Fasting breath hydrogen in celiac disease

Area of Science:

• Gastroenterology
• Clinical Diagnostics
• Microbiology

Background:

• Elevated breath hydrogen (H2) levels have been observed in various gastrointestinal disorders.
• The clinical significance of high basal H2 levels, particularly in celiac disease, requires further elucidation.

Purpose of the Study:

• To investigate the clinical significance of elevated basal breath hydrogen (H2) levels in patients with untreated celiac disease.
• To compare H2 levels across different gastrointestinal conditions, including functional bowel disorders, small bowel bacterial overgrowth, and celiac disease.
• To assess the relationship between H2 levels, gluten-free diet adherence, and intestinal healing in celiac disease.

Main Methods:

• Breath H2 analysis was performed on fasting subjects from various groups: healthy volunteers, functional bowel disorder patients, small bowel bacterial overgrowth patients, untreated celiac disease patients, treated celiac disease patients, and disease controls.
• Fasting H2 levels were measured and compared between groups.
• In a subset of celiac patients, H2 levels were monitored before and after a gluten-free diet.

Main Results:

• Patients with untreated celiac disease exhibited significantly higher fasting H2 levels compared to healthy volunteers, functional bowel disorder patients, treated celiac patients, and disease controls.
• Elevated fasting H2 levels were also noted in patients with small bowel bacterial overgrowth, with no significant difference compared to untreated celiac disease.
• The prevalence of elevated fasting H2 levels was highest in untreated celiac disease (58.8%) and bacterial overgrowth (43.7%).
• In celiac patients on a gluten-free diet, H2 levels decreased, normalizing only with evidence of intestinal healing.

Conclusions:

• High fasting breath hydrogen levels are a frequent characteristic of untreated celiac disease.
• The normalization of fasting H2 levels following a gluten-free diet serves as a predictive marker for villous regrowth and intestinal healing in celiac disease.