Category: Gastrolyzer

Hydrogen-methane breath testing (HMBT) is a widely used, non-invasive method to diagnose conditions such as small intestinal bacterial overgrowth (SIBO) and carbohydrate malabsorption (e.g. lactose intolerance). The accuracy of HMBT results depends heavily on proper quality controls, accurate calibration, appropriate sample collection, and meticulous interpretation of results. This article explores these aspects to emphasise their significance in obtaining reliable and clinically meaningful results.

Introduction to HMBT

HMBT measures the amount of hydrogen (H₂) and/ or methane (CH₄) in the breath after ingesting specific carbohydrates. Under normal conditions, small amounts of H₂ and/ or CH₄ are produced in the large intestine. However, in cases of carbohydrate malabsorption or SIBO, undigested carbohydrates are fermented by bacteria in the small intestine (SIBO) or the large intestine (malabsorption), producing H₂ and/ or CH₄ that is absorbed into the bloodstream and exhaled in the breath. The GastroCH₄ECK® HMBT device is one of two devices in the Gastrolyzer® range, manufactured by Bedfont® Scientific Limited. The GastroCH₄ECK® offers non-invasive direct breath testing, providing instant results. Breath samples can be captured using a breath bag and analysed at a later time.

Quality Control in HMBT

Quality control is a critical component of any diagnostic test to ensure the accuracy, reliability, and reproducibility of the results. The effectiveness of HMBT relies heavily on stringent quality control measures. Inconsistencies or errors in any stage of the testing process can significantly impact the interpretation of results, potentially leading to misdiagnosis and inappropriate treatment. In HMBT, quality control involves several key processes.

Calibration of the HMBT device:

The HMBT device must be calibrated at intervals advised by the manufacturer using a known standard gas concentration to ensure it provides accurate readings. This involves running the standard gas through the device and adjusting the machine to match the known concentration. Zero calibration involves ensuring that the device reads zero when exposed to ambient air, as ambient air should ideally contain negligible H₂. Accurate zero calibration ensures that any detected H₂ is due to gastrointestinal fermentation and not background noise. Span calibration involves adjusting the device to read accurately at a higher concentration using a calibration gas with a known H₂ and CH₄ concentration. Regularly changing the filters in the breath device is necessary to maintain its accuracy and prevent contamination. A log for filter changes helps track when filters were last replaced and ensures that they are changed according to the manufacturer’s recommendations, thus maintaining the integrity of the samples.

Standard Operating Procedures (SOPs):

SOPs for HMBT should include detailed instructions for preparing the patient, conducting the test, and handling samples. Routine maintenance is crucial to prevent significant errors and variability in results. The GastroCH₄ECK® must be calibrated before first use, after transportation, and once every 4 weeks. To ensure timely calibration, a reminder will be displayed on the screen during start-up. Bedfont® recommends that the GastroCH₄ECK® should have an annual service to check sensors and components to ensure its longevity and accuracy. This maintenance includes a thorough inspection, cleaning, calibration, and replacement of worn-out parts. Keeping a log of annual maintenance activities helps track the condition of the device and ensures that it receives timely servicing, preventing unexpected malfunctions.

Unlike other HMBT devices that measure carbon dioxide (CO₂), the GastroCH₄ECK® measures oxygen (O₂), which is a quality indicator for the breath sample¹. The measurement of O₂ is essential as it helps to ensure that the bacteria in the large intestine, rather than those in the mouth or stomach, are responsible for any gas production observed during the test.

The accuracy of the HMBT results relies on proper sample collection and patient preparation. Several factors must be considered to ensure valid results. Patients are advised to follow a specific diet for 24-48 hours before the test, avoiding high-fibre and fermented foods to prevent high baseline H₂ and CH₄. Fasting for at least 12 hours before the test is crucial to minimise these baseline levels and align with standardisation studies establishing normal ranges in a fasting state, ensuring predictable and stable intestinal motility.

Patients should always consult with a healthcare professional first, before stopping any medication to ensure proper preparation and guidance. Certain medications, such as antibiotics, probiotics, and laxatives, should be avoided as they can disrupt gut flora and affect H₂ and CH₄ production. However, patients on long-term use with unchanged symptoms may continue these medications unless instructed by a healthcare professional. On the day of the test, patients should avoid physical activity and remain seated to prevent accelerated gastrointestinal transit, which can affect timing and H₂ and CH₄ concentration. Additionally, patients should avoid sleeping, as it alters gastrointestinal motility and impacts test results.

The test will begin with a collection of a baseline breath sample to measure the H₂ and CH₄ levels before carbohydrate ingestion. Then the patient will ingest a specific carbohydrate (e.g. lactulose, glucose, or lactose). The choice of the substrate depends on the clinical question (e.g. lactulose for SIBO, lactose for lactose intolerance). The patient must consume the standardised amount of the test substrate dissolved in a specified amount of water, following international guidelines. Breath samples are then collected at regular intervals (e.g. every 15-20 minutes) for 2-3 hours post-ingestion. Consistent timing is essential to accurately capture the H₂ and CH₄ production curves.

Several factors can affect the accuracy of HMBT results. Patients must adhere to the dietary and fasting instructions; non-compliance can lead to high baseline H₂ and CH₄ levels. Proper calibration and maintenance of the HMBT device is essential, malfunctioning equipment can lead to inaccurate readings. To avoid interpretation variability in HMBTs, it is crucial to adhere to a single reference guideline for performance and analysis. Currently, the most credible guideline is the North American Consensus². Using this guideline ensures standardised procedures and consistent interpretation of results, minimising discrepancies and enhancing the reliability of HMBTs.

Environmental Monitoring:

Each HMBT device manufacturer provides specific instructions regarding the storage and operational temperatures for their devices. It is crucial to adhere strictly to these temperature guidelines when conducting direct breath tests and calibrations. Failure to operate the device within the recommended temperature can potentially affect accuracy.

Conclusion

HMBT is a reliable and non-invasive diagnostic tool for conditions like SIBO and carbohydrate malabsorption, provided that stringent quality controls, accurate calibration, proper sample collection, and meticulous interpretation are in place. Adhering to these protocols ensures the accuracy and clinical utility of HMBT, ultimately leading to better patient outcomes.

By focusing on these aspects, healthcare providers can maximise the diagnostic potential of HMBT and provide effective, targeted treatments for patients with gastrointestinal disorders.

