have diabetesYou are taking chemotherapy drugs••You are taking anti-epileptic drugs•You are taking a medication which is taken daily at a set time You are due to undergo a gastroscopy and/or colonoscopy on •the same day as the breath test procedure24 hours before the testFoods from the following list are allowed to be eaten and does not infl uence the test result:•Red meat•Fish eg. white fi sh, shellfi sh, tuna, salmon,•Chicken•Tofu, QuornEggs – scrambled, boiled, fried, poached••Cheese – all typesMilk, natural yoghurt, ice cream••White: bread / rolls / croissants / chapattis/ rotis / naan /pitta bread / pastry•White pasta or rice•Rice crispies, cornfl akes, congee•Rich tea biscuits/other plain biscuits•Oil, butter, margarine, ghee•Potato (no skin) eg. boiled, mashed, roast, crisps•Tea/Coff ee with a splash of milk & no sugar. Herbal tea. •Salt / pepper / herbs / spices / marmite / mayonnaise /mustard / salad dressing•Sugar free chewing gumThe following food does infl uence the test result and should NOT be consumed for 24 hours before the test:•Canned drinks, carbonated drinks & fruit juices•Alcohol•Fruit (including fresh, tinned, stewed, dried, or preserved)•ALL vegetables except potatoes (no skin)•Sweets, chocolateSugar••Marmalade, jam, honey, chocolate spread, peanut butter •Tomato Ketchup, brown sauce, pickle, chutney, chilli sauce •Wholegrain cereals eg. weetabix, all bran, bran fl akes,muesli•Brown rice or pastaWholemeal: bread / rolls / chapattis/ rotis / naan••Lentils, pulses•Nuts12 hours before the test:•Please do not eat or drink anything except water for 12 hours before the test ie. if your test is at 8am, stop eating anddrinking after 8pm on the previous night.You are allowed to drink water at any time.••Take your evening medications as usual.On the morning of your test•Please clean your teeth. Avoid mouthwash unless it issugar free. Sugar free mouthwash will be provided at theendoscopy suite.•Unless told otherwise, DO NOT take your usual medication (as it may be sugar coated) before the test, however do bring ALL your usual medication with you to the hospital so you can take it after completion of the test.•Do not smoke for an hour before the test or during the test as it raises your hydrogen levels and causes a false positive result.What will happen when I come up for the breath test?•You will be asked to complete a questionnaire about yoursymptoms.•You will be asked to blow (exhale) into a bag for a baseline measurement.You will be given a small sweet liquid to drink.••You will then be asked to blow (exhale) in to a bag at specifi c times until the test is completed.