Substrate | Gas Reading | Diagnostic Criteria for Malabsorption | Proportion of Malabsorption | Reference |
---|---|---|---|---|
Fructose breath tests | ||||
Fructose (A. 15 g fructose in 150 cc water; B. 25 g fructose in 250 cc water; C. 50 g fructose in 500 cc water; D. 50 g fructose in 125 cc water) | Hydrogen and methane | Rise of ≥ 20 ppm over baseline hydrogen, methane, or both; or successive rise of ≥ 5 ppm over baseline in 3 consecutive readings. Test duration of 4–6 h | 0% (A), 10% (B), 80% (C), and 60% (D) in healthy patients (n = 20 each) | Rao et al., 2007 [20] |
Fructose (50 g fructose) | Hydrogen and methane | Hydrogen levels ≥ 20 ppm; methane levels ≥ 12 ppm; or sum of combined peaks ≥ 15 ppm. Test duration of 2–4 h | 55% in IBS patients (n = 94), and 65% in IBS patients on fructose-reduced diet (n = 88) | Berg et al., 2013 [21] |
Fructose (25 g fructose in 200 cc water) | Hydrogen | Rise of ≥ 20 ppm over baseline hydrogen. Test duration of 2 h | 16% in lactose intolerant patients (n = 279) | Schnedl et al., 2020 [22] |
Fructose (1 g/kg fructose up to maximum of 25 g) | Hydrogen and methane | Rise of ≥ 20 ppm over baseline hydrogen. Test duration of 2.5 h | 55% in patients with abdominal symptoms (n = 222) | Escobar et al., 2014 [23] |
Fructose (35 g in 300 cc water) | Hydrogen and methane | Rise of ≥ 20 ppm over baseline hydrogen; or ≥ 10 ppm over baseline methane twice in succession. Test duration of 5 h | 45% in functional gastrointestinal disease patients (n = 1372) | Wilder-Smith et al., 2013 [24] |
Fructose (1 g/kg fructose up to maximum of 25 g) | Hydrogen | Rise of ≥ 20 ppm over baseline hydrogen. Test duration of 3 h | 35% in pediatric patients with gastrointestinal symptoms (n = 323) | Kwiecień et al., 2021 [25] |
Fructose (35 g fructose in 300 cc water) | Hydrogen and methane | Rise of ≥ 20 ppm over baseline hydrogen; or ≥ 10 ppm over baseline methane. Test duration of 5 h | 27% in functional gastrointestinal disease patients (n = 30) | Wilder-Smith et al., 2021 [26] |
Fructose (A. 50 g fructose, B. 25 g fructose) | Hydrogen | Rise of ≥ 20 ppm over baseline hydrogen. Test duration of 2 h | 58% (A) and 19% (B) in healthy patients (n = 21) | Truswell et al., 1988 [27] |
Fructose (1 g/kg fructose up to maximum of 25 g) | Hydrogen | Rise of ≥ 20 ppm over baseline hydrogen. Test duration of 2 h | 30% in pediatric patients with chronic abdominal pain (n = 118) | Posovszky et al., 2019 [28] |
Fructose (1 g/kg fructose up to maximum of 25 g) | Hydrogen and methane | Rise of ≥ 20 ppm over baseline hydrogen; rise of ≥ 5 to ≥ 12 ppm methane; or ≥ 10 to ≥ 15 ppm for hydrogen-plus-methane. Test duration of 3 h | 50% in pediatric patient with abdominal symptoms (n = 54) | Hammer et al., 2021 [29] |
Fructose (1 g/kg fructose up to maximum of 25 g) | Hydrogen and methane | Rise of ≥ 20 ppm over baseline hydrogen; or ≥ 10 ppm over baseline methane. Test duration of 3 h | 60% (by hydrogen), 35% (by methane) in pediatric patients with abdominal symptoms (n = 187) | Schneider et al., 2020 [30] |
Fructose (40 g fructose in 330 cc water) | Hydrogen | Rise of ≥ 20 ppm over baseline hydrogen. Test duration of 3 h | 65% in healthy patients (n = 20), 70% in IBS patients (n = 30) | Skoog et al., 2008 [31] |
