Multiple Food Intolerances Increase Hydrogen Levels in Breath Tests
- Authors
- Wolfgang J Schnedl, Simon Michaelis, Dietmar Enko, Sandra J Holasek
- Journal
- Clinical Nutrition ESPEN
- Year
- 2025
- DOI
- 10.1016/j.clnesp.2025.11.007
- Study Type
- Human
- Outcome
- Neutral
- Peer Reviewed
- Yes
- Country
- Austria
- Health Condition
- Fructose Malabsorption
- Body System
- Digestive System
TL;DR
Fructose malabsorption patients with additional food intolerances (lactose, histamine) or H. pylori infection show significantly elevated hydrogen levels in breath tests compared to FM-only patients.
Key Finding
Patients with fructose malabsorption who also had additional food intolerances or Helicobacter pylori infection showed significantly elevated exhaled hydrogen levels during breath testing compared to those with fructose malabsorption alone.
Summary
Researchers studied 318 patients with fructose malabsorption (difficulty digesting fructose sugar) who took hydrogen breath tests—a diagnostic tool that measures undigested food in the intestines by detecting hydrogen in exhaled breath. They found that patients who had fructose malabsorption plus other food intolerances (like lactose or histamine intolerance) or a Helicobacter pylori bacterial infection showed significantly higher hydrogen levels in their breath compared to patients with only fructose malabsorption. This suggests that having multiple digestive problems at once can affect the results of these breath tests.
Practical Takeaway
If you're being tested for food malabsorption using a hydrogen breath test, this study suggests that doctors should consider whether you have other concurrent digestive conditions or infections, as these can affect test results and their interpretation. However, this was a retrospective analysis of existing patient data rather than a controlled experiment, so more research would be needed to fully understand how these conditions interact during testing.
Abstract
Background & aims: Food intolerance/malabsorption, including fructose malabsorption (FM), histamine intolerance (HIT), lactose intolerance (LIT), and Helicobacter pylori (H. pylori), may present with symptoms similar to symptoms of the irritable bowel syndrome (IBS) spectrum. We aimed to investigate whether extra food intolerances/malabsorption and H. pylori infection affect the results of hydrogen breath tests in FM patients. Methods: A hydrogen (H2) breath test was conducted for evaluating FM and LIT. A serum diamine oxidase value determination, a search for H. pylori and antibodies to tissue transglutaminase were made. A retrospective analysis of 318 patients with FM identified 50 with FM-only, 50 FM patients with HIT and 50 FM patients with additional LIT, 50 FM and HIT patients also had LIT. Thirty-one FM patients had H. pylori, 26 FM patients had HIT and H. pylori and 40 FM patients had LIT and H. pylori, and 21 had FM, HIT, LIT and H. pylori. Results: With the Kruskal-Wallis test we compared the area under the curve (AUC) and demonstrated that H2 was significantly elevated in FM with LIT and FM and H. pylori patients compared to those with FM-only (p=0.039, respectively). The comparison of the AUCs of FM-only to FM, LIT, and HIT (p=0.006) and to FM, LIT, and HIT with H. pylori revealed a significant elevation (p=0.026) in H2 values. Conclusion: In patients diagnosed with FM, the presence of additional food intolerance/malabsorption and H. pylori infection has been demonstrated to significantly increase expiratory H2 values during fructose H2 breath tests.