Ecce Medical Quintron
Breath-Tests and Digestive Problems
“...improved analytical instrumentation and a greater understanding of its limitation have transformed the H2
breath test from an investigative curiosity to a mainline clinical tool.”
- Noel W. Solomons, M.D., Current Concepts in Gastroenterology, Vol. 8/1: 30-34 and 37-40, 1983
What do Breath-tests have to do with digestive problems?
When some bacteria digest (or ferment) food substances, they produce acids,
water and gases. The major gases which are produced by bacteria include,
primarily, carbon dioxide (CO2), hydrogen (H2), methane (CH4) and small
concentrations of aromatic gases. Carbon dioxide is produced by all cells
during metabolism, but only bacteria can produce H2 and CH4 as metabolic
by-products, and this is accomplished primarily by bacteria which thrive in
the absence of oxygen (called anaerobic bacteria). So, if either H2 or CH4 are
produced biologically, it tells us that some food substance is exposed to bacterial fermentation.
In the digestive tract, bacteria are normally limited to the colon. Most of the bacteria contained in food are
killed by the acidity of the stomach, so the small intestine usually has few bacteria. In some conditions, called
“bacterial overgrowth”, bacteria exist in high concentrations in the small intestine. Their presence in that area
can interfere with the absorption of some vitamins and other essential foodstuffs, so it is important to diagnose
the condition.
The colon is concerned with conserving water and salt by reabsorbing them from the lumenal contents.
However, the colon is involved in other functions, some of which depend on having a high bacterial-count.
Fiber, very popular in breakfast cereals, is not digested in the small
intestine, so it undergoes bacterial fermentation in the colon. Shortchain
fatty acids (SCFA) produced by that process are absorbed in
the colon, and are beneficial to health. It is becoming apparent that
substantial amounts of starch (10-20% of foods like legumes) escape
digestion in the small intestine and are broken down in the colon,
thus, adding to the efficiency of energy production by such foodstuffs.
In addition, colonic bacteria contribute to fecal bulk, and the shortchain
fatty acids mentioned above reduce colonic pH. These
factors may reduce the likelihood of diarrhea, confer some degree
of protection against other severe colon problems, and enhance the
colonic absorption of metal ions like calcium, magnesium and zinc.
Thus, fermentation in the colon
is normal, and it is important.
Gases which are produced
in the colon are reabsorbed
and equilibrated with the
blood leaving that area. They appear in the lung and cross the capillary
membrane into the alveoli, from which they are expired during breathing.
The alveolar air can be collected with QuinTron collection devices and
analyzed on BreathTracker or MicroLyzer instrumentation.
BreathTracker SC
Breath Hydrogen and Methane Analysis With Sample Correction Feature
The ability to analyze H2, CH4 and CO2 provides physicians with necessary information to confidently diagnose carbohydrate malabsorptions and/or small intestinal bacterial overgrowth (SIBO).
The BreathTracker SC analyzes trace-gas concentrations of hydrogen (H2), methane (CH4) and carbon dioxide (CO2) in a patient’s alveolar breath sample using solid-state sensors. The results are measured and displayed in parts per million (ppm) for H2 and CH4 and percent (%) for CO2. The BreathTracker SC also utilizes an added feature for sample contamination detection and correction based on CO2 measured in patient samples.
As with all breath-tests, you may encounter sample contamination from various sources such as: unsupervised or improper collection, patients that are unable to follow directions, variations in ventilation (ie: patients taking a large inspiration in the early samples of a test and more normal breaths later in the test). The ability to detect and correct for these factors helps smooth out the sample inconsistencies resulting in more realistic patterns of gas production.
CO2 is the most reliable “normalizing” component in the sample because it ordinarily has the most consistent alveolar composition of any gas in the sample; the body physiologically regulates the alveolar CO2-pressure (PACO2) around 40mmHg (torr).
Therefore, the CO2 correction factor is based on the concept that CO2 is present in the alveolar (lung) air at a virtually constant concentration while CO2 in room air is virtually zero (in fact it is present, but in extremely trace concentrations). If an alveolar air sample is accidentally contaminated (mixed) with room air, the CO2 concentration in the sample will be reduced, as will other gases in the sample.
Detecting this dilution, and by knowing the degree to which the CO2 is diluted, is indicative of improper sample collection or handling and makes it possible to apply a correction to the analysis of each trace gas, allowing the instrument to estimate the “true alveolar” concentration of these trace gases, unless the sample is completely invalid.
Studies have indicated the importance of measuring H2 and CH4, as approximately 35% of healthy adult subjects are methane producers. These tests were for carbohydrate malabsorption and small intestinal bacterial overgrowth (SIBO). (Reference: Clin Gastroenterolo Hepatol 2006 Feb;4(2):12390)
Since the BreathTracker SC utilizes CO2 as an indicator for sample dilution and contamination detection, physicians have the ability to send patients home to collect their samples unsupervised which allows the physician and technicians to see more patients and analyze the breath samples at a later time.†
BreathTracker DP
Breath Hydrogen and Methane Analysis.