HMBT with the Gastrolyzer® range

Utilising reliable diagnostic tools such as HMBT offers precise insights into the underlying causes of gastrointestinal symptoms, enabling healthcare professionals to formulate effective and tailored treatment plans. Bedfont® Scientific Limited manufactures the Gastrolyzer® range of non-invasive breath testing devices that help to detect gastrointestinal disorders, one breath at a time. The Gastrolyzer® range includes the Gastro⁺™ which measures H₂ and the GastroCH₄ECK® device which measures H₂, CH₄, and O₂. Both devices provide instant results, recorded in parts per million (ppm).

To learn more about how the Gastrolyzer® range can help support your patients with gastrointestinal disorders, visit https://www.gastrolyzer.com/

References:

1. Lee SM, Falconer IH, Madden T, and Laidler PO. Characteristics of oxygen concentration and the role of correction factor in real-time GI breath test. BMJ Open Gastroenterology. 2021 Jun 1;8(1):e000640. DOI:10.1136/bmjgast-2021-000640.
2. Rezaie A, Buresi M, Lembo A, Lin H, McCallum R, Rao S, Schmulson M, Valdovinos M, Zakko S, Pimentel M. Hydrogen and methane-based breath testing in gastrointestinal disorders: the North American consensus. Official journal of the American College of Gastroenterology| ACG. 2017 May 1;112(5):775-84. DOI: 10.1038/ajg.2017.46.

Bedfont® Scientific Limited hosted an insightful webinar Mastering Gut Health: Understanding SIBO, Carbohydrate Malabsorption, and Accurate Gastrointestinal Investigation. Gastrointestinal Physiologist and Bedfont® Medical Advisory Board member Melissa Dooley, led the discussion and shared valuable information on various gastrointestinal disorders and the importance of not self-diagnosing.

The webinar covers some important topics:

• SIBO & dietary malabsorption
• Finger-prick food intolerance testing. Does it play a supporting role in clinical testing, or is it a costly test without scientific evidence?
• Food allergies vs food intolerances
• Home breath testing devices & regulations

Small Intestinal Bacterial Overgrowth (SIBO) What is it?

SIBO occurs when there are higher numbers of bacteria in the small intestine. Too much bacteria here can interfere with the digestion and the absorption process. Bacteria, however, can also provide some benefits, such as:

What causes SIBO?

One of the most common causes is a dysfunction of the normal intestinal motility. Slow movement through the intestines allows bacteria to grow, causes of this can be:

• History of food poisoning
• Diabetes
• Certain medications
• Nerve damage

However, in some cases, the cause can be unknown. Melissa continues to discuss the consequences of SIBO, which include the dampening of villi, protein and carbohydrate malabsorption and B12 deficiency to name a few.

How can we test for SIBO?

The ‘Gold standard’ of SIBO diagnosis, culturing jejunal aspirate, is limited because many bacteria species do not grow in routine culture media, not to mention how invasive and costly this procedure is. The hydrogen breath test was developed due to difficulty accessing the small intestine and is used to detect SIBO and dietary malabsorption.

How can breath samples tell me what is happening in my intestines?

During metabolism, all cells produce carbon dioxide, however, only bacteria produce hydrogen and methane as metabolic by-products. These gases pass through the walls of the intestine into the blood. Once the blood reaches the lungs, a gas exchange occurs, allowing these gases to be detected in exhaled breath.

How to take a SIBO or malabsorption test

Before drinking the relevant substrate, a baseline breath sample is taken. The substrate ingested is mixed with 250ml of water and the type of substrate depends on the test being taken. The substrates can be either:

• Glucose
• Lactulose
• Sucrose
• Sorbitol

Breath samples are then taken at 15-30-minute intervals, depending on the test and can take up to 4 hours depending on the type of test. Treatment can involve antibiotics or dietary changes, depending on the test type and results.

Fructose malabsorption

• Inherited or acquired abnormality of the fructose-transporting protein
• Overuse of high fructose corn syrup or fruit juices in children
• SIBO
• Celiac disease
• Chemotherapy or radiation
• Dumping syndrome

Symptoms of fructose intolerance can include:

• Bloating
• Diarrhoea
• Constipation
• Flatulence

Unfortunately, there is no known cure, but an appropriate diet would help. Foods that have a high content of glucose will help absorb fructose.

To test for fructose intolerance, the patient would need to ingest 25g of fructose in 250ml of water. Breath samples would then be taken at 30-minute intervals over 3 hours.

Lactose malabsorption

Lactose is normally hydrolysed into glucose and galactose, which is readily absorbed in the jejunum. Lactose needs to be hydrolysed in the small intestine by lactase. If the lactase enzyme is lacking, the lactose will not be completely hydrolysed and result in lactose malabsorption. Symptoms of lactose malabsorption can include:

• Distension
• Cramps
• Flatulence

Lactose malabsorption is the most common intolerance, affecting almost half the world’s population.

Food allergies vs food intolerances

Often people confuse a food intolerance and a food allergy. A food intolerance can be caused by a change of routine, hormones, and eating out. Symptoms can be quite disruptive to someone’s life and lead them to avoid social activities due to the unpredictability of the symptoms. Because of this, many sufferers will turn to the internet for a quick and easy solution.

An intolerance is where the enzymes in the gut responsible for breaking foods down are deficient, defective, or there is an issue with the mechanism that transports the molecules through the small intestine. Symptoms are:

• Abdominal pain
• Discomfort
• Diarrhoea

Common food intolerances are:

• Lactose
• Fructose
• Sucrose
• Sorbitol

It’s important not to self-diagnose as many conditions can cause similar symptoms to irritable bowel syndrome (IBS) & SIBO, but they will have different treatments and management. It’s always important to visit your GP or healthcare professional. A food intolerance can be diagnosed by an elimination diet or a breath test.

If you have a food intolerance you may be able to consume a small amount of the food, however, with an allergy you must avoid these foods as food allergies can be fatal. Food allergies can be tested through skin prick allergy testing or an elimination diet.

Tests currently not recommended by healthcare professionals for food intolerances are finger prick tests and hair analysis tests, as these do not have any supportive scientific evidence.

Breath testing is the recommended method for detecting lactose malabsorption for several reasons. If you proceed with an elimination diet and remove milk, you may still ingest lactose which can be found in many unsuspecting foods such as:

• Hot dogs
• Breaded chicken
• Sweets

So even if the patient attempts to remove lactose from their diet, they can un-intentionally ingest lactose.

