<<Disclaimer: Verify this information before applying it to your situation.>> Why isn't the sorbitol H2-breath test being used more frequently to diagnose and monitor celiac disease and GF dietary compliance? The test has been around for years. Serological tests and biopsies have received the predominance of attention and discussion in celiac disease research papers, but yet the sorbitol H2-breath test has been shown to have greater value in detecting early stage and "silent"-type celiac disease. Additionally, the test has the ability to assess the extent of intestinal recovery and to detect patients non-compliant with their GF diets. It seems that the test is mostly being used in Italy. Doctors in the U.S. and worldwide should become more aware of and be routinely using this test. Below are abstracts describing and discussing the sorbitol H2-breath test: ---------- Minerva Pediatr. 1994 Dec;46(12):569-74. [Hydrogen breath test in celiac disease: relationship to histological changes in jejunal mucosa] [Article in Italian] Ansaldi-Balocco N, Malorgio E, Faussone D, Dell'Olio D, Morra I, Forni M, Oderda G. Istituto Discipline Pediatriche, Universita degli Studi, Torino. Hydrogen concentration in expired breath depends on the fraction of ingested carbohydrates unabsorbed by the small intestinal mucosa which reach the large intestine and are fermented by the colonic flora. The aim of this study is to assess whether in coeliac children breath hydrogen excretion reflects the histological changes in the jejunal mucosa. Hydrogen breath test was performed on 40 children (15 males 25 females) divided into three groups. Group I (controls): 9 children with symptoms suggestive of coeliac disease who, after the appropriate workup, were found to suffer from other gastrointestinal disorders and had abnormal jejunal mucosa. Group II: 14 children who had been diagnosed as coeliacs according to the ESPGAN criteria, were kept on a gluten free diet for a minimum of 6 months and had a normal jejunal mucosa. Group III: 17 coeliac children who ate small quantities of gluten or were on a normal diet. At histology, 10 of them showed a total and 7 a partial atrophy of the jejunal mucosa. Breath hydrogen levels were measured both at baseline and after ingestion of a 2% sorbitol solution in water, at 30 minute intervals for four hours. The peak hydrogen level and the total surface area under the hydrogen excretion curve were also assessed. Coeliac children on a gluten containing diet excrete significantly more H2 than controls or coeliacs on a gluten free diet. Patients with more severe histological lesions had higher peak H2 levels and greater total excretion areas. In coeliac children, sorbitol breath H2 test represents a simple noninvasive technique to detect impaired jejunal function and it should have an important role as a screening test and in assessing dietary compliance. PMID: 7731420 [PubMed - indexed for MEDLINE] ---------- Scand J Gastroenterol. 2001 Nov;36(11):1170-2. Sorbitol H2-breath test versus anti-endomysium antibodies for the diagnosis of subclinical/silent coeliac disease. Tursi A, Brandimarte G, Giorgetti GM. Division of Emergency, L. Bonomo Hospital, Andria (BA), Italy. [log in to unmask] BACKGROUND: Recent studies have shown that the prevalence of anti- endomysial antibodies (EMAs) in clinical practice is lower than expected; the aim of our study was therefore to compare the sorbitol H2-breath test (BT) with EMAs in the diagnosis of subclinical/silent coeliac disease and to compare with histologic lesions. METHODS: We studied 123 consecutive patients with subclinical (96) and silent (27) coeliac disease. Expiratory samples were collected before the patients drank the test solution (5 g of sorbitol in 150 ml of tap water) and every 30 min for 4 h. An increase in H2 concentration of at least 20 ppm over fasting baseline was considered positive for sorbitol malabsorption. EMAs were screened by the indirect immunofluorescence method. RESULTS: EMAs were positive in 77/96 (80.80%) and sorbitol H2-BT in 94/96 (97.91%) patients with subclinical coeliac disease, while EMAs were positive in 17/27 (62.96%) and sorbitol H2-BT in 26/27 (96.29%) patients with silent coeliac disease (P < 0.001 in both forms of coeliac disease). The best cut-off values in ppm and minutes are higher and shorter in the severe form than in the minor form of intestinal damage, respectively (P < 0.001 in both forms). CONCLUSIONS: This study indicates that almost all subclinical/silent coeliac patients show abnormal sorbitol H2-BT and that there is a strict correlation between cut-off value (in ppm and minutes) and histologic lesions. In particular, the maximal cut- off value (in ppm and in minutes) correlates statistically with the more severe the grade of intestinal damage. Finally, the prevalence of EMA in subclinical/silent disease is lower than expected. PMID: 11686216 [PubMed - indexed for MEDLINE] ---------- Scand J Gastroenterol. 2003 Jul;38(7):727-31. Dig Liver Dis. 2002 Dec;34(12):846-50. Sorbitol H2-breath test versus anti-endomysium antibodies to assess histological recovery after gluten-free diet in coeliac disease. Tursi A, Brandimarte G, Giorgetti GM. Emergency Department "L. Bonomo" Hospital, Andria, BA, Italy. [log in to unmask] BACKGROUND: Gluten-free diet plays a key role in treatment of coeliac disease, but it is difficult to evaluate its effect on improvement of villous architecture using sensitive non-invasive tests. AIMS: To compare sorbitol H2-Breath Test with antiendomysial antibodies in the follow-up of coeliac disease to detect histological recovery METHODS: A total of 38 consecutive patients with coeliac disease were studied. All underwent Sorbitol H2-Breath Test, antiendomysial and oesophagogastroduodenoscopy with multiple bioptic samples before diet and then 6, 12 and 18 months after gluten-free diet. Expiratory samples were collected before patients drank the test solution (5 g sorbitol in 150 ml tap water) and thereafter every 30 min for 4 hours. An increase in H2 concentration of > or = 20 ppm above fasting baseline was considered positive for sorbitol malabsorption. Antiendomysial antibodies were evaluated by the indirect immunofluorescent method. RESULTS: Antiendomysial antibodies were positive in 32/38 patients before gluten-free diet (84.21%), while they were positive in 20/34 (54.82%), 2/16 (12.5%) and 0/2 (0%) cases after 6, 12 and 18 months of gluten-free diet, respectively, no correlation being found with improvement of histological lesions (p = ns). As far as concerns sorbitol H2-Breath Test, maximal cut-off value (in ppm) decreased progressively and parallel to histological recovery during follow-up. Indeed, it decreased from a mean 63 ppm before diet to 35, 19 and 12 ppm, after 6, 12 and 18 months of gluten-free diet, with a stetistical difference being found before and after (p < 0.001). Likewise, the peak value (in minutes) appeared progressively later during follow-up, parallel to histological recovery. In fact, it appeared at a mean of 119 minutes before gluten-free diet, while it appears at a mean of 164, 195 and 219 minutes after 6, 12 and 18 months on gluten-free diet. A statistical difference before and after start of gluten-free diet was found also in this case (p < 0.001). CONCLUSIONS: Sorbitol H2-Breath Test is better than antiendomysial antibodies in revealing histological recovery in the follow-up of coeliac patients after the start of gluten-free diet due to its good correlation with histological damage. Moreover, it also appears to be able to detect dietary mistakes of the patients on gluten-free diet. PMID: 12643292 [PubMed - indexed for MEDLINE] ---------- Continued in Part 2 of 2 *Support summarization of posts, reply to the SENDER not the Celiac List*