Mouth to pouch transit after restorative proctocolectomy: hydrogen breath analysis correlates with scintigraphy.
OBJECTIVE
Fast intestinal transit may be responsible for slow adaptation and unacceptable steady-state function after restorative proctocolectomy. Investigation of GI transit time may be valuable in such a setting. We hypothesized that postprandial hydrogen breath tests may yield transit data that correlate with technetium-labeled meal scintigrams.


METHODS
This study compared intestinal transit after a lactulose and bean meal via the breath hydrogen and scintigraphy methods in 21 ileoanal pouch subjects. The meal consisted of baked beans (425 g), 30 ml (20 g) lactulose syrup, 1 mCi 99mtechnetium sulfur colloid in finely chopped liver and 170 ml tap water. The meal contained 120 Kcal (70% carbohydrate, 18% protein and 12% fat).


RESULTS
Of 21 pouch subjects, 11 (53%) had breath tests and scintigraphy transit studies that differed by 5-21 min. Three of 21 (14%) scintigraphy mouth to pouch transit times were faster than breath test transits by 43-107 min. Seven of 21 (33%) subjects did not have breath test peaks >10 ppm. Mouth to pouch transit for breath hydrogen (104+/-16 min) and scintigraphy (98+/-7 min) tests had significant correlation (r = 0.96, p < 0.0001) among subjects with alveolar hydrogen peaks and accurate scintigrams (n = 11). Scintigrams were five times more expensive than breath tests.


CONCLUSIONS
A peaking hydrogen breath test provides an alternative to scintigraphy for estimating intestinal transit after ileoanal pouch.
Ternent
C A
CA
Section of Colon and Rectal Surgery, Creighton University School of Medicine, Omaha, Nebraska, USA.
Thorson
A G
AG
Blatchford
G J
GJ
Christensen
M A
MA
Thompson
J S
JS
Lanspa
S J
SJ
Adrian
T E
TE
D000328:Adult; D001944:Breath Tests; D004435:Eating; D007887:Fabaceae; D005260:Female; D005772:Gastrointestinal Transit; D006801:Humans; D006859:Hydrogen; D007792:Lactulose; D008297:Male; D008875:Middle Aged; D010946:Plants, Medicinal; D011184:Postoperative Period; D016737:Proctocolectomy, Restorative; D011877:Radionuclide Imaging; D012119:Respiration
D007792:Lactulose; D006859:Hydrogen