Other test methods can include:

• Endoscopic biopsies (invasive & costly)
• Blood test (repeated every 30 minutes)
• Stool acidity test (infants, young children)

Home breath testing devices

Home breath testing devices were more widely optimised due to the COVID-19 pandemic, to prevent waiting list delays and people felt safer taking the tests at home. There are several benefits of home testing kits, such as:

• Living far from the clinic and difficulty getting there
• Difficulty getting time off work
• Childcare issues
• Difficulties leaving the house with symptoms

However, the limitation of a home test could be that the patient doesn’t collect their samples correctly, resulting in the test having to be retaken. Therefore, patients must be provided with very clear and precise instructions to follow.

There are many home testing devices available now, but using one of these devices without the advice or guidance of a healthcare professional could result in self-interpretation, misdiagnosis, and incorrect preparation, leading to unnecessary avoidance of important food groups.

Home testing devices must be sourced from a reputable healthcare professional, who can discuss the results or provide a report for the treating medical professional. This will ensure an appropriate follow-up is conducted to make sure the patient doesn’t end up with a nutritional deficiency due to self-diagnosis.

There are many factors involved in diagnosing and treating gastrointestinal conditions. Melissa has highlighted these conditions and discussed the importance of not self-diagnosing, watch the full webinar now:

World Digestive Health Day occurs annually on the 29th May. Launched in 2004 to mark the 45th anniversary of the World Gastroenterology Organisation’s (WGO) incorporation in 1958 (founded in 1935). This year’s theme is “Your Digestive Health: Make it a Priority”, emphasising that prioritising digestive health is vital for promoting well-being and enhancing quality of life1.

We have all been exposed to common digestive complaints that can arise from food intolerances at one time or another; whether we have eaten something and felt a bit bloated or sluggish, or perhaps even experienced some changes in bowel pattern. This can be more frequent or associated with eating out, travelling, hormonal imbalance, or even because of lifestyle changes. For some, these symptoms can occur frequently or can be severe, which may result in many sufferers turning to the internet to look for fast, easy and convenient solutions. It is understandable why people get frustrated with their digestive health, especially with unpredictable episodes that affect the quality of life, and this can lead to the avoidance of social events, or cause anxiety around eating out.

Remember, it is important not to self-diagnose as a number of conditions can cause similar symptoms to irritable bowel syndrome (IBS) and food intolerances but will have different treatment and management. For this reason, it is important to visit your GP/Family Doctor who may recommend further evaluation.

Some of the common food intolerance symptoms experienced can arise from carbohydrate malabsorption such as from lactose malabsorption, fructose malabsorption and sucrose malabsorption.

The intestine can only absorb a limited amount of fructose; most people can absorb 25-50g of fructose per sitting. Fructose malabsorption is a dietary impairment of the small intestine, whereby there is a limitation in the fructose carrier system which transports this sugar across the cell membrane.

Fructose malabsorption is not a food allergy, meaning there is no production of IgE antibodies or release of histamine. There are generally no typical allergic symptoms such as itching or hives.

In the large intestine, the unabsorbed fructose is metabolised by normal colonic bacteria to short-chain fatty acids and the gasses hydrogen, carbon dioxide, and methane. The increase in hydrogen or methane gas is detected with the breath test.

Possible causes of fructose malabsorption include:

• Inherited or acquired abnormality of fructose transporting protein GLUT-5 (other family members are often affected).
• Overuse of High Fructose Corn Syrup, or fruit juices in children.
• Small intestinal bacterial overgrowth (SIBO).
• Coeliac disease.
• Chemotherapy or radiation (damage of small intestinal mucosa).
• Dumping syndrome (rapid gastric emptying)

It can be difficult to see a relationship between the foods eaten and the symptoms experienced; this is because most foods contain a mixture of glucose and fructose, and foods with a high glucose content can help to absorb fructose. One molecule of glucose enables the absorption of one molecule of fructose. An example of this is when fructose was given in the form of sucrose (sucrose = fructose + glucose), its absorption capacity was increased e.g., table sugar (50% fructose, 50% glucose). The greater the glucose-to-fructose ratio in the food, the easier the fructose will be absorbed.

Lactose is normally hydrolysed into glucose and galactose, which are readily absorbed in the jejunum. Lactose needs to be hydrolysed in the small intestine by a B-galactosidase lactase-phlorizin hydrolase, generally called lactase. Lactase is found most abundantly in the jejunum at the tip of the intestinal villi and therefore is more vulnerable to intestinal diseases that cause cell damage than other sugars, which are located deeper.

If the enzyme lactase is lacking (or if inadequate amounts are produced), the lactose will not be completely hydrolysed, and the resultant condition is lactose malabsorption (also referred to as lactase deficiency). It is the most common type of carbohydrate intolerance and is the most common genetic disorder affecting more than half the world’s population.

When poorly absorbed lactose reaches the colon, gases produced may cause distension, cramps, flatulence, and general discomfort, along with diarrhoea, which can range from mild to explosive discharge. These symptoms produce the condition lactose intolerance, which is lactose malabsorption with discomfort. Symptoms associated with lactose intolerance may be mild or severe depending on the degree of lactase deficiency and the amount of lactose consumed. Lactose malabsorption can be diagnosed with a hydrogen methane breath test (HMBT) that will measure the level of gases in exhaled breath samples.

The number of people with lactose malabsorption is surprisingly large. It is estimated that about 68% of the world’s population has lactose malabsorption. It is more common in certain areas of the world such as Asia and among African Americans, American Indians, and Hispanics.

There are different types or forms of lactose malabsorption:
Congenital Lactase Deficiency (CLD) is a rare genetic condition. In this type, there is a marked deficiency of lactase production, if any at all, in the small intestine from birth. It is caused when a baby inherits 2 ineffective genes from their parents (one from each).

Familial Lactase Deficiency is the result of a defective lactase enzyme protein. Unlike CLD, the level of lactase enzyme production is normal but since the genes are producing a defective enzyme, lactase is deemed dysfunctional and ineffective.

Primary lactase deficiency is a condition that develops over time. After about the age of 2, the body
begins to produce less lactase. It is the most common type of lactase deficiency.

Developmental Lactase Deficiency results from low lactase levels and is a consequence of prematurely born babies. Premature babies born 28-32 weeks of gestation will have reduced lactase activity.

