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. 1984 Aug;25(8):839–845. doi: 10.1136/gut.25.8.839

Is raised breath hydrogen related to the pathogenesis of pneumatosis coli?

N W Read, M N Al-Janabi, P A Cann
PMCID: PMC1432562  PMID: 6745722

Abstract

Clinical and physiological studies were carried out in five patients with pneumatosis coli in order to investigate the origin of the high fasting breath hydrogen concentration in this condition and to determine its possible significance in the pathogenesis of the disease. All five patients excreted abnormally high fasting concentrations of hydrogen in their breath (69 +/- 9 ppm, mean +/- SEM). Moreover, analysis of the contents of the gas filled cysts revealed between 2% and 8% of hydrogen gas. Colonic washout significantly reduced breath hydrogen concentrations to 9 +/- 6 ppm, but did not abolish the cysts. Conversely, deflation of the cysts was achieved with oxygen or antibiotics, though this only reduced breath hydrogen concentrations to about 66% of their original value. After feeding a radiolabelled meal, breath hydrogen concentrations rose before the meal appeared to reach the colon, suggesting overgrowth of anaerobic bacteria in the small intestine. Despite this, 14C glycocholate breath tests were within normal limits. An alternative possibility is that the high levels of hydrogen excreted in the breath may be produced in the intestinal lumen possibly from the fermentation of copious amounts of colonic mucus. Finally, measurement of whole gut transit time and stool weight suggested that patients were constipated despite passing mucus and blood. The relevance of our observations to the pathogenesis of submucosal cysts is unclear, but the data favour the hypothesis that these are produced by invasion of the colonic submucosa with anaerobic bacteria.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bond J. H., Jr, Levitt M. D., Prentiss R. Investigation of small bowel transit time in man utilizing pulmonary hydrogen (H2) measurements. J Lab Clin Med. 1975 Apr;85(4):546–555. [PubMed] [Google Scholar]
  2. Caspary W. F. Breath tests. Clin Gastroenterol. 1978 May;7(2):351–374. [PubMed] [Google Scholar]
  3. Corbett C. L., Thomas S., Read N. W., Hobson N., Bergman I., Holdsworth C. D. Electrochemical detector for breath hydrogen determination: measurement of small bowel transit time in normal subjects and patients with the irritable bowel syndrome. Gut. 1981 Oct;22(10):836–840. doi: 10.1136/gut.22.10.836. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Down R. H., Castleden W. M. Oxygen therapy for pneumatosis coli. Br Med J. 1975 Mar 1;1(5956):493–494. doi: 10.1136/bmj.1.5956.493. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Forgacs P., Wright P. H., Wyatt A. P. Treatment of intestinal gas cysts by oxygen breathing. Lancet. 1973 Mar 17;1(7803):579–582. [PubMed] [Google Scholar]
  6. Gillon J., Tadesse K., Logan R. F., Holt S., Sircus W. Breath hydrogen in pneumatosis cystoides intestinalis. Gut. 1979 Nov;20(11):1008–1011. doi: 10.1136/gut.20.11.1008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Hughes D. T., Gordon K. C., Swann J. C., Bolt G. L. Pneumatosis cystoides intestinalis. Gut. 1966 Oct;7(5):553–557. doi: 10.1136/gut.7.5.553. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Höflin F., van der Linden W. Pneumatosis cystoides intestinalis treated by oxygen breathing. Scand J Gastroenterol. 1974;9(5):427–430. [PubMed] [Google Scholar]
  9. KEYTING W. S., MCCARVER R. R., KOVARIK J. L., DAYWITT A. L. Pneumatosis intestinalis: a new concept. Radiology. 1961 May;76:733–741. doi: 10.1148/76.5.733. [DOI] [PubMed] [Google Scholar]
  10. MARSHAK R. H., BLUM S. D., ELIASOPH J. Pneumatosis involving the left side of the colon. J Am Med Assoc. 1956 Aug 25;161(17):1626–1628. doi: 10.1001/jama.1956.62970170002005a. [DOI] [PubMed] [Google Scholar]
  11. Perman J. A., Modler S. Glycoproteins as substrates for production of hydrogen and methane by colonic bacterial flora. Gastroenterology. 1982 Aug;83(2):388–393. [PubMed] [Google Scholar]
  12. Read N. W., Al Janabi M. N., Bates T. E., Barber D. C. Effect of gastrointestinal intubation on the passage of a solid meal through the stomach and small intestine in humans. Gastroenterology. 1983 Jun;84(6):1568–1572. [PubMed] [Google Scholar]
  13. Read N. W., Miles C. A., Fisher D., Holgate A. M., Kime N. D., Mitchell M. A., Reeve A. M., Roche T. B., Walker M. Transit of a meal through the stomach, small intestine, and colon in normal subjects and its role in the pathogenesis of diarrhea. Gastroenterology. 1980 Dec;79(6):1276–1282. [PubMed] [Google Scholar]
  14. Scarpello J. H., Sladen G. E. Appraisal of the 14C-glycocholate acid test with special reference to the measurement of faecal 14C excretion. Gut. 1977 Sep;18(9):742–748. doi: 10.1136/gut.18.9.742. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Sicard G. A., Vaughan R., Wise L. Pneumatosis cystoides intestinalis: an unusual complication of jejunoileal bypass. Surgery. 1976 Apr;79(4):480–484. [PubMed] [Google Scholar]
  16. Stone H. H., Allen W. B., Smith R. B., 3rd, Haynes C. D. Infantile pneumatosis intestinalis. J Surg Res. 1968 Jul;8(7):301–307. doi: 10.1016/0022-4804(68)90102-9. [DOI] [PubMed] [Google Scholar]
  17. Wood R. E., Herman C. J., Johnson K. W., di Sant'Agnese P. A. Pneumatosis coli in cystic fibrosis: clinical, radiological, and pathological features. Am J Dis Child. 1975 Feb;129(2):246–248. doi: 10.1001/archpedi.1975.02120390072016. [DOI] [PubMed] [Google Scholar]
  18. Yale C. E., Balish E., Wu J. P. The bacterial etiology of pneumatosis cystoides intestinalis. Arch Surg. 1974 Jul;109(1):89–94. doi: 10.1001/archsurg.1974.01360010067017. [DOI] [PubMed] [Google Scholar]

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