Skip to main content
SpringerLink
Log in

D-Xylose hydrogen breath tests compared to absorption kinetics in human patients with and without malabsorption

  • Intestinal Disorders, Inflammatory Bowel Disease, Irritable Bowel Syndrome, and Immunology
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Thed-xylose breath H2 test may be useful in characterizing intestinal absorptive function. Our aim was to determine whether breath H2 followingd-xylose administration reflects the extent to which thed-xylose is absorbed by comparing it to a kinetic model ofd-xylose absorption. Twenty-five subjects were studied. They ingested 15 gd-xylose on the first day and 25 gd-xylose on the third day. On the second day they received 10 g intravenousd-xylose along with 15 g oral lactulose. Multiple serum and urine samples were obtained ford-xylose content to calculate its rate constants and extent of absorption by multicompartmental analysis. Breath H2 determinations were obtained every 15 min for 3 hr following the 15 gd-xylose and lactulose ingestion. Peak breath H2 concentration correlated with extent of absorption (r=−0.787,P<0.001),K 0, the rate constant for nonabsorptive loss (r=0.744,P<0.001), and 5-hr urine content (r=−0.705,P<0.001). Area under the breath H2 curve also correlated with these parameters: extent of absorption (r=−0.770,P<0.001),K 0 (r=0.662,P<0.001), 5-hr urine content (r=−0.629,P<0.012). Peakd-xylose breath H2 to peak lactulose breath H2 showed no correlation with extent of absorption. The extent of absorption was higher with the 15-g dose than the 25-g dose in all patients tested (P<0.01). This was the result of decreased nonabsorptive loss (lowerK 0), as the rate constant for absorption,K a , was not statistically different (P>0.05). Peakd-xylose breath H2 can be used as an inverse estimate ofd-xylose absorption. Lactulose breath H2 cannot be used as a standard for comparison ford-xylose. The three compartment kinetic model ford-xylose absorption with passive absorption of this carbohydrate is supported by similar rate constants for absorption for the twod-xylose doses used.d-xylose at 15 g may be a more appropriate dose than 25 g for H2 breath testing as it does not lead to increased nonabsorptive losses.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Craig RM, Atkinson AJ Jr:d-Xylose testing: A review. Gastroenterology 95:223–231, 1988

    Google Scholar 

  2. Fordtran JS, Soergel KH, Ingelfinger FJ: Intestinal absorption ofd-xylose in man. N Engl J Med 267:274–279, 1962

    Google Scholar 

  3. Rolston DDK, Mathan VI: Xylose transport in the human jejunum. Dig Dis Sci 34:553–558, 1989

    Google Scholar 

  4. Wyngaarden JB, Segal S, Foley JB: Physiologic disposition and metabolic fate of infused pentoses in man. J Clin Invest 36:1395–1407, 1957

    Google Scholar 

  5. Levitt MD, Donaldson RM: Use of respiratory hydrogen (H2) excretion to detect carbohydrate malabsorption. J Lab Clin Med 75:937–945, 1970

    Google Scholar 

  6. Craig RM, Murphy P, Gibson TP, Quintanilla A, Chao GC, Cochrane C, Patterson A, Atkinson AJ jr: Kinetic analysis ofd-xylose absorption in normal subjects and in patients with chronic renal failure. J Lab Clin Med 101:496–506, 1983

    Google Scholar 

  7. Worwag EM, Craig RM, Jansyn EM, Kirby D, Hubler GL, Atkinson AJ Jr:d-Xylose absorption and disposition in patients with moderately impaired renal function. Clin Pharmacol Ther 41:351–357, 1987

    Google Scholar 

  8. Cook G: Breath hydrogen after oral xylose in tropical malabsorption. Am J Clin Nutr 33:555–560, 1980

    Google Scholar 

  9. Casellas F, Chicharro L, Malagelada JR: Potential usefulness of hydrogen breath test withd-xylose in clinical management of intestinal malabsorption. Dig Dis Sci 38:321–327, 1993

    Google Scholar 

  10. Breiter HC, Craig RM, LeVee G, Atkinson AJ Jr: Use of kinetic methods to evaluated-xylose malabsorption in patients. J Lab Clin Med 112:533–543, 1988

    Google Scholar 

  11. Ehrenpreis ED, Gulino SP, Patterson BK, Craig RM, Yokoo H, Atkinson AJ Jr: Kinetics ofd-xylose absorption in patients with human immunodeficiency virus enteropathy. Clin Pharmacol Ther 49:632–640, 1991