Secondary lactase deficiency occurs when injury to the small intestine or certain digestive diseases reduce the amount of lactase a person produces e.g. coeliac disease, inflammatory bowel disease, and Crohn’s disease.When the epithelium heals, the activity of lactase returns.

Sucrose is a disaccharide composed of glucose and fructose. It is hydrolysed by the enzyme sucrase, an a-glucosidehydrolase, which is naturally occurring in the small intestine.

Some people with genetic sucrase-isomaltase deficiency (GSID) are often misdiagnosed with IBS. People with GSID cannot digest sucrose and maltose (sugar found in grains) and can have difficulty digesting starch. Symptoms range from mild to severe.

Importance of not self-diagnosing:
If you are suffering from food intolerances, this may mean that the enzymes in your gut responsible for breaking down the food particles are either deficient, defective, or there may be an issue with the mechanism that transports molecules through the small intestine.

This point is of great importance as some people want to take the reins on their health, and in some cases self-diagnose. In recent times, there has been a large increase in online devices available aimed at providing you with “diagnostic” results. This includes devices that encompass home testing apps with instant results.

While there are some home testing devices available that are overseen by appropriately qualified professionals, there are other heavily marketed devices aimed at those with common digestive symptoms that are not up to the same standard or have practitioner involvement.

In the absence of practitioner involvement, devices that are used to allow patients to self-test at home with instant results and self-interpretation could potentially lead to a misdiagnosis or inadvertently avoiding important food sources. You must remember that if a person is not properly adhering to the clinically recommended protocols for testing, residual food in the intestinal tract may be detected on home testing breath devices leading to inaccuracies.

This comes back to the point about experienced practitioner involvement, as you don’t want to see a
patient unnecessarily avoiding food groups like lactose just because they misinterpreted the report, did
not prepare for the test in accordance with recommended protocols, given misinformation/misinformed
how the device is intended to be used or did not conduct the test correctly.

When your digestive health is out of sync, foods are not agreeing with your gut, and you are feeling the
burden of your symptoms, before choosing a quick and self-guided approach it is important to talk with your medical practitioner. There are a lot of easy-to-use home tests available, but it is important they are sourced from a reputable health professional who is available to discuss the results with you and recommend appropriate follow-up

Hydrogen Methane Breath Testing (HMBT):

Utilising reliable diagnostic tools such as HMBT offers precise insights into the underlying causes of gastrointestinal symptoms, enabling healthcare professionals to formulate effective and tailored treatment plans. Bedfont® Scientific Limited manufactures the Gastrolyzer® range of non-invasive breath testing devices that help to detect gastrointestinal disorders, one breath at a time. The Gastrolyzer^® range includes the Gastro^+™ which measures H² and the GastroCH4ECK device which measures H², CH⁴, and O². Both devices provide instant results, recorded in parts per million (ppm).

To learn more about how the Gastrolyzer^® range can help support your patients with gastrointestinal
disorders, visit https://www.gastrolyzer.com/.

References:
1. World Digestive Health Day: WDHD 2024 [Internet]. WDHD. Cited 17th May 2024]. Available from: https://wdhd.worldgastroenterology.org/ongoing-wdhd-campaigns/wdhd-2024

Gastrointestinal disorders such as carbohydrate malabsorption and lactose intolerance can be diagnosed with the aid of hydrogen (H₂) and methane (CH₄) breath testing (HMBT). Bedfont® Scientific Limited manufacture the GastroCH₄ECK^® device which measures H₂, CH₄, and Oxygen (O₂). Unlike other HMBT devices which measure carbon dioxide (CO₂), the GastroCH4ECK® device measures O₂ as it is a quality indicator for the breath sample¹.

What is the role of O₂ in HMBT:
When a patient comes in for a HMBT test, after recording their baseline results, the patient will digest a specific substrate which is metabolised by the bacteria in the small intestine which will start producing H₂ and/or CH4 gas. H₂, CH₄, and O₂ will then be monitored in intervals; the O₂ measurement is important because it helps to ensure that the bacteria in the large intestine, rather than those in the mouth or stomach, are responsible for any gas production observed during the test.

The science behind O₂ being measured:
The Earth’s atmosphere consists of around 78% nitrogen (N₂), 20.9% O₂, 0.93% argon (Ar), CO₂ 0.03%; with the rest being various gases². When you breathe in, your body converts a percentage of O₂ into CO₂, which settles at the base of the lungs, known as an end-tidal sample. During HMBT, if the levels of O₂ exceed 14%, it indicates that an end-tidal sample has not been achieved, likely due to dilution by dead space in the upper airway. In such cases, the GastroCH₄ECK^® device compensates for this discrepancy with a correction ratio which will be displayed onscreen.

The earliest use of recorded modern HMBT was in the 1970s, with the rationale that defined CO₂ concentration of an end-tidal breath as 5% was published in the same decade³. Eventually, the O₂ concentration measurement was adopted, and the O₂ end-tidal breath was 14%. When completing a breath test with the GastroCH₄ECK^® device, an on-screen dial will help to guide the exhalation rate; keep the arrow pointing in the green section of this indicator throughout the test. The arrow will change colour as the O₂ level in the breath sample reduces to the target 15%, at which point it will turn green and the test will automatically stop after 3 seconds. Once the test is completed, the final results will be shown onscreen H₂ and CH₄ measured in parts per million (ppm). The final results for the O2 percentage and correction factor have a visual indicator to help interpret results displayed as a traffic light system.

Quality of measuring O₂:
The quality of measuring O₂ in an HMBT is crucial for accurately assessing functions, especially related to gastrointestinal health. Standardised testing protocols help ensure uniformity across the different testing facilities. Consistent protocols for fasting duration, substrate administration, and sampling intervals will help enhance the reliability and comparability of test results. Regular calibration is necessary to maintain accuracy, ensuring that measurement devices function and provide results correctly.

In summary, the measurement of O₂ for HMBT is crucial because it ensures the accuracy and reliability of the results. O₂ levels can influence the production of H₂ and CH₄ in the gut, and impact the test results and treatment. Healthcare professionals can obtain more precise measurements, leading to better diagnosis and management of gastrointestinal conditions like small intestinal bacterial overgrowth (SIBO) and improving patient outcomes.

