China
Africa
Explore chapters and articles related to this topic
Gastrointestinal Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Gareth Davies, Chris Black, Keeley Fairbrass
The general principles of breath tests are shown in Figure 10.17. Results need interpreting with caution as they can be affected by factors such as age, high-fibre meals and abnormal gastric emptying.
Other Complications of Diabetes
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Gastroparesis is diagnosed after other causes are excluded, with postprandial gastric stasis confirmed by gastric emptying scintigraphy. This involves ingesting a technetium-labeled egg meal. Gastric emptying is measured by scintiscanning at 15-minute intervals over 4 hours. Retention of 10% or more of the meal at the end of 4 hours confirms gastroparesis. Other tests include antroduodenal manometry, a breath test using a nonradioactive isotope carbon-13 bound to a digestible substance, electrogastrography, MRI, and ultrasonography. Upper endoscopy or an upper GI series with small bowel assessment can rule out mechanical obstruction or other GI conditions. Ultrasonography is done if there are biliary tract symptoms or extreme abdominal pain.
Paper 4
Published in Aalia Khan, Ramsey Jabbour, Almas Rehman, nMRCGP Applied Knowledge Test Study Guide, 2021
Aalia Khan, Ramsey Jabbour, Almas Rehman
Breath tests should not be done within 4 weeks of antibacterial treatment or 2 weeks of anti-secretory drugs. Both the breath and faecal antigen tests become negative after eradication unlike the serological test, therefore either the breath or faecal test should be used for diagnosis. Treatment with a proton pump inhibitor or ‘Test and Treat’ are two suggested interventions for un-investigated dyspepsia (NICE 2004). Also guidance suggests that breath test is the best investigation to check for eradication (SIGN).
Gastroparesis syndromes: emerging drug targets and potential therapeutic opportunities
Published in Expert Opinion on Investigational Drugs, 2023
Le Yu Naing, Matthew Heckroth, Prateek Mathur, Thomas L Abell
Gastrointestinal motility is inhibited by nitrergic neurons, and nitric oxide is considered the main inhibitory neurotransmitter responsible for smooth muscle relaxation. Impairment in nitric oxide synthase (NOS) in enteric nerves causes decreased gastric accommodation, accelerates gastric emptying of liquids, and leads to uncoordinated antral contractility, resulting in pylorospasm and delayed gastric emptying of solids. Tetrahydrobiopterin (BH4) is a cofactor for NOS and stimulates and stabilizes its dimerization. In diabetes mellitus, BH4 synthesis is decreased. It causes NOS uncoupling and conversion to a peroxy-nitrite synthase which causes overproduction of superoxide and resultant impaired gastric accommodation and delay in gastric emptying. CNSA-001, a synthetic pharmaceutical formulation of seriapterin, is a precursor of BH4. A recent phase II randomized controlled trial (RCT) pilot study of 21 non-pregnant diabetic women (80% type II diabetes) with moderate/severe gastroparesis showed improvement of gastric accommodation and subjective improvement in bloating, fullness, nausea, and pain in the treatment group at 14 and 28 days. There was no statistical difference in upper GI symptom scores and gastric emptying breath test parameters. BH4 compounds have been cited as a model for basing therapy of pathophysiology, not just symptoms [47,48].
Lactose after Roux-en-Y gastric bypass for morbid obesity, is it a problem?
Published in Scandinavian Journal of Gastroenterology, 2020
F. Westerink, H. Beijderwellen, I. L. Huibregtse, M. L. A. De Hoog, L. M. De Brauw, D. P. M. Brandjes, V. E. A Gerdes
The lactose hydrogen breath test (LBT) and lactose tolerance test (LTT) are the two most frequently used tests in clinical practise and were therefore used in this study. Over 25% of postoperative patients tested positive on the LBT, twice as many as preoperative patients and with an even larger difference in the Non-Northwest European subgroup. In the normal population, the LBT has a sensitivity and specificity of 88 and 85 percent respectively [14], but whether this is altered after RYGB is unknown. Furthermore, a positive lactose LBT may not only be the result of lactase deficiency, leading to lactose fermentation into hydrogen and methane by colonic bacteria. Gut microbiome changes are seen after RYGB and (subclinical) small intestinal bacterial overgrowth (SIBO) after RYGB is reported [18]. SIBO can influence lactose breath testing [19]. We did not exclude SIBO before lactose testing in this study, which may have led to more positive results on the lactose breath test. If so, this probably further decreases the number of patients with true lactose intolerance/malabsorption because of lactase deficiency. The relatively high methane levels we found in postoperative patients might be due to microbiome changes after RYGB.
Washout kinetics of ethanol from the airways following inhalation of ethanol vapors and use of mouthwash
Published in Clinical Toxicology, 2020
Lena Ernstgård, A. Pexaras, G. Johanson
This study shows that, in practice, inhalation of ethanol, even if carried out immediately before the breath alcohol test, does not result in an overestimate of the true BrAC value. In contrast, use of mouthwash might overestimate BrAC. People suspected of drunken driving, sometimes use mouthwash as an excuse when found positive in a breath alcohol test. However, in our study the BrAC fell below the Swedish statutory limit (0.10 mg/L) in less than 16 min in all 11 subjects. This suggests that the use of mouthwash does not explain a positive alcohol breath test as, in practice, it takes longer to get the car started, driving, be stopped by the police and carry out the breath test. In any case, a positive alcohol breath tests can easily be verified by repeating the test after 15 min or using a 15-min period of observation before testing, as already applied in many countries (e.g., California, Canada). Thus, after a positive breath test in Sweden, the driver is offered to breathe in an evidence instrument (Evidenzer, infrared technique) twice with 6–9 min in between or to take a venous blood sample. In California, a 15 min observation period is required before performing evidential roadside screening breath test [12]. Likewise, two breath tests are performed with 15 min in between for legally purposes in Canada [31].