Fructose (1 g/kg fructose up to maximum of 50 g) | Hydrogen | Rise of ≥ 20 ppm over baseline hydrogen. Test duration of 3 h (symptoms monitored for 24 h) | 68% in patients with abdominal pain (n = 31) | Ozaki et al., 2018 [32] |
Fructose (A. 50 g fructose in 150 cc water, B. 50 g fructose in 250 cc water, C. 25 g in 250 cc water) | Hydrogen and methane | Rise of ≥ 3 ppm over 3 consecutive breath samples from baseline; or ≥ 20 ppm over baseline hydrogen and/or methane. Test duration of | 74% (A, n = 203), 70% (B, n = 33), 39% (C, n = 36) in patients with abdominal symptoms | Choi et al., 2003 [33] |
Fructose (1 g/kg fructose up to maximum of 50 g) | Hydrogen and methane | Rise of ≥ 20 ppm over baseline hydrogen and/or methane. Test duration of 5 h | 59% in healthy pediatic patients (n = 34), 41% in pediatric patients with functional abdominal pain (n = 71) | Martínez-Azcona et al., 2019 [34] |
Fructose (25 g fructose in 250 cc water) | Hydrogen | Rise of ≥ 20 ppm over baseline hydrogen. Test duration of 2 h | 14% in healthy Thai patients (n = 77) | Densupsoontorn et al., 2007 [35] |
Fructose (2 g/kg fructose up to maximum of 50 g) | Hydrogen | Rise of ≥ 20 ppm over baseline hydrogen. Test duration not reported | 62% in pediatric patients with recurrent abdominal pain (n = 121) | Gijsbers et al., 2012 [36] |
Fructose (25 g fructose in 250 cc water) | Hydrogen and methane | Hydrogen and/or methane levels ≥ 20 ppm. Test duration of 5 h | 35% in IBS patients (n = 90) | Melchior et al., 2014 [37] |
Fructose (A. 1 g fructose, B. 15 g fructose, C. 45 g fructose in 240 cc water) | Hydrogen | Rise of ≥ 20 ppm over baseline hydrogen. Test duration of 3 h | 0% (A, n = 9), 3% (B, n = 10), 62% (C, n = 13) in pediatric patients with abdominal pain | Gomara et al., 2008 [38] |
Fructose (50 g fructose in 250 cc water) | Hydrogen | Rise of ≥ 20 ppm over baseline hydrogen. Test duration of 3 h | 75% in obese African American patients (n = 16), 43% in obese Hispanic patients (n = 21) | Walker et al., 2012 [39] |
Fructose (25 g fructose in 200 cc water) | Hydrogen | Rise of ≥ 20 ppm over baseline hydrogen. Test duration of 2 h | 24% in patients with abdominal symptoms (n = 341) | Enko et al., 2016 [40] |
Fructan breath tests | ||||
Fructan (10 g inulin dissolved in 100 cc water) | Hydrogen | Rise of ≥ 20 ppm over baseline hydrogen. Test duration of 3 h | 19% in IBS patients (n = 21), 5% in healthy patients | Gutierrez et al., 2016 [41] |
Fructan (10 g fructan dissolved in 100 cc water) | Hydrogen and methane | Rise of ≥ 20 ppm over baseline hydrogen; or ≥ 15 ppm over baseline methane. Test duration of 3 h | 64% in IBS patients (n = 102) | Leelasinjaroen et al., 2017 [42] |
Fructan (10 g fructan dissolved in 100 cc water) | Hydrogen and methane | Rise of ≥ 20 ppm over baseline hydrogen; or ≥ 15 ppm over baseline methane. Test duration of 3 h | 58.3% in IBS patients (n = 24) | Yu et al., 2014 [43] |
Fructan (10 g fructan dissolved in 100 cc water) | Hydrogen and methane | Rise of ≥ 20 ppm over baseline hydrogen; or ≥ 15 ppm over baseline methane. Test duration of 3 h | 77% in female IBS patients | Attaluri et al., 2009 [44] |