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Kiyama T, Tokunaga A, Naji A, Barbul A. Changes in the negative logarithm of end-tidal hydrogen partial pressure indicate the variation of electrode potential in healthy Japanese subjects. Sci Rep 2023; 13:15473. [PMID: 37726384 PMCID: PMC10509160 DOI: 10.1038/s41598-023-42651-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/13/2023] [Indexed: 09/21/2023] Open
Abstract
Molecular hydrogen (H2) is produced by human colon microbiomes and exhaled. End-tidal H2 sampling is a simple method of measuring alveolar H2. The logarithm of the hydrogen ion (H+)/H2 ratio suggests the electrode potential in the solution according to the Nernst equation. As pH is defined as the negative logarithm of the H+ concentration, pH2 is defined as the negative logarithm of the H2 effective pressure in this study. We investigated whether changes in pH2 indicated the variation of electrode potential in the solution and whether changes in end-tidal pH2 could be measured using a portable breath H2 sensor. Changes in the electrode potential were proportional to ([Formula: see text]) in phosphate-buffered solution (pH = 7.1). End-tidal H2 was measured in the morning (baseline) and at noon (after daily activities) in 149 healthy Japanese subjects using a handheld H2 sensor. The median pH2 at the baseline was 4.89, and it increased by 0.15 after daily activities. The variation of electrode potential was obtained by multiplying the pH2 difference, which suggested approximately + 4.6 mV oxidation after daily activities. These data suggested that changes in end-tidal pH2 indicate the variation of electrode potential during daily activities in healthy human subjects.
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Affiliation(s)
- Teruo Kiyama
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Bunkyo, Tokyo, Japan.
- Department of Surgery, TMG Asaka Medical Center, Asaka, Saitama, Japan.
- Department of Surgery, Musashino Tokushukai Hospital, Nishi-Tokyo, Tokyo, Japan.
| | - Akira Tokunaga
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Bunkyo, Tokyo, Japan
| | - Abumrad Naji
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Adrian Barbul
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA
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Alegre E, Sandúa A, Calleja S, Deza S, González Á. Modification of baseline status to improve breath tests performance. Sci Rep 2022; 12:9752. [PMID: 35697832 PMCID: PMC9192647 DOI: 10.1038/s41598-022-14210-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 06/02/2022] [Indexed: 11/20/2022] Open
Abstract
Breath tests used to evaluate carbohydrates malabsorption require baseline H2 and CH4 levels as low as possible. Test cancellation is recommended when exceeding certain cut-offs (H2 ≥ 20 ppm and CH4 ≥ 10 ppm). Although following preparation protocols, many patients have baseline levels above those cut-offs. We investigated if light walking can reduce baseline H2 and CH4 levels. We retrospectively analyzed baseline H2 and CH4 levels from 1552 breath tests. Baseline levels (B1), especially in H2, were lower when obtained at later hours of the day. In those with baseline levels above cut-off, re-sampling (B2) after light walking for one hour, decreased H2 levels 8 ppm (Q1–Q3: 1–18 ppm), and 2 ppm (Q1–Q3: 0–3 ppm) for CH4. Consequently, 40% of tests with elevated B1 levels, presented B2 levels below mentioned cut-offs. Ten percent of tests considered negative when using B1 for calculations, turned positive when using B2 instead. All positive tests when using B1 values, remained elevated when using B2. Re-sampling after light walking for one hour could allow test performance in those with previous elevated baseline levels, avoiding diagnosis delays. Using the second sample for delta calculations identifies positive patients for malabsorption that would have been considered negative.