•You will be asked to write down any bowel symptoms you experience during the test.What happens afterwards?You may eat and drink as normal. You will be given a drink and a sandwich following the procedure and can take your usual medications.When will I know the results?The results will be sent to your GP and the consultant who referred you for the test. A follow up appointment will be arranged if required.Endoscopy Suite Contact DetailsThe working times of the Endoscopy Suite are 08.00 - 17.00 Monday to Friday: 0207 811 8328. If your call is unanswered, you can leave an answerphone message. Answerphone messages will be checked twice daily (Monday – Friday) and a member of the Endoscopy Suite will return your call as soon as possible.Outside of working hours, you can ring the main switchboard number: 0207 352 8171 and ask to speak to the Clinical Site Practitioner (bleep 022) at Chelsea.If you would like this information sheet in a diff erent format, please contact the PALs offi ce on 0800 783 7176 or talk to the clinical staff responsible for your care.ReferencesThis booklet is evidence based wherever the appropriate evidence is available, and represents an accumulation of expert opinion and professional interpretation. Details of the references used in writing this booklet are available on request from:The Royal Marsden Help CentreFreephone: 0800 783 7176Email: patientcentre@No confl icts of interest were declared in the production of this bookletPublished October 2012. Planned review October 2014© The Royal Marsden NHS Foundation Trust EU-1331-01Life demands excellenceRadiotherapy andChemotherapy ServicesF538021 & F538022。
氢呼气试验文献整理
2、小肠菌群过度生长：
1）IBS，正常与IBS对照组进行氢呼气试验，IBS组氢呼气增多，但小肠菌群过度生长是否是IBS的病因仍具争议。
????【11】Ford?AC,?Spiegel?BM,?Talley?NJ,?Moayyedi?P.?Small?intestinal?bacterial?overgrowth?in?irritable?bowel?syndrome:?systematic?review?and?meta-analysis.?Clin?Gastroenterol?Hepatol.?2009?Dec;7(12):1279-86.?Epub?2009?Aug?12.?Review.?PubMed?PMID:?19602448.?IBS中小肠菌群过度生长：荟萃分析。
Fridge?JL,?Conrad?C,?Gerson?L,et?al.?Risk?factors?for?small?bowel?bacterial?overgrowth?in?cystic?fibrosis.?J?Pediatr?Gastroenterol?Nutr.?2007?Feb;44(2):212-8.?PubMed?PMID:?17255834.胆囊纤维化患者小肠菌群过度生长的风险因素。
2）小肠菌群过度生长与药物
????【12】Lombardo?L,?Foti?M,?Ruggia?O,?Chiecchio?A.?Increased?incidence?of?small?intestinal?bacterial?overgrowth?during?proton?pump?inhibitor?therapy.?Clin?Gastroenterol?Hepatol.?2010?Jun;8(6):504-8.?Epub?2010?Jan?6.?PubMed?PMID:20060064.PPI治疗期间小肠菌群过度生长发病率增加。
甲烷和氢呼气使用手册
甲烷和氢呼气使用手册甲烷和氢呼气试验解决了很多其它试验难以检查的项目以及一些无法完成的检测盲区，譬如胰腺功能检查、小肠细菌过增长、肠道通过时间以及乳糖酶缺乏症，都是其它检查方法都不能完成的“盲区”。
呼气检测方法是一种无创、无痛、准确、环保、快捷技术，具有广泛的临床应用价值。
检测前需要做好准备工作。
∙禁食12小时∙头天晚餐不吃不易消化的食物。
∙晚饭后至测试前不喝含糖的饮料。
∙清晨清洁口腔。
∙不吸烟、不喝酒。
∙避免剧烈运动。
空腹基础值的解释：H2 <10ppm：正常H2 10-20ppm：禁食不充分或晚餐进食不宜消化食物。
H2 >20ppm：考虑小肠细菌过度生长该技术的应用范围涵盖40%-60%的胃肠疾病，消化科、儿科、体检中心、内分泌科、胃肠及肝胆外科等临床科室都可开展。
1填补国内外胰腺功能检查的盲区，诊断胰腺炎后的胰腺损伤程度可评价糖尿病的病因和预后。
2诊断和治疗不明原因的长期腹泻及腹胀、消化不良综合症、儿童和成人的乳糖酶缺乏症、小肠细菌过度生长。
3慢性便秘的病因测定肠道通过时间和回盲瓣功能障碍。
4诊断糖尿病患者自主神经节病变所致的胃肠动力异常。
5对慢性结肠炎合并碳水化合物吸收不良，确定其肠道感染状况及是否有吸收不良暨严重程度。
6评价亚健康状况常伴有小肠细菌过度生长最常用的几种氢呼气试验1、支链淀粉呼气试验(测定胰腺外分泌功能)用一定负荷量的支链淀粉作试验餐，可诊断胰腺损伤程度，这个试验填补目前国内外胰腺功能无法检测的盲区。
评估胰腺炎后胰腺功能损伤和糖尿病患者的病因和预后。
2、乳果糖呼气试验(用于小肠细菌过量增长、口盲通过时间、回盲瓣功能不良)适应症：慢性腹泻或慢性结肠炎功能性肠病，消化不良综合症、慢性肝病或肝硬化糖尿病患者的胃肠动力异常慢性便秘亚健康状态3、乳糖呼气试验(测定乳糖酶缺乏症、小肠细菌过增长、胃肠通过时间)适应症：乳糖酶缺乏症或不耐症各种功能性肠病慢性腹泻或慢性肠炎肠道预激综合症的诊断胃肠或肝胆外科手术后肠道功能恢复的评估。
甲烷和氢呼气检测设备
