What is a breath test? The breath test is a very simple and usually non-invasive diagnostic tool in clinical practice (some tests use radioactive isotopes but are mainly used in experiments)

It is generally requested by internists and gastroenterologists: it has numerous indications, so it has nothing to do with pulmonary and respiratory diseases.

Breath test: ‘exploits’ the production of gas that occurs in our intestines

Many patients flock to doctors’ surgeries because of a frequent and annoying ailment, ‘abdominal bloating’.

They arrive exhausted and discouraged, having tried countless remedies, from grandmother’s advice to carminative herbal teas to a wide variety of over-the-counter products.

And they are often worried, because they fear that this bloating hides who knows what serious organic pathology.

Swelling rarely conceals a more or less serious organic pathology, if it is not accompanied by warning symptoms.

Of course the symptom should not be overlooked and one should discuss it with one’s doctor and a specialist with experience in the subject.

In most cases it is the manifestation of a ‘functional’ disorder which, although it has a much better prognosis than some notorious diseases, often negatively affects quality of life and is therefore by no means negligible or of secondary importance.

But the gas that swells our belly is not ingested gas.

The air that we ingest through swallowing, soda or smoking is mostly eliminated through belching.

The gas that causes the unpleasant feeling of bloating is instead the product of fermentation processes that occur further down in the intestine

Fermentation processes in nature are very important.

Think of alcohol, leavening and lactic acid that turns milk into yoghurt and improves the taste of cheese.

But this fermentation needs two main players: on the one hand the bacteria and fungi, and on the other hand the ‘substrates’ i.e. the building blocks that have to be broken down and transformed.

This happens to the lactose in milk, the sugar in grapes and the starch in flour, which is nothing more than a chain of glucose, a monosaccharide, i.e. a very small sugar omni-present in products of vegetable origin and in particular those with a more or less sweet taste.

Try your experiment, hold some bread or a small piece of uncooked pasta in your mouth and after a while you will taste sweet.

Of course, this will never happen when chewing meat or fish or a poached egg.

And now I invite you to pay attention to another ‘spell’ that you will have repeated countless times or witnessed at your grandmother’s house: a small piece of brewer’s yeast, warm water and a teaspoon of sugar, the potion is ready!

After a few minutes, a gaseous froth will form on top of the ‘mixture’; in a nutshell, the yeast has fed itself with sugar and in return has returned gas as a waste product and that penetrating smell of alcohol that you smell when you discover the dough rising.

But although simple, the fermentation process requires a number of precautions… yeasts and bacteria do not like cold or excessive heat.

Well, all these conditions are present in our intestines, particularly in the colon.

It is populated by the so-called ‘saprophytic’ flora that coexists with our body and has many effects on it, most of which are not yet known, and which, when in balance with each other, are important for the proper functioning of our organism.

Our intestine has a constant temperature and through the ingestion of food receives waves of nutrients and undigested substrates.

Thus, in the ‘normal’ individual, ingested food undergoes digestive processes that break it down into smaller elements that are absorbed.

The non ‘digestible’ products arrive at the colon, are attacked by bacteria that ‘ferment’ them with the production of gas that is then expelled from the anus in the form of flatus and partly reabsorbed.

The intestine consists of two parts, the small or small intestine ‘upstream’ and the large intestine ‘downstream’.

The small intestine is responsible for the digestive role and the absorption of nutrients; in the large intestine, on the other hand, fermentation processes and water reabsorption take place.

This is why the intestinal flora is significantly more represented in the large intestine in the ‘normal’ subject.

Well, we have talked about physiology, but our bloated and worried patients are interested in pathology and mainly in the remedy for it.

Just imagine what happens to individuals who do not absorb certain sugars because they are ‘intolerant’ to them.

These sugars remain in the intestinal cavity and draw water from the walls of the intestine by a process known as osmosis.

A bit like a dry sponge immersed in a liquid.

This ‘sugary’ solution induces the proliferation of bacteria, which are originally more scarce than in the large intestine, and the resulting ‘contamination’ and fermentation.

Liquids and gas distend our intestines, and particularly in ‘hypersensitive’ subjects they cause complaints such as bloating, diarrhoea, and pain.

These are the most difficult patients to treat, often labelled as ‘anxious’ because blood tests show no alterations, endoscopic examinations are completely negative as are all the other investigations they undergo.

Well that is what breath tests are for, to assess how your body reacts to the ingestion of certain ‘substrates’

For this you will be given particular products to drink or eat and you will be asked to collect exhaled air at regular intervals to try to detect abnormal gas production that indicates intestinal dysfunction at a more or less proximal level.

Many individuals are ‘intolerant’ to lactose and rush to the toilet at the first sip of cappuccino.

The lactose breath test is used to detect whether this sugar is being poorly absorbed

Lactose is a di-saccharide, i.e. it consists of two monosaccharides, glucose and galactose.

The intestine cannot absorb lactose unless it is first digested by lactase, an enzyme found on the mucosal surface.

If lactose is ‘malabsorbed’ due to its ‘maldigestion’, in addition to the frequent occurrence of symptoms, it will enrich the exhaled air with hydrogen and/or methane, as it will arrive undigested at the colon, where it will be fermented by the flora, which in turn will produce gases that will be carried through the blood to the lungs and from there expelled.

Respiratory tests have many applications but must be performed according to an extremely strict protocol

In particular, it is essential that the patient adheres to a very particular diet the day before that has the function of significantly reducing the presence of indigestible substrates (such as fibre) from our intestines that would consequently make the interpretation of the test impossible.

The test must then be carried out on an empty stomach and very scrupulous sampling.

If you suffer from abdominal bloating, diarrhoea or constipation, abdominal pain, suspect that some food is ‘bad for you’, have a brick in your belly after lunch or the sensation of endlessly long digestion, nausea and general malaise, a breath test can help identify the culprit(s).

But the invitation is to consult a specialist as first of all, you will have to rule out more dangerous pathologies and, above all, you will have to be directed to the correct breath test.

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Brugnoni