ARS | Publication request: Impact of hydrogen breath testing on diagnosis, management, and clinical outcome in children with chronic functional GI symptoms

Submitted to: Gastroenterology
Publication Type: Abstract Only
Publication Acceptance Date: April 1, 2009
Publication Date: May 1, 2009
Citation: Chumpitazi, B.P., Mysore, K., Shulman, R.J. 2009. Impact of hydrogen breath testing on diagnosis, management, and clinical outcome in children with chronic functional GI symptoms [abstract]. Gastroenterology. 136(5 Suppl.1):A513.

Technical Abstract: Chronic functional gastrointestinal (GI) symptoms (e.g. abdominal pain) in children may have numerous etiologies including carbohydrate malabsorption and small bowel bacterial overgrowth (SBBO). Hydrogen breath testing (HBT) frequently is used as a modality to evaluate for these two diagnoses. However, the utility of HBT in children with chronic functional GI symptoms has not been evaluated. To determine if HBT impacts diagnosis, management and clinical outcome in children with chronic functional GI symptoms. Retrospective chart review of all children undergoing HBT from 2006-2008. Children with a GI symptom for a minimum of 3 months at the time of the HBT, and documented follow-up were included. Those with organic etiologies were excluded. Clinical outcome was categorized into 4 groups (poor, fair, good, excellent) based on GI symptom status at the time of last follow-up as compared to baseline. Seventy children underwent 73 breath tests. Breathe testing included 64 lactose breath tests (LBT), 4 fructose breathe tests (FBT), 3 lactulose breath tests (LacBT) and 3 sucrose breath tests. Symptoms included abdominal pain in 62 (89%), diarrhea in 36 (51%), flatus in 24 (34%), constipation in 19 (27%), bloating in 16 (23%), and nausea in 15 (21%). Diagnoses: 22 children were identified with lactose malabsorption, 4 with fructose malabsorption, and 4 with SBBO. Clinical management: 22/22 (100%) children with positive LBT as compared to 9/48 (19%) with a negative LBT began a lactose restricted diet (P<0.001). All children with a positive FBT underwent fructose restriction, though no children with a negative FBT did so. Of those with SBBO, 3 of 4 (75%) received antibiotics, and 2 of 4 (50%) began probiotics. Children were followed-up for a mean of 6.6 ± 1.0 (SE) months. The Table demonstrates clinical outcomes based on LBT result. All children with fructose malabsorption had a good outcome. Of those with SBBO, 1 had a good outcome and 3 a poor outcome. HBT suggested a diagnosis in approximately 40% of children with chronic functional GI symptoms. Those with a positive HBT underwent different clinical management as compared to those with a negative HBT. However, other than those undergoing fructose restrictions, management based on HBT result did not affect clinical outcome.