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Affiliation(s)
- Estibaliz Alegre
- Clínica Universidad de Navarra (Service of Biochemistry), Av. Pío XII 36, 31008, Pamplona, Spain. .,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
| | - Amaia Sandúa
- Clínica Universidad de Navarra (Service of Biochemistry), Av. Pío XII 36, 31008, Pamplona, Spain
| | - Sofía Calleja
- Clínica Universidad de Navarra (Service of Biochemistry), Av. Pío XII 36, 31008, Pamplona, Spain
| | - Sara Deza
- Clínica Universidad de Navarra (Service of Biochemistry), Av. Pío XII 36, 31008, Pamplona, Spain
| | - Álvaro González
- Clínica Universidad de Navarra (Service of Biochemistry), Av. Pío XII 36, 31008, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
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Yu J, Wang D, Tipparaju VV, Jung W, Xian X. Detection of transdermal biomarkers using gradient-based colorimetric array sensor. Biosens Bioelectron 2022; 195:113650. [PMID: 34560350 DOI: 10.1016/j.bios.2021.113650] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 12/24/2022]
Abstract
Accurate assessment of dietary macronutrients intake is critical for the effective management of multiple diseases, such as obesity, diabetes, cardiovascular disease, metabolic disease, and cancer. Conventional self-reporting method is burdensome, inaccurate, and often biased. Though blood analysis and breath analysis can provide evidence-based information, they are either invasive or subject to human errors. Here we reported a wearable transdermal volatile biomarkers detection system based on novel colorimetric sensing technology for dietary macronutrients intake assessment. This technique quantifies the emission rates of transdermal volatile biomarkers via a gradient-based colorimetric array sensor (GCAS). The optical system of the GCAS device tracks the localized color development associated with the chemical reaction between the volatile biomarkers and the porous sensing probes, and determines the biomarkers emission rates through image processing algorithms. The localized chemical reaction and the image-based signal processing also make the GCAS capable for multiplexed detection of multiple analytes simultaneously. The GCAS sensor has been applied for transdermal acetone detection on 5 subjects in a keto diet intervention. The study indicates that the transdermal acetone increases after the subjects consuming keto diets and it decreases to basal level after intaking carb-rich diets. The transdermal acetone response from the GCAS sensor correlates well with breath acetone concentration in the range between 0 and 40 ppm and the correlation factor (R2) is as high as 0.8877. This method provides a noninvasive, low-cost, and wearable tool for assessing dietary macronutrients intake outside of lab or hospital settings. It could be widely applied in disease management, weight control, and nutrition management.
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Affiliation(s)
- Jingjing Yu
- Center for Bioelectronics and Biosensors, The Biodesign Institute, Arizona State University, USA; Department of Electrical Engineering and Computer Science, South Dakota State University, Brookings, SD, 57007, USA
| | - Di Wang
- Center for Bioelectronics and Biosensors, The Biodesign Institute, Arizona State University, USA; Intelligent Perception Research Institute, Zhejiang Lab, Hangzhou, 311100, China
| | - Vishal Varun Tipparaju
- Center for Bioelectronics and Biosensors, The Biodesign Institute, Arizona State University, USA
| | - Wonjong Jung
- Photonic Device Lab., Device Research Center, Samsung Advanced Institute of Technology, Samsung, Electronics Co., Ltd., Suwon-si, Gyeonggi-do, 16678, Republic of Korea
| | - Xiaojun Xian
- Center for Bioelectronics and Biosensors, The Biodesign Institute, Arizona State University, USA; Department of Electrical Engineering and Computer Science, South Dakota State University, Brookings, SD, 57007, USA.
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Uetsuki K, Kawashima H, Ohno E, Ishikawa T, Iida T, Yamamoto K, Furukawa K, Nakamura M, Honda T, Ishigami M, Hirooka Y, Fujishiro M. Measurement of fasting breath hydrogen concentration as a simple diagnostic method for pancreatic exocrine insufficiency. BMC Gastroenterol 2021; 21:211. [PMID: 33971823 PMCID: PMC8111728 DOI: 10.1186/s12876-021-01776-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/20/2021] [Indexed: 12/16/2022] Open
Abstract
Background Pancreatic exocrine insufficiency (PEI) is associated with the outcome of pancreatic disease. However, there is no method for assessing PEI that can be used noninvasively and easily for outpatient. It has been reported that changes in intestinal bacteria caused by PEI may increase breath hydrogen concentration (BHC) levels during glucose or lactose loading. We have evaluated the usefulness of fasting breath hydrogen concentration (FBHC) measurement without glucose loading for the evaluation of PEI. Methods Sixty patients underwent FBHC measurement, BT-PABA testing, and microbiome analysis. They were classified into PEI group (PABA excretion rate < 73.4%, n = 30) and non-PEI group (n = 30). The FBHC of the two groups were compared, and the diagnostic ability of PEI by them was evaluated. The 16 s rRNA (V3–V4) from fecal samples was analyzed by MiSeq. Results FBHC levels was higher in the PEI group 15.70 (1.4 to 77.0) ppm than in the non-PEI group 2.80 (0.7 to 28.2) ppm (P < 0.0001). FBHC was negatively correlated with PABA excretion rate (r = − 0.523, P < 0.001). The cutoff value of FBHC of 10.7 ppm (95% CI: 0.678–0.913, P < 0.001) showed a sensitivity of 73.3% and specificity of 83.3% for PEI diagnosis. In the PEI group, there was a significant increase of relative abundance of phylum Firmicutes (P < 0.05) and the genus Clostridium (P < 0.05). Conclusion FBHC shows good potential as a simple and repeatable test for the diagnosis of PEI. The elevated FBHC levels may be caused by hydrogen-producing bacteria such as Clostridium.
