Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Are there other ways in which hydrogen breath
testing can be used?
Antibiotics are used for treating bacterial overgrowth of the small
bowel; however, any one
antibiotic may be effective at eliminating the overgrowing bacteria only
50%-60% of the time. Therefore, if symptoms do not disappear in an individual
following treatment with antibiotics, it may be useful to repeat the breath test
to determine if the antibiotics have eliminated the bacteria. If not, a
different antibiotic or non-antibiotic treatment can be tried.
What are the side effects of hydrogen breath
testing?
The side effects of hydrogen breath testing are exactly what one would
expect to see in individuals who poorly digest and absorb sugars and
carbohydrates, for example, bloating, distention, pain, and diarrhea. When
lactulose is used these symptoms are unlikely to occur or are mild because the
dose of lactulose used for testing is small.
What are the alternatives to hydrogen breath
testing?
For diagnosing lactose
intolerance, an alternative procedure to breath testing requires blood
samples to be taken after the ingestion of lactose. If the digestion and
absorption of lactose is normal, the levels of glucose in the blood should rise.
The elevation of blood glucose
occurs because the lactose is broken down into its two component sugars,
galactose and glucose, as it is absorbed into the blood. A second
alternative is to give a dose of lactose (or other dietary sugar) and observe an
individual for symptoms. If the individual is intolerant, bloating, distention,
pain, flatulence, and diarrhea are likely to occur. A third alternative is a
trial of a diet in which the potentially-offending sugar is strictly eliminated.
All of these alternatives, however, have limitations and problems.
Bacterial overgrowth can be diagnosed by culturing (growing) the bacteria
from a sample of fluid from the small intestine and counting the numbers of
colonic bacteria that are present. This procedure requires a tube to be passed
through the nose,
throat, esophagus and
stomach under X-ray
guidance so that fluid can be obtained from the small intestine. It is an
uncomfortable and expensive procedure, and most laboratories are not able to
accurately culture the samples.
An alternative method for diagnosing rapid transit through the small
intestine involves eating food that is labeled with a
radioactivemarker and
determining the time it takes for the marker to reach the colon. Progress of the
marker through the bowel is assessed with a scanner that acts somewhat like a
Geiger counter.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Diarrhea is a change is the frequency and looseness of bowel movements. Cramping, abdominal pain, and the sensation of rectal urgency are all symptoms of diarrhea. Absorbents and anti-motility medications are used to treat diarrhea.
Gas or "intestinal gas" means different things to different people. Everyone has gas and eliminates it by belching or farting (passing it through the rectum).
Crohn's disease is a chronic inflammatory disease,
primarily involving the small and large intestine, but which can
affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are
common symptoms.
In lactose intolerance, the digestive system cannot digest lactose (the main sugar in milk). Symptoms of lactose intolerance include diarrhea, flatulence, abdominal pain, abdominal bloating, abdominal distention, and nausea. There are several tests to diagnose lactose intolerance. Treatment is generally made with dietary changes, supplements, and adaptation to small amounts of milk.
IBS (irritable bowel syndrome) is a common gastrointestinal disorder involving abnormal gut contractions (motility) characterized by abdominal pain,
bloating, mucous in stools, and irregular bowel habits with alternating diarrhea
and constipation, symptoms that tend to be chronic and to wax and wane over the
years. Treatment options include medication and lifestyle changes such as diet, exercise, and stress management to control symptoms. Also called spastic colitis, mucus colitis, nervous colon syndrome.
Celiac disease is a result of an immune reaction to gluten, a protein found in wheat or related grains and present in many foods that we eat. Celiac disease causes impaired absorption and digestion of nutrients through the small intestine. Signs and symptoms of celiac disease include malabsorbption (diarrhea, foul smelling gas, bloating, and increased amounts of fat in the stool) and malnutrition (weight loss, edema, anemia, bruising easily, neuropathy, and infertility). Treatment for celiac disease is a gluten free diet, and at times if necessary, medications
Small intestinal bacterial overgrowth (SIBO) refers to a condition in which abnormally large numbers of bacteria (at least 100,000 bacteria per ml of fluid) are present in the small intestine and the types of bacteria in the small intestine resemble more the bacteria of the colon than the small intestine. There are many conditions associated with small intestinal bacterial overgrowth, to include: diabetes, scleroderma, Crohn's disease, and others. There is a striking similarity between the symptoms of irritable bowel syndrome and SIBO. It has been theorized that SIBO may be responsible for the symptoms of at least some patients with irritable bowel syndrome. Symptoms of SIBO include: excess gas, abdominal bloating, diarrhea, and abdominal pain.
Dyspepsia (indigestion) is a functional disease in which the gastrointestinal organs, primarily the stomach and first part of the small intestine, function abnormally. It is a chronic disease in which the symptoms fluctuate infrequency and intensity. Symptoms of dyspepsia include upper abdominal pain, belching, nausea, vomiting, abdominal bloating, early satiety, and abdominal distention (swelling). These symptoms are most often provoked by eating.
The inflammatory bowel diseases (IBD) are Crohn's disease (CD) and ulcerative colitis (UC). The intestinal complications of Crohn's disease and ulcerative colitis differ because of the characteristically dissimilar behaviors of the intestinal inflammation in these two diseases.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
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