甲烷和氢呼气检测设备丁文京博士北美医学教育基金会前言甲烷和氢呼气检测是了解人体胃肠功能和代谢的一个重要无创检查方法，也是了解由于肠道微生态变化所导致的疾病的一个有实用价值的方法。
甲烷和氢呼气检测的原理甲烷和氢呼气检测之所以可以用于临床检验的基本是基于以下几个基本要素：第一、人体的新陈代谢虽然可以产生氢离子，但是不产生分子状态的氢气和也不能产生甲烷气体。
我们呼出气中的甲烷和氢气全部来自于胃肠道的细菌在酵解碳水化合物过程中产生的代谢产物。
第二、胃肠道产生甲烷和氢气必须基于两个最基本的条件，即胃肠道要有碳水化合和可以酵解碳水化合物的细菌，这两个因素缺一不可。
所以可以认为甲烷和氢呼气主要是反映与胃肠道细菌和胃肠道对碳水化合物消化吸收有关的疾病。
第三、正常情况下，胃肠道细菌酵解碳水化合物后产生包括甲烷和氢在内的气体，其中大约有14-21%的气体可以通过肠粘膜屏障进入血液循环，经血液循环到达肺泡，通过气体交换呼出体外。
呼出气中的甲烷和氢含量很低，在ppm水平。
ppm是英文Parts Per Million的缩写，称百万分率，表示百万分之几。
在某些疾病情况时，肠粘膜的通透性变化，甲烷好氢通过率增加，有报导肠道甲烷和氢的通过率可以达到50%。
第四、正常情况下小肠内的细菌非常少，所以在甲烷和氢呼气曲线在小肠段呼出的量很少，当小肠内细菌增加时，临床上称为小肠细菌过度生长，在小肠段代谢产生的甲烷好氢就会增加，甲烷和氢呼气曲线会明显上升。
第五、某些肠道细菌可以利用氢，使2个氢分子与1个碳原子结合生产甲烷。
不同的文献报道，大约有15-35%的人群由于上述原因，在疾病时呼出气中氢的浓度没有变化，会出现假阴性结果。
中国人大约有65%左右的人群没有产甲烷的细菌，或只有很少产甲烷的细菌，其呼出其中或者没有甲烷，或者只有很少量的甲烷。
鉴于这两个因素，现在临床日益认识到有必要同时测量呼出气中的甲烷和氢，整合这两个参数的变化以减少假阴性。
胰腺外分泌功能检测方法的临床应用
!L"!胰腺外分泌功能检测方法的临床应用左 林１，杨都江２ａ，陆慧敏２ｂ１四川大学华西临床医学院，成都６１００４１；２四川大学华西医院ａ．胃肠外科，ｂ．胰腺外科，成都６１００４１摘要：胰腺外分泌功能的检测方法较多，且各种方法的检测指标不同，尚无统一标准。
本文总结了临床上应用较广泛或具有良好应用前景的胰腺外分泌功能检测方法，简述了各种方法的操作过程并评述了其临床实用性和进展，为胰腺外分泌功能检测方法的临床应用与研究思路提供一定的参考。
关键词：胰腺，外分泌部；胰泌素试验；粪便脂肪检测；呼气试验基金项目：四川省科技厅项目（２０１８ＳＺ０３８１）；四川大学华西医院学科卓越发展１．３．５工程项目（ＺＹＪＣ１８０２７）ＣｌｉｎｉｃａｌａｐｐｌｉｃａｔｉｏｎｏｆｐａｎｃｒｅａｔｉｃｅｘｏｃｒｉｎｅｆｕｎｃｔｉｏｎｔｅｓｔｓＺＵＯＬｉｎ１，ＹＡＮＧＤｕｊｉａｎｇ２ａ，ＬＵＨｕｉｍｉｎ２ｂ．（１．ＷｅｓｔＣｈｉｎａＭｅｄｉｃａｌＳｃｈｏｏｌ，ＳｉｃｈｕａｎＵｎｉｖｅｒｓｉｔｙ，Ｃｈｅｎｇｄｕ６１００４１，Ｃｈｉｎａ；２．ａ．Ｄｅｐａｒｔ ｍｅｎｔｏｆＧａｓｔｒｏｉｎｔｅｓｔｉｎａｌＳｕｒｇｅｒｙ；ｂ．ＤｅｐａｒｔｍｅｎｔｏｆＰａｎｃｒｅａｔｉｃＳｕｒｇｅｒｙ，ＷｅｓｔＣｈｉｎａＨｏｓｐｉｔａｌ，ＳｉｃｈｕａｎＵｎｉｖｅｒｓｉｔｙ，Ｃｈｅｎｇｄｕ６１００４１，Ｃｈｉｎａ）Ｃｏｒｒｅｓｐｏｎｄｉｎｇａｕｔｈｏｒ：ＬＵＨｕｉｍｉｎ，ｈｍ．ｌｕ＠ｓｃｕ．ｅｄｕ．ｃｎ（ＯＲＣＩＤ：００００－０００２－５７５９－１９１９）Ａｂｓｔｒａｃｔ：Ｔｈｅｒｅａｒｅｃｕｒｒｅｎｔｌｙｖａｒｉｏｕｓｐａｎｃｒｅａｔｉｃｅｘｏｃｒｉｎｅｆｕｎｃｔｉｏｎｔｅｓｔｓｗｉｔｈｄｉｆｆｅｒｅｎｔｉｎｄｉｃａｔｏｒｓｆｏｒｄｅｔｅｃｔｉｏｎ，ａｎｄｔｈｅｒｅｉｓｓｔｉｌｌａｌａｃｋｏｆｕｎｉｆｉｅｄｓｔａｎｄａｒｄ．Ｔｈｉｓａｒｔｉｃｌｅｓｕｍｍａｒｉｚｅｓｔｈｅｐａｎｃｒｅａｔｉｃｅｘｏｃｒｉｎｅｆｕｎｃｔｉｏｎｔｅｓｔｓｗｈｉｃｈａｒｅｗｉｄｅｌｙｕｓｅｄｏｒｈｏｌｄｐｒｏｍｉｓｅｆｏｒａｐｐｌｉｃａｔｉｏｎｉｎｃｌｉｎｉｃａｌｐｒａｃｔｉｃｅ，ｂｒｉｅｆｌｙｉｎｔｒｏｄｕｃｅｓｔｈｅｐｒｏｃｅｄｕｒｅｓｏｆｅａｃｈｔｅｓｔ，ａｎｄｒｅｖｉｅｗｓｔｈｅｉｒｃｌｉｎｉｃａｌｐｒａｃｔｉｃａｂｉｌｉｔｙａｎｄａｄｖａｎｃｅｓ，ｓｏａｓｔｏｐｒｏｖｉｄｅａｒｅｆｅｒｅｎｃｅｆｏｒｔｈｅｃｌｉｎｉｃａｌａｐｐｌｉｃａｔｉｏｎａｎｄｒｅｓｅａｒｃｈｉｄｅａｓｏｆｐａｎｃｒｅａｔｉｃｅｘｏｃｒｉｎｅｆｕｎｃｔｉｏｎｔｅｓｔｓ．Ｋｅｙｗｏｒｄｓ：Ｐａｎｃｒｅａｓ，Ｅｘｏｃｒｉｎｅ；ＳｅｃｒｅｔｉｎＴｅｓｔ；ＦｅｃａｌＦａｔＴｅｓｔ；ＢｒｅａｔｈＴｅｓｔＲｅｓｅａｒｃｈｆｕｎｄｉｎｇ：ＴｈｅＳｉｃｈｕａｎＰｒｏｖｉｎｃｉａｌＤｅｐａｒｔｍｅｎｔｏｆＳｃｉｅｎｃｅａｎｄＴｅｃｈｎｏｌｏｇｙＳｕｐｐｏｒｔｉｎｇＰｒｏｊｅｃｔ（２０１８ＳＺ０３８１）；１．３．５ＰｒｏｊｅｃｔｆｏｒＤｉｓｃｉｐｌｉｎｅｓｏｆＥｘｃｅｌｌｅｎｃｅ，ＷｅｓｔＣｈｉｎａＨｏｓｐｉｔａｌ，ＳｉｃｈｕａｎＵｎｉｖｅｒｓｉｔｙ（ＺＹＪＣ１８０２７）ＤＯＩ：１０．３９６９／ｊ．ｉｓｓｎ．１００１－５２５６．２０２２．０４．０４４收稿日期：２０２１－０８－１６；录用日期：２０２１－０９－２６通信作者：陆慧敏，ｈｍ．ｌｕ＠ｓｃｕ．ｅｄｕ．ｃｎ 胰腺是人体最重要的消化器官之一，兼具内分泌和外分泌功能［１］。
D. To provide background knowledge.
2. What does the underlined word“outperformed”mean in paragraph 4?
A. Gone beyond.
B. Looked alike.
C. Made use of.
be related to 与……有关
give sb real⁃time feedback 给某人实时的反馈
over a course of weeks 在几个星期的时间里
be accessible to 可使用的
so far 到目前为止
a number of 很多；大量
suffer from 遭受
32
Crazy English 2022.2
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据估计，全世界有十分之一的人患有与消化系统相关的疾病。然而，发现哪
些食物会引起不良反应是一个漫长而艰苦的过程，而且代价昂贵。为了解决这
一问题，爱尔兰工程师安格斯·肖特和彼得·哈特发明了只有 5 平方厘米大小的
negatives and positives.“It is important to complement them with other tests that can deter⁃
mine if a patient is suffering from more serious conditions. Anyhow, they are hugely valu⁃
performed other hydrogen breath test methods.