    Google Scholar 

  12. Strocchi A, Ellis C, Furne J, Levitt M: Study of constancy of hydrogen-consuming flora of human colon. Dig Dis Sci 39:494–497, 1994

    Google Scholar 

  13. Thompson DG, Binfield P, De Belder A, O'Brien J, Warren S, Wilson M: Extra intestinal influences on exhaled breath hydrogen measurements during the investigation of gastrointestinal disease. Gut 26:1349–1352, 1985

    Google Scholar 

  14. Strocchi A, Levitt MD: Maintaining intestinal H2 balance: Credit the colonic bacteria. Gastroenterology 102:1424–1426, 1992

    Google Scholar 

  15. Saltzberg D, Levine G, Lubar C: Impact of age, sex, race, and functional complaints on hydrogen (H2) production. Dig Dis Sci 33:308–313, 1988

    Google Scholar 

  16. Perman JA, Modler S, Barr RG, Rosenthal P: Fasting breath hydrogen concentration: Normal values and clinical application. Gastroenterology 87:1358–1363, 1984

    Google Scholar 

  17. Thompson DG, O'Brien JD, Hardie JM: Influence of the oropharyngeal micro flora on the measurement of exhaled breath hydrogen. Gastroenterology 91:853–860, 1986

    Google Scholar 

  18. Bond JH, Currier BE, Buchwald H, Levitt MD: Colonic conservation of malabsorbed carbohydrate. Gastroenterology 78:444–447, 1980

    Google Scholar 

  19. Gilat T, Hur B, Gelman-Malachi E, Terdiman R, Peled Y: Alterations of colonic flora and their effect on the hydrogen breath test. Gut 19:602–605, 1978

    Google Scholar 

  20. Strocchi A, Ellis C, Levitt MD: Use of metabolic inhibitors to study H2 consumption by human feces: Evidence for a pathway other than methanogenesis and sulfate reduction. J Lab Clin Med 121:320–327, 1992

    Google Scholar 

  21. Mastropaolo G, Rees WD: Evaluations of the hydrogen breath test in man: definition and climination of the early hydrogen peak. Gut 28:721–725, 1987

    Google Scholar 

  22. Bond JH, Levitt MD: Use of pulmonary hydrogen (H2) measurements to quantitate carbohydrate absorption. Study of partially gastrectomized patients. J Clin Invest 51:1219–1225, 1972

    Google Scholar 

  23. Strocchi A, Ellis C, Levitt MD: Reproducibility of measurements of trace gas concentrations in expired air. Gastroenterology 101:175–179, 1991

    Google Scholar 

  24. Solomons NW, Viteri FE, Hamilton LH: Application of a simple gas chromatographic technique for measuring breath hydrogen. J Lab Clin Med 90:856–862, 1977

    Google Scholar 

  25. Eberts TJ, Sample RH, Glick MR, Ellis GH: A simplified colorimetric micromethod for xylose in serum or urine with phloroglucinol. Clin Chem 25:1440–1443, 1979

    Google Scholar 

  26. Fabiny DL, Ertingshausen G: Automated reaction-rate method for determination of serum creatinine with CentrifiChem. Clin Chem 17:696–700, 1971

    Google Scholar 

  27. Berman M, Weiss MF: SAAM Manual (US Public Health Service publication No. 1703). Washington, DC, United States Printing Office, 1967

    Google Scholar 

  28. Stephen AM, Haddad AC, Phillips SF: Passage of carbohydrate into the colon. Direct measurements in humans. Gastroenterology 85:589–595, 1983

    Google Scholar 

  29. Metz G, Gassull MA, Leeds AR, Blendis LM, Jenkins DJA: A simple method of measuring breath hydrogen in carbohydrate malabsorption by end expiratory sampling. Clin Sci Mol Med 50:237–240, 1976

    Google Scholar 

  30. Levitt MD: Production and excretion of hydrogen gas in man. N Engl J Med 281:122–127, 1969

    Google Scholar 

  31. Read NW, Al-Janabi MN, Bates TE, Holgate AM, Cann PA, Kinsman RI, McFarlane A, Brown C: Interpretation of the breath hydrogen profile obtained after ingesting a solid meal containing unabsorbable carbohydrate. Gut 26:834–842, 1985

    Google Scholar 

  32. Rumessen JJ, Gudmand-Hoyer E: Absorption capacity of fructose in healthy adults. Comparison with sucrose and its constituent monosaccharides. Gut 27:1161–1168, 1986

