Hydrogen (H₂) Breath Test and Gastric Bacteria in Acid-Secreting Subjects and in Achlorhydric and Postgastrectomy Patients before and after Antimicrobial Treatment

Abstract

Sixteen patients with pentagastrin-fast achlorhydria and 12 patients who had undergone Billroth II gastrectomy (at least 3 years previously) were compared with 10 acid-secreting volunteers and 13 patients with endoscopically proven peptic disease. The concentration and type of gastric bacteria were analysed in achlorhydrics, Billroth II patients, and patients with peptic disease. A 6-h hydrogen (H2) breath test after a standardized meal was performed in all subjects. The mean concentration of gastric bacteria was significantly higher in achlorhydrics and Billroth II patients than in patients with peptic disease. End-expiratory H2 excretion was elevated in achlorhydrics and Billroth II patients to levels significantly exceeding those of acid-secreting volunteers and patients with peptic disease. In achlorhydrics, total bacterial concentration in gastric juice was correlated to H2 excretion between 60 and 180 min after the meal. Treatment of achlorhydric and postgastrectomy patients with trimethoprim/sulphamethoxazole lowered H2 breath concentrations in both groups and reduced symptoms in achlorhydrics. Elevated end-expiratory H2 levels after a test meal indicate upper gastrointestinal bacterial overgrowth in achlorhydrics and in postgastrectomy patients.

Calcium Carbonate Breath Test for Non-Invasive Estimation of Gastric Acid Secretion

“…A relatively good correlation coefficient of 0.70 was found between the conventional stimulated acid output values and the excess amount of hydrogen exhaled during the test. However, it could be difficult for this test to detect gastric acid secretion because substantial amounts of hydrogen gas exist in the exhaled air in some pathological conditions, especially in patients with intestinal bacterial overgrowth (Armbrecht et al 1985). In addition, magnesium in its metallic form has not yet been approved for clinical use in many countries including Japan, whereas the clinical use of ordinary Ca 12 CO 3 has been widespread as an antacid.…”

Intestinal permeability and bacterial growth of the small bowel in patients with primary sclerosing cholangitis

“…Blood tests were obtained from all patients at the time of the study to investigate liver function and blood tests were also taken for full blood count, electrolytes, iron status, vitamin B 12 , folic acid, gastrin and pepsinogen. Gastrin and pepsinogen were obtained to evaluate indications for atrophic gastritis, which can be associated with SIBO [34].…”

Alkaline Reflux Gastritis after Partial Gastrectomy: Evidence for a Pathogenetic Role of Deoxycholic Acid

“…Brook et al [ 17] examining patients submitted to gastric surgery sug gested that because of bile reflux a peristomal gastritis may induce in the long term a functional impairment of parietal cells with consequent increase of intragastric pH. Bacterial overgrowth, documented in patients after gastric surgery [18], may occur with consequent dehydroxylation and deconjugation of bile salts, which main tain gastric injury also in absence of anatomical causes (excluded in our patients). Bacterial overgrowth with consequent nitrosamine production has been thought to be responsible for the high prevalence of cancer in the gastric remnant [19], Deoxycholic acid itself, however, has recently been claimed to promote colonic carcino genesis [20].…”