Update on diagnostic value of breath test in gastrointestinal and liver diseases

Table 1 List of breath tests available for clinical utilization

Indications

Tests for small intestinal bacterial overgrowth

Glucose hydrogen breath test

Lactulose hydrogen breath test

13C-glycocholate breath test

13C-xylose breath test

Tests for carbohydrate malabsorption

Fructose hydrogen breath test

Lactose hydrogen breath test

Saccharose hydrogen breath test

13C-lactose breath test

13C-fructose breath test

13C-saccharose breath test

Methane breath test

Tests for Helicobacter pylori infection

13C-urea breath test

14C-urea breath test

Tests for the evaluation of gastric emptying

13C-octanoic acid breath test

Tests for the evaluation of exocrine pancreatic insufficiency

13C-mixed triglycerides breath test

13C-starch breath test

13C-egg protein breath test

Tests for the evaluation of hepatocellular function

13C-aminopyrine breath test

13C-ethacetin breath test

UBT: Urea breath test; 14C: 14 carbon; 13C: 13 carbon.

Table 2 Comparison of the 14C and 13C urea breath test

	14C-UBT	13C-UBT
Test performed at	Nuclear medicine department	No specific location required
Analysis	Specialized nuclear medicine department and β-scintillation counters	Mass spectrometry analysis (in a hospital or mailed to the manufacturer)
Radioactive hazard	Yes	No
Patient selection	Not suitable for children or pregnant women	Safer for children or pregnant women

UBT: Urea breath test; 14C: 14 carbon; 13C: 13 carbon.

Table 3 Representative diagnostic accuracy in terms of sensitivity and specificity of various breath tests available for clinical use

Test	Indication	Sensitivity and specificity
Glucose hydrogen breath test	SIBO	62% and 83%[7]
Lactulose hydrogen breath test	SIBO	31% and 86%[5]
13C-glycocholate breath test	SIBO	76% and 33%[69]
13C-xylose breath test	SIBO	89% and 30%[69]
Fructose hydrogen breath test	Carbohydrate malabsorption	98% and 86%[65]
Lactose hydrogen breath test	Carbohydrate malabsorption	80% and 100%[66]
13C-lactose breath test	Carbohydrate malabsorption	84% and 96%[70]
13C-urea breath test	H. pylori infection	96% and 93%[39]
13C-aminopyrine breath test	Evaluation of liver function	85.7% and 67.5%[58]
13C-methacetin breath test	Evaluation of liver function	92.6% and 94.1%[67]
13C-phenacetin breath test	Evaluation of liver function	98% and 60%[68]
13C-mixed triglycerides breath test	Evaluation of exocrine pancreatic insufficiency	89% and 81%[56]
13C-octanoic acid breath test	Assessment of gastric emptying	67% and 80%[71]

SIBO: Small intestinal bacterial overgrowth; 13C: 13 carbon.