Fasting breath hydrogen concentration in short bowel syndrome patients with colon incontinuity before and after antibiotic therapy

Objective Nutrition success in short bowel syndrome (SBS) depends on the intake nutrients and the intestinal absorption capacity. An evaluation of energy expenditure and oxidation of substrate can be obtained with indirect calorimetry by measuring O2 and CO2 in the respiration. Elevated colonic fermentation can occur in SBS, producing H2 and CO2, which can also be eliminated through respiration and as a consequenc affect the results from indirect calorimetry. The objective of this study was to determine the fasting breath H2 concentration and alterations before and after antibiotic therapy in patients with severe SBS with colon in continuity. Methods The study was conducted in two phases. In phase 1, the fasting breath H2 concentrations were measured in 10 patients with severe SBS with colon incontinuity and a control group of 10 healthy volunteers. In phase 2, the fasting breath H2 concentrations were re-evaluated after treatment for 7 d with antibiotics in six patients with high rates of H2. The analyses were performed with a gas chromatograph (microanalyzer DP; Quintron Instruments, Milwaukee, WI, USA), with results of breath hydrogen and methane concentration expressed in parts per million (ppm). Results In phase 1, the levels of fasting breath H2 were higher in the patients with severe SBS with colon incontinuity than in the healthy controls (32.00 ± 17.77 versus 5.30 ± 3.31 ppm; P < 0.001), with 7 of 10 patients presenting levels of H2 above the normal rate (12 ppm). The presence of an ileocecal valve did not modify the results significantly. In phase 2, all six patients treated with antibiotics presented normalization in the levels of fasting breath H2 (from 43.50 ± 6.90 ppm to 1.33 ± 1.03 ppm; P < 0.001) and concomitant improvement in the gastrointestinal symptoms. Conclusions In relation to the healthy controls, patients with SBS with colon incontinuity presented higher levels of fasting breath H2. Antibiotic therapy normalized the levels of fasting breath H2 and improved the gastrointestinal symptoms. We suggest that the breath H2 test may be performed routinely in patients with SBS to diagnose elevated intestinal fermentation, prevent errors in the interpretation of the indirect calorimetry, and treat eventual associated gastrointestinal symptoms.