Figure 3 Production of hydrogen (H2) and methane (CH4) in a patient with bacterial overgrowth of the small bowel (SBBO). Fasting H2 and CH4 production at-10 and 0 minutes; 10 grams of lactulose was administered at 0 minutes.
positive when the hydrogen concentration increases by 14-20 ppm (85). Smoking and exercise are not allowed during the test, and the day previous to the test (86). The hydrogen breath test shows stable intra-individual results in healthy people. However, in patients with high values there is a large day-to-day variation (87). The coefficient of variation is 5-10% (84,88). Sensitivity of 93% and specificity of 78% have been described (85). The glucose hydrogen breath test has a sensitivity of 62% and a specificity of 83% compared with jejunal culture (51). Poor sensitivity due to rapid absorption of glucose substrate in the proximal small bowel, which inhibits hydrogen generation, can be explained by a washout effect of concomitant diarrhea, loss of bacterial microbiota because of recent antibiotic therapy, or an acidic bowel lumen.
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