Testing:
Bedfont^® manufactures the Gastrolyzer^® range of non-invasive breath testing devices that help to detect gastrointestinal disorders, one breath at a time. The Gastrolyzer^® range consists of the Gastro^+™ which measures H2 and the GastroCH4ECK device which measures H₂, CH₄, and O₂; both devices provide instant results recorded in ppm. To find out more about how you can support your patients with gastrointestinal disorders with the Gastrolyzer® range, visit https://www.gastrolyzer.com/.

References:
1. Lee SM, Falconer IH, Madden T, and Laidler PO. Characteristics of oxygen concentration and the role of correction factor in real-time GI breath test. BMJ Open Gastroenterology. 2021 Jun 1;8(1):e000640. DOI:10.1136/bmjgast-2021-000640.
2. The atmosphere [Internet]. National Oceanic and Atmospheric Administration. [Cited 19th April 2024]. Available from: https://www.noaa.gov/jetstream/atmosphere
3. Niu HC, Schoeller DA, Klein PD. Improved gas chromatographic quantitation of breath hydrogen by normalization to respiratory carbon dioxide. The Journal of laboratory and clinical medicine. 1979 Nov 1;94(5):755-63. PMID: 501202.
4. Wolfson MR, Shaffer TH. Cardiopulmonary physical therapy. Fourth Edition, 2004.

Did you ever have an exam or a competition and get that feeling of butterflies in your tummy?

Or did you receive bad news and felt sick, or may have even vomited?

Then you have experienced the communication pathway that happens between the gut and brain,
often referred to as the gut-brain axis.

Also known as our 2nd brain, scientists call this system the enteric nervous system (ENS) and it has around 100 million nerve cells lining your gastrointestinal tract. The nervous system also works closely with your endocrine and immune system.

Our second brain communicates back and forth with our big brain—

For many years, it was believed that anxiety and depression contributed to irritable bowel syndrome and other functional gut symptoms, but studies now show that it may also be the other way around.

When the gastrointestinal system is aggravated, it may send signals to the central nervous system that affect mood. There is a notable higher incidence of people with IBS and functional bowel problems that develop depression and anxiety.

The microbiome also plays an important role in the gut-brain connection. They produce many of the chemical neurotransmitters that transport messages between your gut and brain.

Irritable Bowel Syndrome, also known as IBS, is one of the most common and debilitating gastrointestinal disorders affecting around 10-15% of the population. It is a functional gastrointestinal condition that most often affects the lower digestive system.

No definite cause of IBS has been identified yet. However, gut inflammation, altered gut motility, gut hypersensitivity to certain foods, and disturbed gut microbiome are all considered to play a role in IBS.

A diagnosis of IBS can leave people feeling frustrated because of the lack of standard or quick solutions, but IBS affect people differently, and therefore a diagnosis of IBS does require support.

IBS is characterised by a group of symptoms which consistently occur together. The most common of these are stomach cramps, bloating, discomfort, diarrhoea, and constipation.

As a functional Gastrointestinal disorder, it comes in multiple forms:

• IBS-C refers to IBS with constipation, and it is one of the more common types.
• IBS-D is also called IBS with diarrhoea.
• IBS-M includes mixed bowel habits, for example, alternating patterns of diarrhoea and constipation.
• Post-infectious IBS occurs after a Gastrointestinal infection.

Mental stress, anxiety, certain foods, and hormonal changes are some known triggers for IBS symptoms. Other triggers may include alcohol, some medicines, infections, and sudden changes in routine such as travelling. The effects of IBS triggers vary from person to person, what may flare up IBS symptoms in one person may resolve IBS symptoms in others.

This again ties in the gut-brain connection, stress and anxiety affect your nerves and make your digestive system overactive. Patients with IBS often suffer the worst abdominal pain when they are stressed. Because of the interplay between our gut and our brain, IBS is not just about the physical symptoms but can be an emotional rollercoaster affecting every aspect of your daily life.

IBS affects more women than men, and the symptoms of IBS in women tend to be more severe than in men. One of the reasons is hormonal imbalances in the menstrual cycle. Many women with IBS see their IBS symptoms fluctuate with their menstrual cycle. That’s because the hormonal fluctuations that occur during different stages of the menstrual cycle impact gut functions, thereby altering IBS symptoms. However, IBS symptoms don’t always correlate with menstrual cycles in every woman and with other factors affecting IBS symptoms, the impact of hormonal fluctuations varies from person to person.

There is no permanent cure for IBS. Effective management strategies often involve a combination of dietary changes, stress reduction techniques, and sometimes medication to address both the physical and psychological aspects of these conditions. Please note that the effectiveness of these medicines and supplements may vary from person to person, and you’re recommended to consult your doctor before using them for IBS.

So, you think you may have IBS? We recommend consulting your doctor about your symptoms to make a diagnosis. Your doctor may recommend tests such as SIBO (small intestinal bacterial overgrowth), lactose intolerance test, or other diagnostic tests.

The relationship between IBS and SIBO:
To understand the relationship between SIBO and IBS, what we need to do is to first look at what SIBO means. SIBO stands for Small Intestinal Bacterial Overgrowth. It refers to the condition where there is an abnormal increase in the bacterial population of the small intestine resulting in a range of symptoms, for example, diarrhoea, abdominal bloating, and even may lead to malnutrition. So, the patients with SIBO suffer almost the same symptoms as the patients with IBS do. Some studies state that approximately 80% of the people clinically diagnosed as IBS have SIBO too.

Take home message:
IBS and SIBO can significantly impact mental health, often leading to anxiety and mood disturbances. Firstly, the production of excessive amounts of gases such as hydrogen and methane from the bacteria in the small intestine may contribute to bloating, discomfort, and abdominal pain, all of which can affect one’s mood, while the social implications of these conditions can exacerbate stress and anxiety.

Secondly, SIBO can disrupt the absorption of important nutrients like Vitamin B12 and serotonin precursors, which are crucial for mood regulation. Lastly, inflammation triggered by SIBO can influence the production of neurotransmitters like serotonin and dopamine, further exacerbating mood disturbances. Overall, addressing SIBO not only targets gastrointestinal symptoms but also holds the potential for improving mood and overall well-being.

BS Awareness Month and upcoming webinar:
Delve deeper into SIBO and IBS leading up to IBS Awareness Month in April with our upcoming webinar featuring Melissa Dooley. Join us for our upcoming webinar SIBO and IBS: How HMBT can aid in investigation and diagnosis on Tuesday 26th March 2024 at 19:00pm GMT. Learn about SIBO and IBS and explore how hydrogen and methane breath testing serves as a powerful tool in identifying and managing these gastrointestinal disorders while also contributing to awareness and discovering effective strategies for integrating them into clinical practice.

