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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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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Lactose as an excipient in LT4 tablets has no clinical relevance.
“Although it has traditionally been recommended to avoid LT4 tablets containing lactose as an excipient, this has no clinical relevance.3,69,79”
From Refractory hypothyroidism: unraveling the complexities of diagnosis and management (2023) · cites this paper as [79]
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Flagged first, then by citations
Research works printed but not linked: 2
- [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.
- [58]Hammer HF, Sheikh MS. Colonic gas excretion in induced carbohydrate malabsorption–effect of simethicone. Eur J Gastroenterol Hepatol. 1992; 4: 141– 5.
Cited by
Sorted by citations
Refractory hypothyroidism: unraveling the complexities of diagnosis and management
Quiroz-Aldave, J. E., Concepción-Zavaleta, M. J., Durand-Vásquez, M. D. C., Concepción-Urteaga, L. A., Gamarra-Osorio, E. R., Suárez-Rojas, J., Rafael-Robles, L. D. P., Paz-Ibarra, J., & Román-González, A. (2023) · Endocrine Practice · doi:10.1016/j.eprac.2023.09.003 · Cited by 14 · see citing works
- 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.
- ORCID
- 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
- PMC
- PMC8830282
- 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
- hybrid
- doi.org
- Licence
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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