[Endoscopic intragastric detection of hydrogen]

Area of Science:

• Gastroenterology
• Microbiology
• Medical Diagnostics

Context:

• Hydrogen (H2) breath-tests are commonly used to diagnose small intestinal bacterial overgrowth (SIBO).
• However, the sensitivity of these breath-tests is limited by various factors, necessitating alternative diagnostic approaches.
• Dyspeptic disorders are often associated with gastrointestinal symptoms, including excess gas production.

Purpose:

• To evaluate the direct measurement of hydrogen gas in stomach aspirates during gastroscopy as a diagnostic tool for SIBO.
• To compare the efficacy of intragastric H2 measurement with the conventional H2 breath-test using glucose.
• To investigate the correlation between intragastric H2 levels and upper gastrointestinal motility.

Summary:

• Hydrogen gas was directly measured in stomach gas samples from 100 out of 109 patients during gastroscopy.
• Intragastric H2 concentrations were significantly higher in patients with dyspeptic disorders compared to those without (p < 0.001).
• The intragastric H2 test was more frequently pathological in dyspepsia than the H2 breath-test (p = 0.01), with no correlation between the two tests in 66 cases.
• High intragastric H2 correlated with prolonged gastric emptying time, suggesting reflux from the small bowel and potential motility disturbances.

Impact:

• Direct intragastric H2 measurement during gastroscopy provides a potentially more sensitive and immediate diagnostic method for SIBO.
• This technique may offer direct evidence of upper gastrointestinal motility disorders, aiding in the diagnosis and management of dyspeptic conditions.
• The findings challenge the sole reliance on H2 breath-tests and highlight a novel approach for evaluating small bowel function.