<<Disclaimer: Verify this information before applying it to your situation.>>

Do-It-Yourself Sorbitol H2 Testing
Roy S. Jamron

If you are seated in front of a computer screen reading this text, then you
very likely have the skills needed to test yourself for celiac disease.
The sorbitol H2 breath screening test for celiac disease is a very simple
test.  It just takes 5 oz. of sugar water, a watch or timer, paper and
pencil, 9 breath measurements, and 4 hours of time.  And the breath H2
(hydrogen) analyzers needed to take the breath measurements are actually
low enough in cost for many of you to consider buying your own and
performing your own convenient tests at home.

Many of us are "self-diagnosed" celiacs.  Our symptoms improved after going
on a gluten-free diet without ever getting a biopsy or a serological test.
The sorbitol H2 breath test makes "self-diagnosing" really and truly
possible.  There are many undiagnosed "silent"-type celiacs who experience
little or no symptoms.  They wouldn't even think of being tested for celiac
disease unless family members or close relatives have been diagnosed with
it.  If "silent" celiacs choose to go on a gluten-free diet, they would
have no symptoms to verify the diet was doing them any good.  By following
up a gluten-free diet with periodic sorbitol H2 breath testing, "silent"
celiacs would have at their fingertips a tool to let them know if the diet
was improving their condition.

Periodic home sorbitol H2 breath testing allows you to track your
improvement on a gluten-free diet.  The test is also sensitive enough to
let you know if you are inadvertantly consuming foods containing gluten.
If you are concerned your celiac children might not be sticking to their
diet, the test can be used to check up on them.  And for those who went on
a gluten-free diet without being tested who now wish they had been tested,
the sorbitol H2 breath test can show results of a gluten challenge much
quicker than a serological test because increased sorbitol H2 levels show
up much sooner than do the tTG and gliadin antibodies needed for
serological testing.  By taking a baseline test just before reintroducing
gluten and comparing test results to followup tests after beginning the
gluten challenge, you will know just when sorbitol H2 levels start to
increase and you no longer need to consume gluten.  Then you can follow the
drop in H2 levels with further testing after resuming a gluten-free diet,
positively confirming celiac disease.

Most experts on celiac disease recommend that positive screening tests be
followed up with a biopsy.  But if you screen test positive, go on a gluten-
free diet, and show declining H2 levels over time with periodic sorbitol H2
breath testing, then why is a biopsy even necessary?  Unlike serological
tests, sorbitol H2 breath test results correlate well with intestinal
healing over time.  It would seem that improvement on a gluten-free diet
verified by periodic sorbitol H2 breath testing is a totally adequate
confirmation of celiac disease.

The sorbitol H2 breath test is a simple test, but it does require the use
and availability of a breath H2 analyzer to take measurements.  The test
and typical results over a followup period of 18 months are described in
the two excerpts below.  The test procedure is as follows:  Patients fast
overnight before the test after a meal of meat and rice.  Presumably the
idea is to not consume any foods or beverages containing sugars the night
before which might influence the test results.  Vegetarians, it seems, have
to make do with rice alone.  In the morning, the patient is to drink a
solution of 5 grams of sorbitol mixed in 150 ml of tap water (about 5 oz.)
Just before drinking the solution, a baseline breath sample is taken.
After drinking the solution, breath samples are taken every 30 minutes over
a period of 4 hours.  8 samples plus the baseline sample make a total of 9
samples. The hydrogen concentration of each sample is measured with a
breath H2 analyzer.  An increase in H2 concentration of at least 20 ppm
over the fasting baseline is considered positive for sorbitol
malabsorption.  Dated copies of all test results should be kept for
comparison to future followup tests.

Three companies currently manufacture breath H2 analyzers consisting of a
line of benchtop analyzers and two hand held analyzers.  All of these
products are easy to use and suitably accurate to perform the sorbitol
test.  QuinTron MicroLyzers are all benchtop models and are considered the
laboratory standard.  The QuinTron CM2 MicroLyzer is the lowest priced
model at $4,019.00 plus calibration gas, accessories and supplies which
could easily bring the total up to nearly $5,000.  Micro Medical makes the
Micro H2 analyzer, a hand held portable device.  A complete Micro H2 kit
with software and calibration gas costs $2,195.  The Bedfont EC60
Gastrolyzer2 Breath Hydrogen Monitor is another hand held portable device.
The basic Gastrolyzer2 kit costs $1,675.00, and adding a calibration gas
kit, software and supplies could bring the total up to over $2,000.  Breath
samples can be taken via a variety of methods.  Samples can be collected in
plastic bags to be analyzed at a later time.  The hand held analyzers offer
the option and convenience of measuring samples blown directly into the
device through disposable cardboard tubes or plastic face masks (suitable
for young children.)  All of these products require periodic calibration to
maintain accuracy, so cylinders of calibration gas must be kept on hand and
be re-purchased when they run out.  The hydrogen sensor, a plug-in solid
state or electrochemical device which is the "heart" of the analyzer, has a
finite lifespan and needs to be replaced every 2 or 3 years at a cost of
several hundred dollars.  Internet links describing each of these products
are listed below.

Breath H2 analyzers are useful for more than just the sorbitol H2 breath
test and can be used to test for a variety of of gastrointestinal problems
using different test protocols and sugar solutions.  These conditions
include lactose and fructose intolerance and bacterial overgrowth.  Consult
PubMed and the internet for more information on these tests.  Here is a
summary of the protocols:

http://www.breathh2.com/protocols.asp

Fasting and avoidance of sugars is required for all of these tests.  The
software provided with the hand held analyzers will guide the operator
through the tests, but, if you can read the documentation, you really don't
need to use the software.  You just need a pencil, paper, and a timer.

Can you afford over $2,000 for a do-it-yourself celiac disease screening
test?  For one, you don't need to spend $2,000 all by yourself.  Members of
local celiac disease special interest groups can pool their resources
together to collectively buy and share a breath H2 analyzer making the idea
of home celiac disease testing very affordable.  Relatives and friends who
suspect celiac disease can also share the cost together.  People concerned
about the possibility of celiac disease in other family members and close
relatives can find do-it-yourself testing very cost effective when spread
over a large number of relatives and family.  Having a breath H2 analyzer
handy makes following up on the progress of intestinal healing very
convenient and practical.  Additionally, you can easily test for lactose
and fructose intolerance, bacterial overgrowth and other conditions, all at
your own convenience.  Feeling charitable?  You can even consider donating
a breath H2 analyzer to your local non-profit community clinic or hospital
making celiac disease screening and other gastroenterological testing
available in any small community.

----------
Continued in Part 2 of 2

*Support summarization of posts, reply to the SENDER not the CELIAC List*