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What are exhaled air tests or breath tests?

They are the reference diagnostic method for various common gastrointestinal disorders, such as Helicobacter pylori infection, bacterial overgrowth or intolerance to different carbohydrates, according to the international consensuses published by the highest referents in Gastroenterology1,2,3.

1MalfertheinerP, et al. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut 2017; 66:6-30.
2RezaieA, et al. Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus. Am J Gastroenterol 2017 May; 112(5):775-784.
3PimentelM, et al. ACG Clinical Guideline: Small Intestinal Overgrowth. Am J Gastroenterol 2020; 115:165-178.

Advantages

For physicians

  • Tests with high specificity and sensitivity.
  • Highly reliable and reproducible method.
  • Reduced diagnostic cost.
  • Suitable for pediatric use.

For patients

  • Non-invasive tests.
  • Convenient and easy to perform tests.
  • Highly tolerated substrates.

Basis of proof

The breath test for the diagnosis of Helicobacter pylori infection is based on the ability of its enzyme urease to metabolize urea to ammonia andCO2. When infection is present, when the patient is administered a solution containing 13C-labeledurea, the urease enzyme hydrolyzes it to 13CO2, which is absorbed, diffuses into the blood, is transported to the pulmonary alveoli and through gas exchange, is excreted through the exhaled air or breath.

In air samples, the isotopic ratio of 13CO2/12CO2is determined, i.e. the concentration of 13CO2generated by the bacteria with respect to the concentration of 12CO2, the normal isotope ofCO2 commonly generated in the metabolic reactions of the organism.

More information

Basis of evidence

Carbohydrates are a type of nutrient usually metabolized and absorbed in the small intestine. However, when there is some kind of disorder such as malabsorption, intolerance or bacterial overgrowth in the small intestine, they reach the colon intact.

Tests with unlabeled substrates are based on the ability of the colonic microbiota to ferment carbohydrates, releasing various gases in the process (hydrogen,H2; methane, CH4; carbon dioxide,CO2; and hydrogen sulfide,H2S). These gases are absorbed by the intestinal wall, diffuse into the blood and are transported to the pulmonary alveoli, where they are excreted with exhalation. Detection of these gases in exhaled air allows identification of the existence of a gastrointestinal disorder.