After the festive season, taking care of your gut health is vital. This time of year is one for feasting, socialising, and spending time with friends and family. However, it also means significant changes in regime and diet. For some, the festive season brings challenges in the form of dietary concerns and gastro symptoms. Thus, it is no surprise that studies show that about one-third of people experience digestive issues during this period.

Many people experience issues like abdominal pain, bloating, diarrhoea, and indigestion. There are multiple reasons for digestive problems during the festive season.

This time of year often results in overindulgence in food, significant dietary changes, consuming foods that a person does not regularly consume and mixing different foods.

This is not to suggest that one should not enjoy the time. However, if you are better prepared, you can likely manage most gastrointestinal issues using home remedies or over-the-counter medications. Moreover, taking timely action may help prevent more severe consequences and a visit to a doctor.

Hence, to manage gastro symptoms effectively, it is vital to understand its causes and what part of the gastrointestinal tract is affected. It could be the upper part, the middle part, or the lower part of the digestive system.

Issues of Upper Gastrointestinal Tract

One can consider the oesophagus (food pipe) and stomach as the upper parts of the gastrointestinal tract. Even though digestion begins in the mouth, most digestive processes start in the stomach, where several digestive enzymes and hydrochloric acid are secreted.

Overeating or eating certain kinds of foods, like those high in fats or consuming too much alcohol, may cause stomach pain, heartburn, and bloating.

One of the most common issues people experience during the festive season is Gastro-oesophageal reflux disease (GORD), which can result in upper gastric symptoms. Certain foods and alcohol may also damage the upper lining of the stomach.

GORD can cause burning chest pain (located in the middle of the chest and may radiate towards the back). Some may even confuse it with heart pain.

It mainly occurs due to the high production of acid in the stomach. Some of this acid makes its way to the lower part of the esophagus, causing pain or heartburn. Overeating or consuming certain foods may loosen the lower oesophageal sphincter (valve), which prevents the backflow of the stomach’s content towards the food pipe.

Most cases of GORD can be managed with great success. One can benefit significantly from over-the-counter medications such as antacids which neutralise the acid and provide almost immediate pain relief. Additionally, one may benefit from other natural remedies like chamomile, licorice and by drinking different teas. It’s important for individuals with GORD to practice moderation and choose lighter, less acidic options when possible.

Mid-Gastrointestinal Tract or Small Intestine Issues

Understanding that most digestive processes occur in a small intestine is vital. Absorption of most nutrients also happens in this part of the intestine.

If you experience bloating, gas, pain in the centre of the abdomen, discomfort, changes in appetite, or mild diarrhoea, then all these issues are likely to be associated with the small intestine. These problems may be due to malabsorption/food intolerance, local infection, or even due to local irritation.

The small intestinal issue often tends to be chronic and many people may benefit from commonly available remedies like digestive enzymes.

For individuals that have food allergies or intolerances, such as wheat, milk, fish, soy, sesame or nuts, this season can be particularly challenging, with hidden ingredients and cross-contamination becoming more prevalent in shared meals. Careful reading of labels and open communication with hosts can help those with food allergies enjoy their food safely.

For those with coeliac disease, there is a greater risk of gluten contamination during the holiday season with traditional foods like stuffing and sauces. Opting for gluten-free alternatives and educating loved ones about the importance of cross-contamination prevention.

One of the chronic issues affecting the small intestine is small intestine bacterial overgrowth or SIBO. This occurs due to an overgrowth of bacteria that are normally present in the small intestine. SIBO may be associated with irritable bowel syndrome, pancreatic issues, and intestinal motility issues. Studies suggest that a high prevalence of patients diagnosed with IBS have small intestinal bacterial overgrowth.

If someone continues to experience issues like frequent bloating and abdominal discomfort, it is advisable to consult with your doctor who may use some more specific tests to diagnose the condition. For example, a hydrogen methane breath test (HMBT) is an important diagnostic investigation for confirming SIBO, and to check if there is a malabsorption or food intolerance present. One such example is the ability of the HBMT to check for lactose malabsorption. This is one of the most common types of carbohydrate malabsorption in the world affecting more than half the world’s population. Symptoms may be mild or severe depending on the degree of lactase deficiency and the amount of lactose consumed.

Most of these intestinal issues are treated through dietary changes, certain medications, and using health supplements. Additionally, some may also benefit from a low FODMAP diet.

Lower-Gastrointestinal Tract or Large Intestine Issues

In this part of the intestine, absorption of water and some vitamins occurs. The final processing of foods happens in the large intestine before their elimination. The large intestine is also rich in microbiota, which has numerous roles in health.

Disturbances of the large intestine are most likely to cause chronic diarrhoea or even constipation. It may also cause pain if you are living with inflammatory bowel disease. One should keep in mind that dietary changes during the festive season may exacerbate inflammation.

There are a few ways to take care of your large intestine, like drinking ample water and being aware of your dietary fibre intake.

If you are living with inflammation, it is worth remembering that any dietary changes may cause worsening symptoms or flares. To prevent such issues, it is better to consult a doctor, as managing IBD is quite challenging.

The Bottom Line

Significant dietary changes and feasting during the festive season cause changes in gastrointestinal function in most individuals. Fortunately, most of these changes do not require medical attention and can be managed through home remedies or over-the-counter medications.

However, in some cases, issues like bloating, diarrhoea, abdominal pain, and discomfort become chronic. In such instances, it is a good idea to seek medical attention. Many of these issues occur due to food intolerance, IBS, SIBO, and other similar conditions. In many instances, hydrogen-methane breath testing is of significant help. Hydrogen and methane breath testing is also a valuable diagnostic tool that can support the management of gastrointestinal symptoms and dietary challenges during this period, allowing for better symptom control and informed decision-making.

Before attending a gathering, communicate with your host about your dietary restrictions, concerns, and allergies. This can help them to provide alternatives and prevent cross-contamination. Stay hydrated by drinking water throughout the day as hydration is crucial for good digestion and can help prevent constipation. Being mindful of portion sizes can help to prevent overindulging. Remember that enjoying your favourite treats is okay, but moderation is key.

By understanding the impact of seasonal foods on various gastrointestinal symptoms and conditions, people can make informed choices, communicate their dietary needs, and enjoy the festive season to the fullest.

