Activated Charcoal Reduces Lactulose-Induced Breath Hydrogen in Patients with Excessive Gas and in Controls

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Objective: To evaluate the effect of activated charcoal on lactulose-induced breath hydrogen flatus passage and abdominal bloating in healthy controls and patients with complaints of excessive gas. Patients and Methods: Five male healthy controls and six male patients with complaints of excessive gas were enrolled. Breath H2, flatus passage and abdominal bloating was noted after oral lactulose over an 8 hour period in both controls and patients. Effect of activated charcoal on all these parameters was evaluated. Results: Patients produced more breath H2, more flatus and more bloating after oral lactulose compared to controls. Activated charcoal improved all these parameters in both patients and controls. Conclusion: Activated charcoal is effective in reducing breath H2 flatus passage and abdominal bloating in response to oral lactulose.

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Objective: To analyze the number of classified advertisements for Gastroenterology in comparison with those for Cardiology in New England Journal of Medicine (NEJM) over a 20 year period from 1985 to 2004. To evaluate if the increase in advertisement for gastroenterology are related to the demand for screening colonoscopy. Methods: Advertisements for gastroenterology and cardiology from each issue of NEJM were manually counted. The mean number of advertisements per week were calculated, smallest and largest number of advertisements for cardiology and gastroenterology were noted. Cardiology/Gastroenterology (C/G) ratio per week was calculated. Appropriate statistical methods were used to analyze and compare the data. Results: In this 20 year period there were 76713 advertisements for cardiology; mean 73.76 ± 36.25 (range 14-218) per week. There were 26130 advertisements for gastroenterology; mean 25.12 ± 18.35 (range 1-122) per week. The C/G ratio for 20 years was 2.93 ± 4.30 (range 1.37-18.20) per week. The C/G ration in the years 1985 to 1997 was significantly higher (3.10-5.81) compared to C/G ratio from 1998 to 2004 which was 1.85-2.79 suggesting a disproportionate increase in the no. of Ads for G correlating with demand for screening colonoscopy. Conclusions: Ads for C (and presumably demand for services) was three times that for G. The ads for G increased after the introduction for screening colonoscopy. The implications of this development are discussed.
Background: We have previously shown that healthy male volunteers after oral lactulose develop significant abdominal bloating, excessive flatus passage and increased breath hydrogen. Objective: The aim of this study was to measure breath hydrogen, abdominal bloating and flatus passage after oral sorbitol and to compare these parameters with those produced by lactulose. Materials and Methods: The same normal volunteers who had participated in the lactulose study also were used in this study. After oral sorbitol, bloating score, number of flatus passage and breath hydrogen over a period of 8 hours was measured. These parameters were compared with those which had been obtained after lactulose. Results: These male healthy volunteers after oral sorbitol produced breath hydrogen, had abdominal bloating and passed flatus similar to that produced after lactulose. Conclusion: Gastrointestinal symptoms produced by some foods and fruits in otherwise healthy persons may be due to the sorbitol content of those foods. The manufacturers should clearly state the amount of sorbitol in such foods.
The etiology of sudden infant death syndrome (SIDS) is not known. Various maternal and infant risk factors have been identified. Adoption of the non-prone position has reduced the incidence of SIDS but has not eliminated the problem. Some sulfate reducing bacteria in the colon produce hydrogen sulfide (H2S) which is as toxic as hydrogen cyanide. Normally, the colonic mechanism for metabolizing and detoxifying H2S is very effective and no H2S appears in the exhaled breath although small amounts are present in the flatus. We are putting forth the hypothesis that in some cases of SIDS colonocytic mechanism for detoxifying H2S may not have matured by the age of 3 months and H2S may be absorbed resulting in SIDS. The hypothesis can be tested by in vitro evaluation of colonic tissue from SIDS cases for its ability to detoxify H2S.
To measure bloating score, flatus passage, and hydrogen production after oral fructose in patients with history of fruit intolerance and compare these parameters with those in normal controls. Some patients complain of abdominal distention and excessive flatus after ingesting certain fruits such as mango, persimmon, and grapes but not after eating apricots and melon. We recorded breath hydrogen, flatus passage and bloating after 20 g fructose in 8 patients with history of fruit intolerance and 4 healthy controls. Breath hydrogen was measured every 15 minutes for 480 minutes using EC-60 gastrolyzer. Number of passage of flatus was recorded over 8 hours. Severity of abdominal distention on a scale of 1 to 10 was noted. The patients with fruit intolerance produced breath hydrogen 1745.2+/-7.8 parts per million, passed flatus 13.8+/-0.3 times, and had bloating score of 5.7+/-0.1. The healthy controls produced breath hydrogen 712.5+/-5.8 parts per million in 8 hours, passed flatus 7.2+/-0.5 time, and had bloating score of 2.7+/-0.2. After 20 g fructose, patients with history of fruit intolerance produce more breath hydrogen, pass flatus more frequently, and have a higher bloating score compared with healthy controls.
It has been reported that activated charcoal reduces intestinal gas production after ingestion of beans as evidenced by decreased breath hydrogen excretion and decreased passage of flatus. In the present study we assessed the ability of activated charcoal to reduce intestinal gas production by in vitro and in vivo methods. In vitro studies were performed using human fecal homogenates incubated with or without additional carbohydrate. In all studies hydrogen and carbon dioxide production and consumption occurred at similar rates in the charcoal-treated homogenate as compared with the untreated control. The influence of activated charcoal on gas production, in vivo, was studied by double-blind assessment of breath hydrogen excretion and flatus excretion after ingestion of a baked bean meal. No significant difference was observed in breath hydrogen concentration or number of passages of flatus in subjects who ingested 16 capsules of activated charcoal (4 g) as opposed to the placebo. We conclude that activated charcoal does not influence gas formation in vitro or in vivo.