Cited by 189Gastrointestinal motility and disordersDigestive system and related healthGut microbiota and health

European guideline on indications, performance, and clinical impact of hydrogen and methane breath tests in adult and pediatric patients: European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Neurogastroenterology and Motility, and European Society for Paediatric Gastroenterology Hepatology and Nutrition consensus

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Hammer, Heinz F., Fox, Mark R., Keller, Jutta, Salvatore, Silvia, Basilisco, Guido, Hammer, Johann, Lopetuso, Loris, Benninga, Marc +9 more·2022·United European Gastroenterology Journal

Abstract

Introduction: Measurement of breath hydrogen (H 2) and methane (CH 4) excretion after ingestion of test‐carbohydrates is used for different diagnostic purposes. There is a lack of standardization among centers performing these tests and this, together with recent technical developments and evidence from clinical studies, highlight the need for a European guideline. Methods: This consensus‐based clinical practice guideline defines the clinical indications, performance, and interpretation of H 2‐CH 4‐breath tests in adult and pediatric patients. A balance between scientific evidence and clinical experience was achieved by a Delphi consensus that involved 44 experts from 18 European countries. Eighty eight statements and recommendations were drafted based on a review of the literature. Consensus (≥80% agreement) was reached for 82. Quality of evidence was evaluated using validated criteria. Results: The guideline incorporates new insights into the role of symptom assessment to diagnose carbohydrate (e.g., lactose) intolerances and recommends that breath tests for carbohydrate malabsorption require additional validated concurrent symptom evaluation to establish carbohydrate intolerance. Regarding the use of breath tests for the evaluation of oro‐cecal transit time and suspected small bowel bacterial overgrowth, this guideline highlights confounding factors associated with the interpretation of H 2‐CH 4‐breath tests in these indications and recommends approaches to mitigate these issues. Conclusion: This clinical practice guideline should facilitate pan‐European harmonization of diagnostic approaches to symptoms and disorders, which are very common in specialist and primary care gastroenterology practice, both in adult and pediatric patients. In addition, it identifies areas of future research needs to clarify diagnostic and therapeutic approaches.

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  1. [13]Hammer HF, Hammer J, Fox M. Mistakes in the management of carbohydrate intolerance and how to avoid them. UEG Education. 2019; 19: 9– 14.
  2. [58]Hammer HF, Sheikh MS. Colonic gas excretion in induced carbohydrate malabsorption–effect of simethicone. Eur J Gastroenterol Hepatol. 1992; 4: 141– 5.

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Authors
Hammer, H. F., Fox, M. R., Keller, J., Salvatore, S., Basilisco, G., Hammer, J., Lopetuso, L., Benninga, M., Borrelli, O., Dumitrascu, D., Hauser, B., Herszenyi, L., Nakov, R., Pohl, D., Thapar, N., Sonyi, M., & European H‐CH‐breath test group
Affiliations
  • University of Graz (AT)
  • University Hospital Zurich (CH)
  • Universität Hamburg (DE)
  • University of Insubria (IT)
  • Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
  • Medical University of Vienna (AT)
  • Agostino Gemelli University Polyclinic (IT)
  • Emma Kinderziekenhuis (NL)
  • Great Ormond Street Hospital (GB)
  • Department of Gastroenterology Clinica Medicala 2 Cluj‐Napoca Romania
  • Universitair Ziekenhuis Brussel (BE)
  • Department of Gastroenterology Medical Centre Hungarian Defence Forces Budapest Hungary
  • Queen Giovanna Hospital (BG)
Corresponding author
Hammer, Heinz F.
Venue
United European Gastroenterology Journal
Publisher
Wiley
Published
2021-08-25
Volume
10
Issue
1
Pages
15-40
ISSN
  • 2050-6406 (ISSN-L)
  • 2050-6414
OpenAlex
W3195731966
Cited by
189
References
233
Citations by year
2026: 34 · 2025: 43 · 2024: 56 · 2023: 26 · 2022: 24 · 2021: 6
FWCI
25.60
Type
journal article
Language
en
Open access
Locations
  • United European Gastroenterology Journal (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion, other-oa)
  • Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, cc-by-nc-nd)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • IrInSubria (University of Insubria) (submittedVersion, other-oa)
  • VUBIR (Vrije Universiteit Brussel) (submittedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by-nc-nd)
  • Zurich Open Repository and Archive (University of Zurich)
Topics
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Digestive system and related health
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
Keywords
hydrogen breath test, methane breath test, carbohydrate malabsorption, lactose intolerance, small intestinal bacterial overgrowth, symptom assessment, pediatric patients, diagnostic standardization, test interpretation
MeSH terms
Gastrointestinal Microbiome, Adult, Breath Tests, Child, Dietary Carbohydrates, Europe, Gastroenterology, Gastrointestinal Transit, Humans, Hydrogen, Intestine, Small, Malabsorption Syndromes, Methane, Societies, Medical, Endoscopy, Digestive System, Consensus, Carbohydrate Metabolism, Nutritional Sciences, Symptom Assessment, Dysbiosis

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