Measurement of lung inflammation in asthmatics - reason for optimism

It is recognized that bronchial asthma is an inflammatory disease. However, aggressive anti-inflammatory therapy is not guided by the degree of lung inflammation. This is of particular concern in children in whom over-aggressive therapy with corticosteroid may lead to growth retardation. Analysis of breath exhaled nitric oxide levels may be an indirect measurement of lung inflammation. Since exhaled nitric oxide levels and inflammation decrease after steroid therapy, measurement of exhaled nitric oxide levels may provide a rationale for optimization of steroid therapy and possible reduction of side effects. Measurement of exhaled nitric oxide levels is not available for routine use but may be so in the near future. This will likely herald a new dawn in the management of asthma, a disease with increasing frequency, mortality and morbidity.(Au)

C breath testing in diagnosis of H. pylori in Guyana

Many techniques for diagnosing H. pylori (HP) have emerged. Serum immunoglobin FlexSure (F/S) is promoted for screening and C Breath Test (B/T) for confirmation of active HP infection. B/T confirmed HP in 97/106 F/S +ve dyspeptic patients in an earlier study. No correlation of pretreatment B/T with eradication of HP was documented. In this study B/T was compared with CLO test and culture, to evaluate the C Breath Test in the diagnosis of active HP infection in dyspeptic patients. The C Breath Test (Tri Med Specialities, Virginia) and HP culture were undertaken in 54 F/S +ve CLO +ve dyspeptic patients who were gastroscoped. B/T+ve was > 100dpm. Repeat B/T were performed 4 weeks and 6 months after a treatment regimen consisting of lanzaprasole, metronidazole and calrithromycin of 7 days. 4/54 were B/T -ve and 3 of the 4 (also culture -ve) were classified false -ve B/T. Total culture positivity was 51.8 percent (28/54). B/T confirmed eradication in 43/50 (86 percent) with no recurrences at 6 months' follow up.(AU)

Small bowel overgrowth in malnourished children as measured by the breadth hydrogen test - abstract

Overgrowth of the small intestine with bacteria has been implicated in the chronic diarrhoea associated with severe malnutrition. The hydrogen breath test has been introduced as a simple non-invasive technique to assess bacterial fermentation in the bowel. An increase in breath hydrogen in excess of 20 ppm within 60 minutes of the oral presentation of substrate is taken as evidence of small bowel overgrowth (SBO). The hydrogen breath test was used in 30 children admitted with severe protein energy malnutrition. Of the 19 children tested on admission and at intervals during recovery, 5 were positive on admission and a further 3 became positive at varying times after admission. Of these 8 with positive results, 5 were treated with metronidazole and all were negative on subsequent testing. Of the 3 children who were not treated one improved, but 2 had persistently positive breath hydrogen. Eleven (11) children had breath hydrogen measured at some time during recovery. In 6 the test was positive; all received metronidazole and became negative. In 2 children who had received metronidazole and were negative, the test became positive at a later date. Three children had a positive test with lactose specifically, one was treated with metronidazole and became negative. Therefore, of 30 children studied, 14 had a positive test at some time, which became negative in the 11 treated with metronidazole. We conclude that small bowel overgrowth as measured by the breath hydrogen test is a frequent accompaniment of severe malnutrition and responds to treatment with metronidazole (AU)