慢性肝病患者中小肠细菌过度生长的研究
网络出版时间：２０２２－０６－２７１７：００ 网络出版地址：ｈｔｔｐｓ：／／ｋｎｓ．ｃｎｋｉ．ｎｅｔ／ｋｃｍｓ／ｄｅｔａｉｌ／３４．１０６５．Ｒ．２０２２０６２４．１７４１．０２１．ｈｔｍｌ◇临床医学研究◇慢性肝病患者中小肠细菌过度生长的研究黄梦雪１，陈 刚１，王 鹏２，曹世国１，许建明１，梅 俏１，洪汝涛１，张卫平１２０２２－０１－２２接收基金项目：国家自然科学基金（编号：８１７００５２１）作者单位：１安徽医科大学第一附属医院消化内科，合肥 ２３００２２２安徽医科大学基础医学院，合肥 ２３００３２作者简介：黄梦雪，女，硕士研究生；张卫平，男，博士，主治医师，硕士生导师，责任作者，Ｅ ｍａｉｌ：ｚｗｐ０２０２＠１６３．ｃｏｍ摘要 目的 利用乳果糖氢呼气试验（ＬＨＢＴ）检测肝硬化和慢性肝炎肝纤维化（ＣＨＦ）患者中小肠细菌过度生长（ＳＩＢＯ）的发生率，探讨其与炎症因子及氧化应激相关指标的关系。
方法 选取３８例ＣＨＦ患者和６０例肝硬化患者以及３１例健康对照组，利用ＬＨＢＴ的方法评估各组ＳＩＢＯ发生率。
然后将受试者分为ＳＩＢＯ阳性组和ＳＩＢＯ阴性组，比较两组间临床症状和实验室检查，并检测其血清脂多糖（ＬＰＳ）、白细胞介素（ＩＬ） ６、肿瘤坏死因子（ＴＮＦ） α、ＩＬ １０水平以及二胺氧化酶（ＤＡＯ）、超氧化物岐化酶（ＳＯＤ）、谷胱甘肽（ＧＳＨ）、过氧化氢酶（ＣＡＴ）水平，并对所检测的ＬＰＳ、ＩＬ ６、ＴＮＦ α、ＩＬ １０、ＤＡＯ、ＳＯＤ、ＧＳＨ、ＣＡＴ的浓度与ＬＨＢＴ集值的相关性进行统计学分析。
结果 ①ＣＨＦ组和肝硬化组以及对照组ＳＩＢＯ阳性率分别为３６ ８４％、６０ ００％和９ ６８％，差异有统计学意义（Ｐ＜０ ０１）；②ＳＩＢＯ阳性组患者和阴性组患者在Ｃｈｉｌｄ Ｐｕｇｈ（ＣＴＰ）分级及腹水的表现上差异有统计学意义（Ｐ＜０ ０５）；③ＳＩＢＯ阳性患者血清中ＬＰＳ、ＩＬ ６、ＤＡＯ、ＣＡＴ、ＳＯＤ水平高于ＳＩＢＯ阴性患者（Ｐ＜０ ０５），ＩＬ １０、ＴＮＦ α以及ＧＳＨ水平与ＳＩＢＯ阴性组差异无统计学意义；④患者ＬＨＢＴ集值与ＬＰＳ、ＩＬ ６、ＤＡＯ、ＳＯＤ、ＣＡＴ呈正相关（Ｐ＜０ ０５），与ＴＮＦ α、ＩＬ １０、ＧＳＨ的相关性差异无统计学意义。
呼气氢试验(BHT) 胃肠病
江苏医药1998, (08) 30-31呼气氢试验临床应用与研究进展郑家驹关键词：呼气氢试验(BHT) 胃肠病呼气氢试验(breath hydrogen test, BHT)作为一种非侵入性胃肠功能检查方法，1984年起在国内广泛开展应用，受到内儿科与消化科医师的重视［1～3］。
由于该试验需使用气相色谱仪，在临床普遍应用受到一定限制。
近年来，相对简单的收集、贮存与分析呼气氢方法，如电化学微量氢气分析仪，可同时测定甲烷分析仪等的不断改进与国产化，使该试验的扩大应用进一步得到发展［4,5］。
本文兹就近年来国内外应用与研究进展作一简介如下。
一、肠内氢气产生的机制适量的糖类物质摄入后，一般均能被小肠吸收。
但一些在小肠内吸收较差的糖，如D-木糖，或小肠内不能消化的糖，如乳果糖、棉子糖及纤维素等，摄入后即直接进入结肠，并被结肠菌株分解或发酵产生氢气。
所产氢气除大部分被排出外，约14％～21%吸收后从肺呼出。
正常呼气中仅含极微量氢气，但肠内只要有2g以上的糖类物质发酵，呼气中的氢气含量即可以明显增高，并可被准确检出［1］。
当肠道吸收细胞病变或缺乏膜结合性双糖酶，如乳糖酶、蔗糖-异麦芽糖酶或麦芽糖酶等时，相应的糖摄入后均可直接进入结肠并产生氢气，并被检测出，而明确诊断。
二、碳水化合物吸收不良呼气氢试验最早被用于乳糖吸收不良症的诊断［1,5,6］。
其原理为在小肠乳糖酶缺乏者中，乳糖(或牛乳)摄入后不被小肠吸收，而由结肠内细菌发酵产生氢气，经血循环并由肺呼出［7～8］，经检测而明确诊断。
该方法与诊断乳糖吸收不良症的其它方法，如空肠粘膜活检标本乳糖酶活性直接测定，或间接的乳糖耐受试验等相比，结果极为一致，而具有非侵入性及简便等优点。
呼气氢试验诊断乳糖吸收不良症时，假阳性结果较少见，如发生，可能与操作因素，包括试验前抽烟、睡眠状态或膳食中纤维素过量等有关［1,5］。
小肠细菌过度生长也可导致摄用试餐碳水化合物后呼气中氢浓度迅速升高反应。
乳糖耐受氢呼吸试验
【名称】乳糖耐受试验和氢呼吸试验【英文名】lactose tolerance test and hydrogen breath test【别名】【概述】乳糖不耐受常见于婴儿，表现为腹泻、吐奶、生长迟滞、吸收障碍。
当给予去乳糖饮食时，患儿临床症状消失。
这种综合征是由于患儿肠道中糖分解酶(乳糖酶)缺乏所引起的。
乳糖耐受试验实际上是利用GTT试验来诊断肠道双糖酶(乳糖酶)缺乏。
测试葡萄糖，观察其在检测个体空腹样本中水平升高或不升高。
氢呼吸试验是检测呼气样本中氢的水平，氢的水平升高是由肠道中乳糖积聚引起的。
结肠细菌代谢乳糖而生成氢气。
【原理】【试剂】【操作方法】实验步骤。
1.遵守GTT操作指示。
2.空腹时抽取血样之后，患者口服200ml含50g乳糖的水溶液(2g乳糖/kg)。
3.间隔O、30min、60min、90min采集血样以备测乳糖水平。
4.血样采集的同时，采集呼气样本以便做氢呼吸试验。
联系实验室，咨询采集标本相关的注意事项。
【正常值】葡萄糖水平从正常值变化为：＞1.7mmol/L(＞30mg/dl)无确定意义：1.1～1.7mmol/L(20～30mg/dl)结果异常：＜1.1mmol/L(＜20mg/dl)氢水平(呼气)。
空腹：＜5ppm或＜5×10-6乳糖消化后：与空腹时水平相比，升高＜12ppm或＜12×10-6【临床意义】1.乳糖不耐受(1)平直的乳糖耐受曲线(即血糖没有升高)意味着糖分解酶缺乏，也见于肠易激综合征。
此种缺陷在美洲印第安人、非裔美国人、亚洲人、犹太人中较普遍。
(2)后续还需进行单糖耐受试验，如葡萄糖/半乳糖耐受试验。
①患者摄入25g的葡萄糖与半乳糖。
②血糖水平正常升高意味着乳糖缺陷。
(3)继发性乳糖缺乏见于：传染性肠炎；肠道细菌过度生长；炎性肠病，Crohn 病；蓝贾第鞭毛虫侵扰；胰腺囊性纤维化。
2.乳糖缺陷测试中氢呼吸试验异常的原因(1)吸收不良使未被消化的乳糖进入结肠后被细菌发酵，生成氢气(H)。
Preparation
Preparation for the Hydrogen Breath TestDigestive and Liver Disease ClinicUT Southwestern Medical CenterTo the Patient: Read these instructions 2 WEEKS before you come for your procedure.WHY DO I NEED THIS TEST?This test will help us measure how much hydrogen gas is in your breath. You may need this test if you: •Have diarrhea, loose stools, bloating and gas•Can not drink milk or eat milk productsPREPARATION FOR THE TEST:•For four weeks before your test, you should not take any antibiotics.•For one week before you test, do not take any laxatives or stool softeners (for example Colace®, Milk of Magnesia®, Ex-Lax®) or stool bulking agents(for example Metamucil® or Citrucel®).•You should also not undergo any test that requires cleansing of the bowel, such as colonoscopy or barium enema.THE DAY BEFORE THE TEST:•You may consume only the following foods and drinks: plain white bread, plain white rice, plain white potatoes, baked or broiled chicken or fish, water, and non-flavored black coffee or tea.