A Pattern of Breath Hydrogen Excretion Suggesting Small Bowel Bacterial Overgrowth in Burmese Village Children

Abstract

Breath hydrogen tests (BHTs) were performed on 340 Burmese village children aged 1–59 months. Normalization (correction of breath H2 values to a constant mean O2 level) eliminated the variations in H2 levels due to sleep, storage temperature, or duration of storage. After a 10 g lactulose test meal, 145 (42.6%) children produced <10 ppm H2 above basal values (non-H2 producers). Of 195 H2 producers, a pattern of breath hydrogen excretion suggesting small bowel bacterial overgrowth (SBBO)—recognized as a transient peak at the 20, 40, or 60 min breath samples following the lactulose test meal and distinguishable from the later colonic peak— was observed in 53 (27.2%), being significantly more frequent in male children, and exhibiting an age-prevalence pattern similar to that of acute childhood diarrhea in these villages. Diarrhea did not alter the state of H2 production (non-H2 producers remain non-H2 producers, and H2 producers remain H2 producers) although the magnitude of peak breath H2 changed.