Maffei H V, Daher S R, Moreira F L
Arq Gastroenterol. 1984 Jul-Sep;21(3):136-42.
Twenty three infants with acute or protracted diarrhea were investigated for carbohydrate (CHO) malabsorption during their normal feeding schedules. All infants were fed a chicken-meat formula which contained rice flour and maltodextrin. End-tidal respiratory H2 concentrations were sequentially evaluated in different clinical settings and compared to fecal pH and reducing substances. Fecal pH below 6.0 and/or breath H2 greater than 25 ppm were considered evidence of CHO malabsorption, as these values disappeared while infants were submitted to a trial of CHO withdrawal per os, reappearing after CHO reintroduction. Values of fecal pH greater than 6.0 most often (84,2%) occurred along with H2 less than 25 ppm, thus frequently reflecting a good CHO absorption. pH values below 6.0, however, although reflecting CHO malabsorption, did not predict the presence of significant H2 concentrations in expired air. In 44.4% of the well-nourished or only mildly malnourished infants some evidence of CHO malabsorption was present, whereas this occurred in all severely malnourished infants. This last group of infants had a longer history of diarrhea prior to admission and needed a longer hospitalization. The frequency of H2 values greater than 25 ppm decreased progressively during the clinical evolution, along with an increase in CHO ingestion, findings possibly related to nutritional improvement. The hydrogen breath test and fecal pH allowed the diagnosis of CHO fermentation when applied as in this study, without a conventional CHO overload and without previous fasting. It did, however, not predict clinical intolerance, as signs of CHO malabsorption still occurred in infants whose diarrhea had already subsided.
对23例患有急性或迁延性腹泻的婴儿在其正常喂养期间进行了碳水化合物（CHO）吸收不良的调查。所有婴儿均喂食含米粉和麦芽糊精的鸡肉配方奶。在不同临床情况下依次评估呼气末呼吸氢气浓度，并与粪便pH值和还原物质进行比较。粪便pH值低于6.0和/或呼气氢气浓度大于25 ppm被视为CHO吸收不良的证据，因为这些值在婴儿口服停用CHO试验期间消失，在重新引入CHO后再次出现。粪便pH值大于6.0的情况最常（84.2%）与氢气浓度低于25 ppm同时出现，因此常反映出良好的CHO吸收。然而，pH值低于6.0虽然反映了CHO吸收不良，但并不能预测呼出气体中是否存在显著的氢气浓度。在44.4%营养良好或仅轻度营养不良的婴儿中存在一些CHO吸收不良的证据，而所有重度营养不良的婴儿均出现这种情况。最后一组婴儿入院前腹泻病史更长，住院时间也更长。在临床病程中，氢气浓度大于25 ppm的频率随着CHO摄入量的增加而逐渐降低，这些发现可能与营养改善有关。如本研究中那样应用时，氢气呼气试验和粪便pH值可在不进行传统CHO负荷试验且无需预先禁食的情况下诊断CHO发酵。然而，它并不能预测临床不耐受情况，因为腹泻已经缓解的婴儿中仍会出现CHO吸收不良的体征。