•Only salt may be used to flavor your food. Butter and margarine are not permitted.•Soda/cola drinks are not permitted.•Do not eat or drink anything else – it could give false results for the test.•Specifically, avoid beans, pasta, fiber cereals, and high fiber foods.•The night before the test, have an early dinner of rice and meat.•Do not eat anything after 10pm the day before the test.•You can drink water only up to 4 hours before the test.THE DAY OF THE TEST:•Two hours before the test, brush your teeth.•Do not eat, drink, chew gum or tobacco, smoke cigarettes, or eat breath mints or candy before or during the test.•Do not sleep or exercise while the test is being done•You may take your morning medication as usual with a sip of waterWHAT TO EXPECT•You will be given some medicine to drink and we will measure samples of your breath to find out how much hydrogen gas it contains.•We will ask you to breathe into a bag every 15-20 minutes. You may need to do this for 3 hours.•You may bring some reading or craft materials with you to occupy your time.NOTIFY THE MEDICAL STAFF OF ANY RECENT ANTIBIOTIC THERAPY, RUNNY DIARRHEA ORCOLONOSCOPIES, SINCE IT MAY AFFECT THE TEST.。
乳果糖氢呼吸试验测定口 (1)
乳果糖氢呼吸试验测定口_盲肠传递时间任一鸣,何绮娜,刘洁东,何平,冯子坛,王玉瑾白求恩国际和平医院消化内科河北省石家庄市050082任一鸣，男，1962-10-03生，汉族，河南省商丘人.1985年河南医科大学医学系毕业，消化内科硕士，主治军医，主要从事消化道疾病胃肠动力学的应用临床研究.项目负责人:河北省石家庄市中山西路6号Tel:-68331收稿日期:1996-01-01接受日期:1996-07-03)Measurement of orocecal transit time by lactulose hydrogenbreath testYi-Ming Ren, Qi-Nia He, Jie-Dong Liu, Ping He, Zi-Tan Feng and Yu-Jin WangDepartment of Gastroenterology, Bethune International PeaceHospital, Shijiazhuang 050082, Hebei Province, ChinaAbstractAIM To investigate the orocecal transit time (OCTT) in patients with FD and IBS.METHODS The OCTT of 13 healthy volunteers, 20 patients with FD and 31 patients with IBS (15 with diarrhoea, 16 with constipation) was measured by lactulose hydrogen breath test (LHBT).RESULTS The OCTT of the FD patients was 99.2±24.5 minutes, similar to that in controls (95.4±19.6minutes,P＞0.05),but significantly longer in FD patients with gastroenteric motilitydisorder (129.0±12.0 minutes,P＜0.01). In patients with IBS who complained predominantly of constipation it was significantly longer (154.4±55.7 minutes,P＜0.01),but significantly shorter in patients with IBS who suffered predominantly from diarrhoea(73.1±22.2 minutes,P＜0.05)than that in controls.CONCLUSION FD and IBS patients have motility disorders of small bowel. LHBT can be used as an essential examination.Subject headings Gastrointestinal transit;Lactulose/diagnosticuse;Hydrogen/analysis;Dyspepsia/physiopathologyRen YM, He QN, Liu JD, He P, Feng ZT,Wang YJ.Measurement of orocecal transit time by lactulose hydrogen breath test.Xin Xiaohuabingxue Zazhi,1997；5(1)：39-40摘要目的测定功能性消化不良(FD)和肠易激综合征(IBS)患者口-盲肠传递时间(OCTT).方法应用乳果糖氢呼吸试验(LHBT)测定了正常人13例，FD 20例和IBS(其中15例主诉腹泻，16例主诉便秘)31例患者的OCTT.结果正常人OCTT为95.4±19.6min，FD患者(99.2±24.5min)与正常人比较无显著性差异(P＞0.05)，但其中5例动力障碍型FD的OCTT则显著延长(129.0±12.0min，P＜0.01)，以便秘为主的IBS患者OCTT显著延长(154.4±55.7min，P＜0.01)，以腹泻为主的IBS患者OCTT显著缩短(73.1±222min，P＜0.05).结论FD和IBS患者存在小肠动力学异常，LHBT可作为辅助检查小肠动力学异常的手段之一.主题词胃肠通过试验;乳果糖/诊断应用;氢/分析;消化不良/病理生理学任一鸣,何绮娜,刘洁东,何平,冯子坛,王玉瑾.乳果糖氢呼吸试验测定口_盲肠传递时间.新消化病学杂志,1997；5(1)：39-40乳果糖氢呼吸试验(lactulose hydrogen breath test, LHBT)应用于小肠动力学研究的原理是检测结肠内未被吸收的碳水化合物经细菌发酵后生成并从呼出气中排出的氢(H2)浓度，以评价口_盲肠传递时间(orocecal transi time, OCTT).LHBT在国外已广泛应用于临床，而国内报道极少.作者报告如下.1 对象和方法1.1 对象①正常对照组：为本院医护人员13例，男7例，女6例，年龄18-42岁，平均33.3岁.功能性消化不良(FD)组：按照1989年芝加哥专题工作会议标准：具有消化道症状，持续4周以上，而无溃疡、肿瘤、食管炎及肝胆胰等疾病.共20例，男8例，女12例，年龄23-61岁，平均37.8岁.全部病例经上消化道内镜或X线、腹部B超或胆系造影等检查，并排除系统性疾病.肠易激综合征(IBS)组：随机选取腹泻患者15例，男9例，女6例，年龄19-64岁，平均38.4岁，便秘患者16例，男8例，女9例，年龄13-46岁，平均38.7岁.