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Elevated fasting breath hydrogen and abnormal hydrogen breath tests in children with sickle cell disease: a
M B Heyman1, W Lande, E Vichinsky
1Department of Pediatrics, University of California, San Francisco 94143-0136.
Insights
Children with sickle cell disease (Hgb S-S) show elevated hydrogen (H2) in breath tests, indicating intestinal abnormalities. Growth-retarded children with Hgb S-S exhibit distinct H2 increases after lactulose ingestion.
Area of Science:
- Pediatric Gastroenterology
- Hematology
- Microbiome Research
Background:
- Sickle cell disease (Hgb S-S) is associated with various complications, including potential gastrointestinal issues.
- Growth retardation is a recognized complication in some children with Hgb S-S.
- Intestinal dysbiosis and altered gut function may play a role in pediatric disease complications.
Purpose of the Study:
- To investigate intestinal abnormalities in children with sickle cell disease using hydrogen breath tests.
- To explore the relationship between elevated breath hydrogen levels and growth retardation in Hgb S-S patients.
- To assess differences in gastrointestinal hydrogen production between Hgb S-S children with and without growth retardation.
Main Methods:
- Hydrogen breath tests were conducted on eight children with sickle cell disease (Hgb S-S).
- Baseline breath hydrogen levels were measured after an overnight fast.
- Breath hydrogen responses to lactulose ingestion were monitored over 120 minutes.
Main Results:
- Children with Hgb S-S exhibited significantly elevated baseline breath hydrogen levels compared to normal values.
- Growth-retarded Hgb S-S children showed a marked increase in breath hydrogen post-lactulose, unlike normally growing children.
- All Hgb S-S children demonstrated higher breath hydrogen production across measured intervals compared to controls.
Conclusions:
- Children with sickle cell disease possess intestinal abnormalities leading to increased fasting hydrogen production.
- Early post-lactulose breath hydrogen elevation in Hgb S-S patients is linked to growth retardation.
- Disordered gastrointestinal motility and/or intestinal flora anomalies may contribute to growth failure in Hgb S-S.
Abstract:
Hydrogen breath tests were performed in eight children with sickle cell disease (Hgb S-S), four of whom were growth retarded. Average base-line breath H2 values after an overnight fast were elevated (22.4 +/- 10.8 ppm; normal = 7.1 +/- 5.0). Breath H2 concentrations increased significantly above base line within 30-40 min after lactulose ingestion in the four growth-retarded children whereas a negligible rise was observed in the four with normal growth indices. Breath H2 production for each time interval in the first 120 min was greater in all Hgb S-S then in normal children (p less than 0.01 for each time interval measured before 60 min). The results indicate that children with sickle cell disease have intestinal abnormalities favoring excess production of H2 in the fasted state combined with early elevations in postlactulose breath H2 in those with growth retardation. The possible role of disordered gastrointestinal motility and/or anomalously distributed intestinal flora in growth retardation of children with Hgb S-S requires further investigation.