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Affiliation(s)
- Kota Uetsuki
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroki Kawashima
- Department of Endoscopy, Nagoya University Hospital, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tadashi Iida
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kenta Yamamoto
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takashi Honda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yoshiki Hirooka
- Department of Gastroenterology and Gastroenterological Oncology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
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Massey BT, Wald A. Small Intestinal Bacterial Overgrowth Syndrome: A Guide for the Appropriate Use of Breath Testing. Dig Dis Sci 2021; 66:338-347. [PMID: 33037967 DOI: 10.1007/s10620-020-06623-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023]
Abstract
The increased availability of noninvasive breath tests, each with limitations, has led to widespread testing for small intestinal bacterial overgrowth (SIBO) in patients with non-specific gastrointestinal complaints. The lactulose breath test (LBT) is based upon an incorrect premise and therefore incorrect interpretations which has resulted in the over-diagnosis of SIBO and the excessive use of antibiotics in clinical practice. Despite limitations, the glucose breath test (GBT) should be exclusively employed when considering SIBO in appropriately chosen patients. This review suggests guidelines for the optimal use and appropriate interpretation of the GBT for suspected SIBO. The LBT should be discarded from future use, and the literature based upon the LBT should be discounted accordingly.
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Affiliation(s)
- Benson T Massey
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, 900 North 92nd Street, Milwaukee, WI, USA
| | - Arnold Wald
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, Madison, WI, 53705-2281, USA.
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Di Stefano M, Mengoli C, Bergonzi M, Miceli E, Pagani E, Corazza GR. Hydrogen breath test in patients with severe constipation: the interference of the mixing of intestinal content. Neurogastroenterol Motil 2014; 26:1754-60. [PMID: 25424581 DOI: 10.1111/nmo.12456] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 09/16/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND The diagnostic accuracy of the hydrogen (H2 ) breath test might be reduced by the release of preformed H2 , trapped in hard stools. Test solution ingestion might induce the mixing of colonic content and a false positive result. We studied severely constipated patients, at diagnosis and after the normalization of bowel function, to clarify whether this mechanism affects test results. METHODS Twenty functional constipated patients, 10 consecutive patients with functional diarrhea and 10 healthy volunteers underwent (i) a H2 breath test after lactulose, to exclude differences among the groups in fermenting capacity; (ii) breath H2 excretion monitoring after non-absorbable, non-fermentable PEG-electrolyte solution, to exclude the role of the delivery to the colon of preexisting fermentable substrates or of the release of preformed H2 entrapped in the feces; (iii) H2 measurement during a 7-h fasting period, to exclude the role of spontaneous variations of breath gas excretion; and (iv) breath H2 excretion monitoring after PEG, after normalization of bowel function. KEY RESULTS All the subjects excreted similar amounts of H2 after lactulose. After PEG, only severely constipated patients showed significant breath H2 excretion, theoretically able to induce a false positivity of the lactose breath test in 70% of patients and a false positivity of glucose breath tests in 50% of patients. Breath H2 excretion after PEG disappeared if fecal consistency improved after therapy. CONCLUSIONS & INFERENCES Severely constipated patients may harbor preformed gas in hard stools which can be released when mixing of the intestinal content is induced. This mechanism may interfere with breath test results.
