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Breath hydrogen after oral xylose in tropical malabsorption.

Thirty hospital in-patients (12 of whom were suspected on clinical grounds of having tropical mahabsorption (TM), and 18 who either had trivial symptoms or were undergoing a routine examination after tropical exposure) had breath hydrogen determinations at 10 mm intervals for 5 hr, and 5-hr urinary and 90-mm blood xylose measurements, after 25 g oral xylose. In seven patients (five of whom had evidence of TM), a significant increase in breath hydrogen above the fasting concentration (T) was observed during the 1st hour (group 1); they all excreted 5 g xylose. The remaining 15 patients did not show a significant increase in hydrogen compared with the fasting concentration (group 3); xylose excretion was >5 g. Correlation between T and urinary xylose excretion in groups 1 and 2 was significant (P < 0.001). Twenty-five patients also had breath hydrogen estimations at lO-min intervals after 33.5 g oral lactulose, and mean T was similar in those in groups 1 to 3; a previous study has demonstrated a significant slowing of transit in TM. A rise in hydrogen production during the 1st hour after xylose is presumably, therefore, a reflection of small intestinal bacterial activity, and is not the result of rapid transit. Bacterial metabolism of xylose seems to be much less in TM than in the blind-loop syndrome, and does not invalidate the test in TM. If hydrogen production rises during the 1st hour after 25 g xylose, total 5 hr urinary xylose excretion is <5 g; that is likely to constitute a valuable noninvasive test in the evaluation of TM. Am. J. Clin. Nutr. 33: 555-560, 1980.