Related Experiment Videos
Carbohydrate malabsorption in infants with diarrhea studied with the breath hydrogen test
Insights
Breath hydrogen (H2) levels in infants with diarrhea indicate carbohydrate malabsorption. Lower H2 levels correlated with longer hospital stays, while formula changes and feeding methods impacted fermentation, suggesting a balance between intestinal absorption and colonic fermentation.
Area of Science:
- Pediatric Gastroenterology
- Microbiology
- Nutritional Science
Background:
- Infants with diarrhea often experience malabsorption of carbohydrates (CHO).
- The extent of colonic fermentation of malabsorbed CHO can be assessed by measuring breath hydrogen (H2) production.
- Understanding this process is crucial for managing infant diarrhea and optimizing nutritional support.
Purpose of the Study:
- To investigate the relationship between breath hydrogen production and clinical outcomes in hospitalized infants with diarrhea.
- To explore how changes in formula composition and feeding methods affect carbohydrate fermentation in the colon.
- To determine the indicators of complete carbohydrate metabolism versus malabsorption in the infant gut.
Main Methods:
- Studied 28 hospitalized infants with diarrhea who produced hydrogen.
- Measured peak breath hydrogen (H2) levels between feedings.
- Monitored breath H2 values, stool glucose, and stool pH in response to changes in formula (glucose vs. glucose polymers) and feeding methods (bolus vs. continuous nasogastric drip).
Main Results:
- Lower admission breath H2 levels were associated with shorter hospitalizations (<6 days).
- Patients hospitalized longer (>5 days) showed decreased H2 levels at discharge compared to admission.
- Substituting glucose for glucose polymers and using continuous nasogastric feeding reduced peak breath H2 values.
- Glucose-positive or acidic stools were occasionally observed and linked to decreased H2 levels.
Conclusions:
- Breath H2 levels and stool characteristics reflect the balance between intestinal absorption and colonic fermentation of carbohydrates.
- High breath H2 levels in the absence of fecal glucose or acidic stools indicate effective colonic utilization of malabsorbed CHO.
- The presence of fecal glucose or acidic stools suggests an incomplete absorption or fermentation of carbohydrates by the infant's colon.
Abstract:
Fermentation of malabsorbed carbohydrate (CHO) reaching the colon was studied by measuring peak breath hydrogen (H2) production between feedings in 28 H2-producing hospitalized infants with diarrhea. Patients who required fewer than six days of hospitalization had lower breath H2 values when tested soon after admission than those who required longer stays. Patients hospitalized for more than five days had lower H2 amounts at discharge than on admission. Peak breath H2 values decreased when glucose was substituted for glucose polymers in formulas, or when the formula was fed by continuous drip via a nasogastric tube instead of by orally administered bolus. Glucose-positive and acidic stools were encountered occasionally and were associated with decreased H2 levels. The responses of H2 levels, stool pH, and glucose excretion after changes in patient management or intestinal metabolism of CHO reflect alterations in the balance between proximal intestinal absorption and distal colonic fermentation. Malabsorbed CHO that reaches a competent colon is utilized via microbial conversion, as indicated by high H2 levels, in the absence of glucose-positive and acidic stools. The presence of glucose in the feces or acidic stools indicates an inability of the colon to completely metabolize and absorb CHO or its products of fermentation.