    Google Scholar 

  33. Bond JH, Levitt MD: Quantitative measurement of lactose absorption. Gastroenterology 70:1058–1062, 1976

    Google Scholar 

  34. Flourie B, Leblond A, Florent CH, Rautureau M, Bisalli A, Rambaud J-C: Starch malabsorption and breath gas excretion in healthy humans consuming low and high starch diets. Gastroenterology 95:356–363, 1988

    Google Scholar 

  35. Fernandez-Banares F, Esteve-Pardo M, de Leon R, Humbert P, Cabre E, Llovet JM, Gassull MA: Sugar malabsorption in functional bowel disease: Clinical implications. Am J Gastroenterol 88:2044–2050, 1993

    Google Scholar 

  36. Levitt MD, Hirsh P, Fetzer A, Sheahan M, Levine AS: H2 excretion after ingestion of complex carbohydrates. Gastroenterology 92:383–389, 1987

    Google Scholar 

  37. Rumessen JJ, Gudmand-Hoyer E: Functional bowel disease: Malabsorption and abdominal distress after ingestion of fructose, sorbitol, and fructose-sorbitol mixtures. Gastroenterology 95:694–700, 1988

    Google Scholar 

  38. Ravich WJ, Bayless T, Thomas M: Fructose: Incomplete intestinal absorption in humans. Gastroenterology 84:26–29, 1983

    Google Scholar 

  39. Kerlin P, Wong L, Harris B, Capra S: Rice flour, breath hydrogen, and malabsorption. Gastroenterology 87:578–585, 1984

    Google Scholar 

  40. Flourie B, Florent C, Jouary JP, Thivend P, Etanchud F, Rambaud JC: Colonic metabolism of wheat starch in healthy humans. Effects on fecal outputs and clinical symptoms. Gastroenterology 90:111–119, 1986

    Google Scholar 

  41. Rumessen JJ, Hamberg O, Gudmand-Hoyer E: Interval sampling of end-expiratory hydrogen (H2) concentrations to quantify carbohydrate malabsorption by means of lactulose standards. Gut 31:37–42, 1990

    Google Scholar 

  42. Flourie B, Florent C, Etanchaud F, Evard D, Franchisseur C, Rambaud JC: Starch absorption by healthy man evaluated by lactulose hydrogen breath test. Am J Clin Nutr 47:61–66, 1988

    Google Scholar 

  43. Christl S, Murgatroyd P, Gibson G, Cummings J: Production, metabolism, and excretion of hydrogen in the large intestine. Gastroenterology 102:1269–1277, 1992

    Google Scholar 

  44. Casellas F, Malagelada JR: Clinical applicability of a shortenedd-xylose breath test for the diagnosis of intestinal malabsorption. Dig Dis Sci 39:2320–2326, 1994

    Google Scholar 

  45. Corazza G, Strocchi A, Sorge M, Benati G, Gasbarrini G: Prevalence and consistency of low breath H2 excretion following lactulose ingestion. Dig Dis Sci 38:2010–2026, 1993

    Google Scholar 

  46. Strocchi A, Corazza G, Ellis C, Gasbarrini G, Levitt MD: Detection of malabsorption of low doses of carbohydrate: Accuracy of various breath H2 criteria. Gastroenterology 105:1404–1410, 1993

    Google Scholar 

  47. Vogelsang H, Ferenci P, Frotz S, Meryn S, Gangl A: Acidic microclimate-possible reason for false negative hydrogen breath test. Gut 29:21–26, 1988

    Google Scholar 

  48. Cloarec D, Bornet F, Gouilloud S, Barry JL, Salim B, Galmiche JP: Breath hydrogen response to lactulose in healthy subjects: relationship to methane producing status. Gut 31:300–304, 1990

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gastroenterology Division, Department of Medicine, Northwestern University Medical School, Searle 1051, 303 E Chicago, 60611, Chicago, Illinois

    Stephen Carlson MD &  Robert M. Craig MD

Authors
  1. Stephen Carlson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert M. Craig MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Supported in part by grant RR0048, National Institutes of Health, National Center for Research Resources.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Carlson, S., Craig, R.M. D-Xylose hydrogen breath tests compared to absorption kinetics in human patients with and without malabsorption. Digest Dis Sci 40, 2259–2267 (1995). https://doi.org/10.1007/BF02209016

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02209016

Key Words

Search

Navigation