病程均超过2个月，腹泻组每日腹泻≥3次，便秘组每周排便少于3次.全部病例经便常规、便培养、钡灌肠或纤维结肠镜检查等排除器质性疾病及系统性疾病.1.2 方法受试者1月内禁用抗菌药物及灌肠术；无长期大量吸烟史；48h内不应用胃肠动力药；检查前1d 不服镇静安眠药、不吸烟、禁食豆奶制品及其它富含纤维素类食物，检查前1d晚餐以大米为主食，肉蛋类为副食，晚餐后禁食水；检查时不吸烟、不剧烈运动、不打盹，取坐位.次日08：00-10：00先取空腹末份呼出气标本，测定空腹氢浓度(fasting hydrogen, FH2)，继服乳果糖20ml〔(含乳果糖10g)(西安第四制药厂)〕，加温开水稀释至100ml，服糖后4h内每间隔15min收集末份呼出气标本1份，个别延长至5-6h.呼出气标本收集于特制气囊内(化げ抗饷骰ぱ芯克?，抽取标本气体1ml经QSP-X型呼吸气敏色谱仪(北京高宝城电子传感技术研究所)测定［1］.口服乳果糖至连续3次末份呼出气标本氢浓度增值△H2＞4.47×10-4mmol/L，以其中首次的增值(first hydrogen rise,△FRH2)所间隔的时间为OCTT，若为双峰，则以第2峰(结肠峰)为准. 乳果糖不耐受：服糖24?h内出现腹痛、腹胀、腹鸣、腹泻者.2 结果受试者64例中，服乳果糖4h内有5例不产氢(正常人1例，FD组2例，腹泻组2例)，其余59例呼出气氢浓度均显著升高，对乳果糖不发酵率为7.8%，产氢率92.2%.氢浓度曲线均呈单峰型.正常组OCTT 为95.4±196min(范围70-120min)；FD组(99.2±24.5min)与正常人比较差异无显著性(P＞0.05)，但其中5例动力障碍型FD患者OCTT显著延长(129.0±12.0min，P＜0.01)；便秘组OCTT(154.4±55.7min)显著延长(P＜0.01)；腹泻组OCTT(731±22.2min)显著缩短(P＜0.05).FH2，FRH2，最大氢生成量(most hydrogen, MH2)，呼出气高峰时间(hydrogen peak time, HPT)表1.全部受试者出现腹泻6例(9.4%)，腹胀腹鸣2例(3.1%)，腹痛1例(1.6%).乳果糖不耐受率14.1%，但症状均轻微，短期消失.表1 FD，FRH2，MH2和HPT (x-±s，×10-4mmol/L)分组n FH2FRH2MH2HPT正常组12 1.8±1.68.9±7.319.2±11.5126.7±37.3 FD 组18 3.5±3.08.6±10917.0±9.0132.8±28.6便秘组16 2.3±4.5 5.4±1.08.5±5.6b177.8±50.3b 腹泻组13 1.7±1.68.1±4.915.2±10.3121.5±35.5b P＜0.01，与各组比较.3 讨论作者应用国产乳果糖为基质测定正常人13例和胃肠功能性疾病患者51例的OCTT，并初步建立了应用国产乳果糖测定OCTT的方法.结果显示，正常人OCTT为95.4±19.6min，与文献报告结果相似.FD患者与正常人比较差异无显著性(P＞0.05)，但其中5例(占27.8%)动力障碍型(以不明原因的恶心、呕吐和上腹痛为特征)表现OCTT显著延长(129.0±12.0min，P＜0.01).Malagelada等［2］观察104例FD，其中33%存在上段小肠的动力异常.上述结果表明FD患者不仅存在上消化道动力异常，而且存在小肠运动功能紊乱.我们认为，LHBT可作为检测小肠动力学异常的手段之一.本文结果提示，IBS可能出现小肠运动功能障碍表现为OCTT延长或缩短，延长的OCTT可能引起或加重便秘，而OCTT缩短则可能对腹泻起着一定的促进作用.本文结果与文献报告一致［1］.但亦有部分便秘和腹泻患者的OCTT正常.因此，OCTT延长或缩短造成IBS患者肠道运动功能病理生理变化的确切机制及其与临床症状的相关性尚待深入研究.国产乳果糖用于LHBT的研究报道尚少.本文国产乳果糖剂量取得满意，产氢率92.2%，不耐受率14.1%，且均无明显不良反应.4参考文献1 黄裕新，王才绂，赵国宁，等.国产乳果糖氢气呼吸试验用于测定小肠传递时间的研究.中华内科杂志，1991；30(12)：761-7632 Malagelada JR, Stanghellini V. Menometric evaluation of functional upper gut synptoms.Gastroenterology, 1985;88(5):1233-1231。
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Hydrogen breath testA hydrogen breath test (or HBT) is used as a diagnostic tool for people with irritable bowel syndrome, and common food intolerances. The test is simple, non-invasive, and is performed after a short period of fasting (typically 8–12 hours). Even though the test is normally known as a "Hydrogen Breath Test" some physicians may also test for methane in addition to hydrogen. Many studies have shown that some patients (approximately 35% or more) do not produce hydrogen but actually produce methane. Some patients produce a combination of the two gases. Other patients, who are known as "Non-Responders", don't produce any gas; it has not yet been determined whether they may actually produce another gas. In addition to hydrogen and methane, some facilities alsoutilize carbon dioxide (CO2) in the patients' breath to determine if the breath samples that are being analyzed are not contaminated (either with room air or bronchial dead space air).Testing may be administered at hospitals, clinics, physician offices or if the physician/laboratory has the proper equipment and breath collection kit, patients can collect samples at home to then be mailed in for analysis.Conditions[edit]Tests vary from country to country, so the following information is provided as a rough guide to typical uses of the hydrogen breath test:Fructose malabsorption– the patient takes a base reading of hydrogen levels in his/her breath. The patient is then given a small amount of fructose, and then required to take readings every 15, 30 or 60 minutes for two to three hours. The basis of the test is a failure to absorb the given sugar, which is then