The festive season, adorned with twinkling lights and joyous gatherings, graces our tables with an array of delightful treats. However, for those grappling with gastrointestinal conditions, this time of year feast brings forth unique challenges. In this seasonal article, we embark on a journey to explore the impact of food on gastro symptoms and discover the invaluable role of Hydrogen and Methane Breath Testing (HMBT) in managing these challenges.

The Yuletide Culinary Extravaganza: The festive season is synonymous with indulgence, featuring a tapestry of rich, decadent dishes that can trigger gastrointestinal symptoms. From creamy mashed potatoes to buttery desserts, the abundance of high-fat and high-sugar foods poses a challenge for those with sensitive digestive systems.

A Culinary Journey Across the UK of Traditional Delights: Let’s embark on exploring the traditional foods of each country in the United Kingdom, along with some insights into their unique traditions and how these might impact digestive health.

1. England:

• Traditional Food: Roast Beef and Yorkshire Pudding, Fish and Chips, Full English Breakfast.
• Tradition: Afternoon Tea, a quintessential English tradition featuring tea, sandwiches, and pastries.
• Impact on Digestive Health: Some may find the richness of traditional English dishes, especially those high in fat, challenging for digestion.

2. Scotland:

• Traditional Food: Haggis, Neeps, and Tatties (turnips and potatoes), Scotch Broth.
• Tradition: Hogmanay, the Scottish New Year’s celebration, often involves festive meals and customs.
• Impact on Digestive Health: Haggis, a savoury pudding, may contain various ingredients, and individual tolerance can vary.

3. Wales:

• Traditional Food: Welsh Rarebit, Cawl (a traditional soup), Bara Brith (fruitcake).
• Tradition: The Eisteddfod, a cultural festival celebrating Welsh arts and literature, includes traditional foods.
• Impact on Digestive Health: Rich and hearty dishes like Welsh Rarebit may be heavy for some digestive systems.

4. Northern Ireland:

• Traditional Food: Ulster Fry (similar to Full English Breakfast), Irish Stew, Wheaten Bread.
• Tradition: The Twelfth, a Protestant celebration, often involves communal meals.
• Impact on Digestive Health: Traditional Irish Stew with lamb and vegetables is generally well-tolerated.

Ranking in Terms of Impact on Digestive Health: Considering individual digestive tolerance, it’s challenging to provide a definitive ranking. However, generally speaking, traditional dishes in Wales and Northern Ireland might be perceived as somewhat lighter compared to the richer and heartier offerings in England and Scotland.

A Neurological Journey of Pleasure: The seasonal indulgence in festive foods is not merely a matter of tradition; it has a profound neurological impact that contributes to the joy and comfort associated with these culinary choices.

Take, for instance, the rich and hearty fare of Scotland. Traditional dishes like haggis, neeps, and tatties are more than just a feast for the taste buds; they evoke a sense of home and nostalgia. The brain, in response to familiar and comforting flavours, releases neurotransmitters like dopamine and serotonin, creating a pleasurable experience that goes beyond the immediate taste.

In Wales, the emphasis on ingredients like lamb and leeks in dishes such as cawl reflects a connection to the land and local agriculture. Consuming these foods during the festive season triggers a neurological response tied to cultural identity and a deep-rooted sense of community. The brain perceives these flavours as not just sustenance but as a reaffirmation of cultural belonging, fostering a positive emotional response.

Moving to Northern Ireland, the fondness for Ulster Fry during the festive season is a sensory experience that goes beyond the plate. The sizzle of bacon, the aroma of fresh soda bread, and the savoury taste of potato bread collectively stimulate the brain’s reward centres. The anticipation and enjoyment of these familiar flavours release endorphins, creating a sense of happiness.

In England, the Christmas pudding, with its blend of spices, dried fruits, and a generous splash of brandy, is a sensory delight. This traditional dessert engages the brain through olfactory and gustatory stimuli. The combination of festive aromas and complex flavours activates the limbic system, responsible for emotions and memory, contributing to a sensory-rich experience.

Gastro Grumbles – The Impact of Festive Foods:

1. Carbohydrate Overload: As we delve into the heart of traditional seasonal fare, laden with carbohydrates, we encounter a dual challenge for individuals with digestive conditions like lactose intolerance or fructose malabsorption. The digestive system contends with potential issues such as bloating, gas, and abdominal discomfort. Simultaneously, the influx of carbohydrates influences the gut microbiome, serving as a substrate for microbial fermentation. This intricate interaction extends beyond digestion, as the brain’s reward centres respond to indulgence in carb-laden delights, experiencing a temporary boost in mood. The release of neurotransmitters like serotonin contributes to both digestive and neurological experiences, highlighting the interconnectedness of our gut, brain, and microbiome.

2. Fatty Feasts: Roasts, velvety gravies, and decadent desserts take centre stage, not only delighting the palate but also affecting the gut microbiome. Individuals with gallbladder issues or difficulties in fat digestion may experience symptoms like nausea, bloating, and diarrhoea. Fats, acting as substrates for microbial metabolism in the gut, influence the composition of the microbiome. This microbial interplay extends to the brain, triggering the release of dopamine, the pleasure neurotransmitter. The holistic impact on the digestive system, brain, and microbiome underscores the complex web of connections affected by festive fatty feasts.

3. Sugar Rush: Sweet treats, a staple during this time of year, pose a challenge for those with conditions like irritable bowel syndrome (IBS). The surge in sugar intake exacerbates digestive symptoms, causing pain and discomfort while concurrently influencing the gut microbiome. Sugar serves as a substrate for microbial activity, affecting the diversity and balance of gut bacteria. At the neurological level, the brain responds to the sugar rush by releasing endorphins, creating a fleeting sense of happiness. This multifaceted impact on the digestive system, brain, and microbiome highlights the intricate relationship between festive indulgences and the comprehensive well-being of our gut health.

4. Chocolate Delights: Amidst the festive spread, the allure of chocolate takes centre stage, captivating taste buds and contributing to the symphony of seasonal delights. While this beloved treat is a source of joy for many, its impact on digestive health can vary. For individuals with conditions like irritable bowel syndrome (IBS), the richness of chocolate may pose challenges, potentially triggering discomfort and digestive distress. On a neurological level, however, the consumption of chocolate triggers the release of endorphins and serotonin, eliciting feelings of pleasure and contentment. The complex interplay between the digestive system and the brain during the indulgence in chocolate adds a nuanced layer to the festive experience, reminding us that even the smallest treat can have both delightful and varied effects on our well-being.

