{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:10:22Z","timestamp":1791562222312,"version":"4.3.4"},"reference-count":29,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,2,22]],"date-time":"2019-02-22T00:00:00Z","timestamp":1550793600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Winkler Bacterial Overgrowth Research Fund"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JGH Open"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:sec><jats:title>Background and Aim<\/jats:title><jats:p>Breath testing has become a commonly used tool in gastroenterology to evaluate changes in the fermentation pattern of the gut microbiome. Currently, hydrogen and methane gas concentrations are measured in breath testing and evaluated against specific cut\u2010off values for interpretation as normal or abnormal. However, microbial gas kinetics is a complex process that is not currently fully considered when interpreting breath gas results. Gas exchange between hydrogen producers and hydrogen consumers (methanogens and sulfate\u2010reducing bacteria) is a process whereby hydrogen availability is determined by both its production and removal. Hydrogen sulfide is a crucial gas involved in this process as it is a major hydrogen\u2010consumptive pathway involved in energy exchange.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a cross\u2010sectional study evaluating lactulose breath testing with the inclusion of hydrogen sulfide measurements in patients referred for breath testing for gastrointestinal symptoms of bloating, excessive gas, and\/or abdominal pain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 159 patients were analyzed between October 2016 and June 2017. Mean hydrogen concentrations with a positive trend through a 3\u2010h period (<jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090.97), mean methane concentrations with a positive trend (<jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090.69), and mean hydrogen sulfide concentrations with a negative trend (<jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u2009\u22120.71) were observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>By incorporating energy exchange in the interpretation of the lactulose breath test, we reevaluated specific breath gas profiles, including those commonly described as \u201chydrogen nonproducers\u201d and the \u201cdouble\u2010peak\u201d phenomenon.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jgh3.12145","type":"journal-article","created":{"date-parts":[[2019,2,22]],"date-time":"2019-02-22T13:00:47Z","timestamp":1550840447000},"page":"228-233","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Reevaluating our understanding of lactulose breath tests by incorporating hydrogen sulfide measurements"],"prefix":"10.1002","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1156-9783","authenticated-orcid":false,"given":"Aleksandr","family":"Birg","sequence":"first","affiliation":[{"name":"Medicine Service New Mexico VA Health Care System  Albuquerque New Mexico USA"},{"name":"Division of Gastroenterology and Hepatology University of New Mexico  Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve","family":"Hu","sequence":"additional","affiliation":[{"name":"Medicine Service New Mexico VA Health Care System  Albuquerque New Mexico USA"},{"name":"Division of Gastroenterology and Hepatology University of New Mexico  Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry C","family":"Lin","sequence":"additional","affiliation":[{"name":"Medicine Service New Mexico VA Health Care System  Albuquerque New Mexico USA"},{"name":"Division of Gastroenterology and Hepatology University of New Mexico  Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,2,22]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2017.46"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2015.47"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.food.102308.124101"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12331"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197106242842502"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm.2014.20.1.31"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm.2011.17.3.312"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2016.30"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/003655200750023561"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-94-017-9269-1_10"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI7712"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0006-2952(01)00657-8"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/SHK.0b013e3182252ee7"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbabio.2009.03.019"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1018867516575"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM196907172810303"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2009.205476"},{"key":"e_1_2_6_19_1","first-page":"89","article-title":"Influence of a methanogenic flora on the breath H2 and symptom response to ingestion of sorbitol or oat fiber","volume":"92","author":"Kajs TM","year":"1997","journal-title":"Am. 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