metabolized by bacteria that give off either hydrogen or methane. Therefore, the more gas that is produced, the less absorption has occurred. If the level of hydrogen rises above 20 ppm (parts per million) over the lowest preceding value within the test period, the patient is typically diagnosed as a fructose malabsorber. If the patient produces methane then the parts per million for the methane typically rises 12 ppm over the lowest preceding value to be considered positive. If the patient produces both hydrogen and methane then the values are typically added together and the mean of the numbers is used to determine positive results, usually 15 ppm over the lowest preceding value.Lactose malabsorption– the patient takes a base reading of hydrogen levels in his/her breath. The patient is then given a small amount of pure lactose(typically 20 to 25 g), and then required to take readings every 15, 30 or 60 minutes for two to three hours. If the level of hydrogen rises above 20 ppm (parts per million) over the lowest preceding value within the test period, the patient is typically diagnosed as a lactose malabsorber. If the patient produces methane then the parts per million for the methane typically rises 12 ppm over the lowest preceding value to be considered positive. If the patient produces both hydrogen and methane then the values are typically added together and the mean of the numbers is used to determine positive results, usually 15 ppm over the lowest preceding value. However, recent study suggest that testing may not correlate with any actual diagnosis.[1]Small Bowel Bacterial Overgrowth Syndrome (SBBOS) or Small Intestinal Bacterial Overgrowth (SIBO) – the patient is either given a challenge dose of glucose, also known as dextrose (75-100 grams), or lactulose (10 grams). A baseline breath sample is collected, and then additional samples are collected at 15 minute or 20 minute intervals for 3–5 hours. Positive diagnosis for a lactulose SIBO breath test – typically positive if the patient produces approximately 20 ppm of hydrogen and/or methane within the first two hours (indicates bacteria in the small intestine), followed by a much larger peak (colonic response). This is also known as a biphasic pattern. Lactulose is not absorbed by the digestive system and can help determine distal end bacterial overgrowth, which means the bacteria are lower in the lower intestine.The idea that a SIBO test should be several hours long and that distal overgrowth is important is wrong and is not supported by the scientific literature.[2][3][4][5][6][7] The optimal testing is 1 hour.[citation needed] Small intestinal bacterial overgrowth (SIBO) occurs as a result of excessive numbers of bacteria inhabiting the proximal small intestine. Bacterial concentrations greater than 105 organisms per milliliter is diagnostic for SIBO. We know bacteria are colonizing the proximal and not the distal small intestine for several reasons. First, the gold standard method for detection of SIBO is jejunal aspirates.[2][3][4][5][6][7] Intestinal fluid of the proximal intestine is sampled, not distal intestinal fluid. Secondly, the consequences of SIBO are the result of competition between bacteria and the human host for ingested nutrients in the intestine. Various functional consequences of bacterial infiltration cause enterocyte damage in the jejunum such as diminished disaccharidase activity, fat malabsorption, decreased amino acid transport and decreased vitamin B12absorption. Thus, detection of proximal bacterial overgrowth is critical.The SIBO breath test typically uses a 10 gram oral dose of lactulose for detection of proximal bacterial overgrowth. The best practice is to have breath samples collected at 20, 40, and 60 minutes after dosing. Since SIBO occurs in the proximal intestine, breath samples should be collected only within 1 hour after lactulose ingestion. This truly reflects proximal intestinal bacterial activity, not distal or colonic activity. The same argument is true if glucose is the substrate. Lactulose is a carbohydrate that is not absorbed by humans. Lactulose is well known to measure oro-cecal transit time.