HMBT: A Gift for Gastrointestinal Health: Enter Hydrogen and Methane Breath Testing, a tool, not so much as part of festive activities or gifts, is used for diagnosing conditions like Small Intestinal Bacterial Overgrowth (SIBO) and carbohydrate malabsorption. During the holiday season, HMBT can offer insights into how our bodies respond to the festive feast.

1. Monitoring Carbohydrate Intolerance: HMBT emerges as a valuable ally in identifying carbohydrate intolerance. Individuals experiencing bloating or discomfort after meals can undergo HMBT to pinpoint specific carbohydrates causing distress, enabling them to make informed dietary choices.

2. Unravelling Fats and Gases: The excessive consumption of fatty foods during the festive season can lead to the production of gases in the gut. HMBT, with its ability to detect hydrogen and methane levels, can assist in understanding the impact of fat-rich meals on digestive processes.

3. Personalised Dietary Guidance: Armed with HMBT results, individuals can collaborate with healthcare professionals to create personalised dietary plans. This empowers them to enjoy the festive season without compromising digestive well-being.

Tips for a Digestive-Friendly Festive Season:

1. Moderation is Key:

Enjoy the festive spread but in moderation. Limiting portion sizes can help prevent overwhelming the digestive system.

2. Mindful Eating:

Slow down and savour each bite. Mindful eating not only enhances the dining experience but can also aid digestion.

3. Choose Wisely:

Opt for dishes that align with your dietary needs. If you have identified specific triggers through HMBT, make conscious choices.

4. Stay Hydrated:

Adequate water intake supports digestion. Ensure you stay hydrated, especially if your meal is rich in salt or sugar.

Conclusion:

As we gather around the festive table, let’s not forget the importance of digestive health. By understanding the potential impact of festive foods and incorporating tools like HMBT into our wellness strategies, we can make the festive season both joyful and comfortable.

Note: This article is intended for informational purposes only and should not be considered as medical advice. Individuals with specific dietary concerns or health conditions should consult healthcare professionals for personalised guidance.

Dr Jafar Jafari, Head of Upper GI Physiology Service at Guy’s and St Thomas’, announces new book in the works highlighting the benefits of HMBT

Dr. Jafar Jafari, expert in the field of gastroenterology, is excited to announce the forthcoming release of his groundbreaking book, “The Essential Guide to Hydrogen and Methane Breath Testing.” at one of the largest Gastroenterology congresses in the world, UEG Week 2023.

Gastrointestinal disorders affect millions of individuals globally, impacting their quality of life and often leading to substantial healthcare costs. Dr Jafari’s new book offers “A Modern Approach to Investigating Gastrointestinal Disorders”, shining a light on the transformative potential of Hydrogen Methane Breath testing (HMBT) to aid in the diagnosis and treatment of various gastrointestinal conditions.

In this comprehensive and expertly researched book, Dr. Jafari delves deep into the science behind HMBT, exploring its role in reshaping the way we understand and manage gastrointestinal health. This book will be published in 2024, and will be published in partnership with leading medical device manufacturer, Bedfont® Scientific Ltd.

Jason Smith, Managing Director at Bedfont®, comments, “We are excited to be working with Dr Jafari on the upcoming release of his new book, we believe it will really help healthcare professionals to unlock the potential of HMBT in Gastroenterology.”

Dr. Jafari, explains, “I have the opportunity to share my knowledge and passion for gastrointestinal health with the next generation of healthcare professionals. This book is a culmination of my experiences, insights, and dedication to the field. I hope it serves as a valuable practical resource for those seeking a deeper understanding of hydrogen and methane breath testing, ultimately leading to improved patient care and outcomes.”

While the official book launch is scheduled for 2024, attendees of UEG 2023 will have the opportunity to get a sneak peek at the book’s content and meet the author, Dr. Jafar Jafari. They can also engage in discussions about the book’s content, its implications for the field, and the future of gastroenterology. This year, UEG 2023 takes place on October 14 – 17, at the Bella Center in Copenhagen; Dr. Jafari will be at Bedfont’s stand, C3-70.

Since 1997, April has been designated as IBS Awareness month by IFFGD (International Foundations for Gastrointestinal Disorders) and listed on the National Health Observances calendar¹. This date gives the ability to impact positive outcomes such as providing additional research, increased educational opportunities, and improved patient care for the functional gastrointestinal community¹.

Irritable bowel syndrome (IBS) is a common condition that affects the digestive system, causing symptoms such as stomach cramps, bloating, diarrhoea and constipation. Irritations tend to come and go over time and can last for days, weeks or months at a time². In England and Wales, the number of people consulting for IBS is estimated to be between 1.6 and 3.9 million³. Unfortunately, although it is fairly common, IBS goes relatively undiagnosed and people are unaware that their symptoms indicate a medically recognized disorder¹.

Traditional investigational methods can include invasive blood tests and lengthy waiting times for bloodwork analysis and results. Despite the fact that there is no direct test for IBS, the Gastrolyzer® range by Bedfont® Scientific Ltd. offers a quick and non-invasive breath analysis tool that can help when investigating a patient’s symptoms.

Hydrogen and Methane Breath Testing (HMBT) with the Gastrolyzer® range works by measuring exhaled levels of H2 & CH4 produced when the bacteria in the gut breaks down food. Interpreting these gas levels can help determine and/or rule out gastrointestinal disorders, such as carbohydrate malabsorption and sugar intolerances.

With results promptly displayed onscreen, it reduces the time of your patient’s discomfit, making HMBT an ideal tool for doctors, dietitians, and gastroenterologists.

All the necessary information about how you can help your patients with the Gastrolyzer® range products can be found on our website, https://www.gastrolyzer.com.

References:

1. Ibs awareness month [Internet]. About IBS. 2022 [cited 2023Mar6]. Available from: https://aboutibs.org/living-with-ibs/ibs-awareness-month/

2. NHS choices. NHS; [cited 2023Mar6]. Available from: https://www.nhs.uk/conditions/irritable-bowel-syndrome-ibs/

3. Irritable bowel syndrome [Internet]. NICE. 2015. [Cited 10th March 2023]. Available from: https://www.nice.org.uk/guidance/qs114/documents/irritable-bowel-syndrome-in-adults-qs-briefing-paper2