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Affiliation(s)
- M Di Stefano
- 1st Department of Medicine, University of Pavia, Foundation IRCCS "S.Matteo" Hospital, Pavia, Italy
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Effects of dietary nutrients on volatile breath metabolites. J Nutr Sci 2013; 2:e34. [PMID: 25191584 PMCID: PMC4153095 DOI: 10.1017/jns.2013.26] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 07/22/2013] [Accepted: 07/25/2013] [Indexed: 12/22/2022] Open
Abstract
Breath analysis is becoming increasingly established as a means of assessing metabolic,
biochemical and physiological function in health and disease. The methods available for
these analyses exploit a variety of complex physicochemical principles, but are becoming
more easily utilised in the clinical setting. Whilst some of the factors accounting for
the biological variation in breath metabolite concentrations have been clarified, there
has been relatively little work on the dietary factors that may influence them. In
applying breath analysis to the clinical setting, it will be important to consider how
these factors may affect the interpretation of endogenous breath composition. Diet may
have complex effects on the generation of breath compounds. These effects may either be
due to a direct impact on metabolism, or because they alter the gastrointestinal flora.
Bacteria are a major source of compounds in breath, and their generation of H2,
hydrogen cyanide, aldehydes and alkanes may be an indicator of the health of their
host.
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Barrett JS, Kalubovila U, Irving PM, Gibson PR. Semiquantitative assessment of breath hydrogen testing. J Gastroenterol Hepatol 2013; 28:1450-6. [PMID: 23517175 DOI: 10.1111/jgh.12199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIM A major use of breath hydrogen testing is to assess absorptive capacity for sugars to assist dietary design for management of gut symptoms. Qualitative reporting takes no account of the vigor of hydrogen response and provides little insight into degrees of malabsorption. This study aimed to describe a semiquantitative reporting method and to compare results with those reported qualitatively. METHODS In consecutive Caucasian patients with Crohn's disease (n = 87), ulcerative colitis (59), functional gastrointestinal disorders (FGID) (162), and healthy controls (76), area under the curve was calculated for lactulose (15 g). This was compared with that for lactose (50 g) and fructose (35 g). Degree of malabsorption was categorized into arbitrary groups. RESULTS Semiquantitative results for ≥ 30% (designated "convincing") malabsorption was most similar to those using a qualitative cutoff value of 20 ppm, but in 38% and 21% of patients, the classification of malabsorption (nil or clinically significant) changed for fructose and lactose, respectively. Using a cutoff of 10 ppm, 49% and 5% were classified differently. Crohn's disease had a higher prevalence (42%) of convincing fructose malabsorption than controls (24%) or patients with FGID (33%) (P < 0.02). Highest prevalence of convincing lactose malabsorption (38%) was in ulcerative colitis, greater than controls (18%) and FGID (18%) (P < 0.02). CONCLUSIONS Semiquantitative assessment provides different results with different clinical implications in more than one third of patients, but disease-related alterations in prevalence are similar to those defined qualitatively. This method may be preferable because it lessens the confounding influence of the vigor of the hydrogen response.
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Affiliation(s)
- Jacqueline S Barrett
- Monash University, Eastern Health Clinical School, Box Hill, Victoria, Australia
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Abstract
PURPOSE OF REVIEW To summarize the recent progress made in noninvasive monitoring of volatile compounds in exhaled breath and above biological liquids, as they are becoming increasingly important in assessing the nutritional and clinical status and beginning to provide support to conventional clinical diagnostics and therapy. To indicate the potential of these developments in medicine and the specific areas which are currently under investigation. RECENT FINDINGS The significance of the following breath gases and their concentrations are reported: acetone and the influence of diet; ammonia confirmed as an indicator of dialysis efficacy; hydrogen and the (13)CO(2)/(12)CO(2) ratio (following the ingestion of (13)C-labeled compounds) as related to gastric emptying and bowel transit times; hydrogen cyanide released by Pseudomonas and its detection in breath of children with cystic fibrosis; and multiple trace compounds in breath of patients with specific pathophysiological conditions and 'metabolic profiling'. SUMMARY Advanced analytical methods, especially exploiting mass spectrometry, are moving breath analysis towards the clinical setting; some trace gas metabolites are already being exploited in diagnosis and therapy. Much effort is being given to the search for biomarkers of tumours in the body. HCN as an indicator of the presence of Pseudomonas in the airways has real potential in therapeutically alleviating the symptoms of cystic fibrosis.
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Affiliation(s)
- Patrik Španěl
- J. Heyrovský Institute of Physical Chemistry, Academy of Sciences of the Czech Republic, Prague, Czech Republic.
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