[2][3][4] The mean oro-cecal transit time in normal healthy individuals is 70 to 90 minutes.[5][6][7] By 90 minutes, at least 50% of individuals would have delivered the lactulose dose to the colon. Approximately 90 to 95% of individuals have colonic bacteria that can metabolize lactulose to hydrogen or methane gas. Thus, any SIBO breath test that collects longer than 60 minutes may be measuring colonic activity. Diagnostic criteria of 20 ppm hydrogen and/or methane changes within 90 or 120 minutes will have higher positive rates of SIBO but this will reflect colonic activity not jejunal metabolism. A one-hour SIBO breath test avoids false positive results by collecting breath up to 60 minutes.Positive diagnosis for a glucose SIBO breath test - glucose is absorbed by the digestive system so studies have shown it to be harder to diagnose distal end bacterial overgrowth since the glucose typically doesn't reach the colon before being absorbed. An increase of approximately 12 ppm or more in hydrogen and/or methane during the breath test could conclude bacterial overgrowth. Recent study indicates "The role of testing for SIBO in individuals with suspected IBS remains unclear."[8]The excess hydrogen or methane is assumed to be typically caused by an overgrowth of otherwise normal intestinal bacteria.[2][3][4][5][6][7]Other breath tests that can be taken include: Sucrose Intolerance, d-xylose and sorbitol. References[edit]1. Jump up^Bratten JR, Spanier J, Jones MP (April 2008). "Lactulose breath testing does notdiscriminate patients with irritable bowel syndrome from healthy controls.". The American Journal of Gastroenterology 103 (4): 958–63. doi:10.1111/j.1572-0241.2008.01785.x. PMID18371134.2. ^ Jump up to:a b c d Basilisco, G.; Risicato, R.; Bonazzi, P; Di Sario, A.; Portincasa, P. (2009). "H2-breath testing for evaluation of oro-caecal transit time".Aliment. Pharmacol. Ther. 29: 23–26.3. ^ Jump up to:a b c d Eisenmann, A.; Amann, A.; Said, M.; Datta, B.; Ledochowski, M. (2008)."Implementation and interpretation of hydrogen breath tests". J. Breath Res. 2: 1–9. doi:10.1088/1752-7155/2/4/046002.4. ^ Jump up to:a b c d Simren, M.; Statzer, P-O. (2006). "Use and abuse of hydrogen breathtests". Gut 55: 297–303. doi:10.1136/gut.2005.075127. PMC1856094.PMID16474100.5. ^ Jump up to:a b c d Hirakawa, M.; Lida, M.; Kohrogi, N.; et al. (1988). "Hydrogen breath testassessment of orocecal transit time: Comparison with barium meal study". Am. J. Gastroenterol. 83: 1361–1363.6. ^ Jump up to:a b c d Bond, J.H.; Levitt, M.D.; Prentiss, R. (1975). "Investigation of small bowel transittime in man utilizing pulmonary hydrogen (H2) measurements". J. Lab. Clin. Med. 85: 546–555.7. ^ Jump up to:a b c d Ghoshal, U. C. (2011). "How to interpret hydrogen breath tests". J.Neurogastroenterol. Motil. 17: 312–317. doi:10.5056/jnm.2011.17.3.312.8. Jump up^Ford, A. C.; Spiegel, B. M.; Talley, N. J.; Moayyedi, P. (August 12, 2009). "Small intestinalbacterial overgrowth in irritable bowel syndrome: systematic review and meta-analysis". Clin.Gastroenterol. Hepatol. 7 (12): 1279–86. doi:10.1016/j.cgh.2009.06.031. PMID19602448.。