The capability to detect methane increases the ability to accurately diagnose and eliminate potential false negatives.
Studies have demonstrated the importance of hydrogen (H2) and (CH4) methane production, indicating approximately 35% of healthy adult subjects are methane producers when testing for carbohydrate malabsorption and small intestinal bacterial overgrowth (SIBO). (Reference: Clin Gastroenterolo Hepatol 2006 Feb;4(2):12390)
The BreathTracker DP measures both hydrogen and methane in a single sample of alveolar air. Several studies have found that significant volumes of methane and hydrogen are produced when bacteria metabolize sugar in the intestinal tract, and recent literature has focused on the interdependence and interaction of hydrogen and methane production in the colon. The reliability of the test is significantly improved when both H2 and CH4 are measured in the same sample and the temporal appearance of breath CH4 and H2 may indicate the location of the bacterial infection in the small intestine.
The BreathTracker DP separates the components using the basic principle of gas chromatography. Room air is used as the carrier gas, which is pumped through the system where the hydrogen and methane are separated from each other and from all other reducing gases. The hydrogen and methane are then carried sequentially past a solid-state sensor that is affected only by reducing gases.
The signals are then processed and the sample concentrations are shown on the instrument’s display in parts per million (ppm).
BreathTracker H2+
Breath Hydrogen Analysis With Sample Correction Feature
Same great features as the BreathTracker H2 with the added sample correction feature to ensure that patients samples are “true alveolar” samples and corrected within reason if contamination occurs.
Also allows for physicians to send patients home with kits †
The BreathTracker H2+ is a basic hydrogen (H2) trace-gas analyzer with the added feature of carbon dioxide (CO2) detection which is used to help detect and correct for any patient sample contaminations which may result in improper H2 values.
As with all breath-tests, you may encounter sample contamination from various sources such as: unsupervised or improper collection, patients that are unable to follow directions, variations in ventilation (ie: patients taking a large inspiration in the early samples of a test and more normal breaths later in the test). The ability to detect and correct for these factors helps smooth out the sample inconsistencies resulting in more realistic patterns of gas production.
Therefore, the CO2 correction factor is based on the concept that CO2 is present in the alveolar (lung) air at a virtually constant concentration; while CO2 in room air is virtually zero (in fact it is present, but in extremely trace concentrations). If an alveolar air sample is accidentally contaminated (mixed) with room air, the CO2 concentration in the sample will be reduced, as will other gases in the sample.
Detecting this dilution, and by knowing the degree to which the CO2 is diluted, is indicative of improper sample collection or sample handling and makes it possible to apply a correction to the analysis of each trace gas, allowing the instrument to estimate the “true alveolar” concentration of these trace gases, unless the sample is completely invalid.
Since the BreathTracker H2+ utilizes CO2 as a factor for sample dilution and contamination detection, physicians have the ability to send patients home to collect their samples unsupervised which allows the physician and technicians to see more patients and analyze the breath samples on another day.†
BreathTracker H2
Breath Hydrogen Analysis
Hydrogen analysis only; economical solution best suited for facilities that do not require patient sample corrections to true alveolar air, and do not require methane analysis.
When cost is the underlying factor in determining which breath-testing instrumentation to purchase, the BreathTracker H2 is the most economical hydrogen (H2) trace-gas analyzer. The BreathTracker H2 can allow you to begin testing for carbohydrate malabsorptions and small intestinal bacterial overgrowth with minimal investment in instrumentation.
Though limited to hydrogen analysis only, the BreathTracker H2 can be easily upgraded to the BreathTracker DP to include analysis of methane (CH4) and/or the additional carbon dioxide (CO2) sensor for sample contamination detection and correction which can be found on the BreathTracker H2+ and BreathTracker SC instruments, should the need arise for more comprehensive diagnosis results.
The short analytical time of 50 seconds or less and the capability of a quick, accurate calibration provides a specificity and accuracy unequalled by any other hydrogen-only analyzer in any price range.
The highest advantage of the BreathTracker instrumentation over competitor hand-held hydrogen monitors is the use of a solid-state hydrogen sensor which do not require periodic replacement unlike the electrochemical fuel-like sensors found in hand-held hydrogen monitors.
The BreathTracker system utilizes a sample loop and internal pump ensuring every sample is processed in the same fashion as each previous sample, unlike the electrochemical sensors which can be pressure sensitive, meaning the harder or softer the patient blows, the hydrogen values will differ.
The BreathTracker system flushes out any previous patient sample to eliminate any cross-interference and returns the instrument to the same internal baseline, unlike the electrochemical instruments which can leave residual hydrogen on the membrane and do not ensure that each sample is analyzed at the same baseline.
