Open Access Research article

Significance of hydrogen breath tests in children with suspected carbohydrate malabsorption

Jan Däbritz123, Michael Mühlbauer4, Dirk Domagk5, Nicole Voos6, Geraldine Henneböhl6, Maria L Siemer5 and Dirk Foell1*

Author Affiliations

1 Department of Pediatric Rheumatology and Immunology, University Children’s Hospital Münster, Röntgenstr 21, Münster 48149, NRW, Germany

2 The Royal Children’s Hospital Melbourne, Murdoch Children’s Research Institute, Gastrointestinal Research in Inflammation & Pathology, Parkville 3052, VIC, Australia

3 Melbourne Medical School, Department of Pediatrics, University of Melbourne, Parkville 3052 VIC, Australia

4 Pediatric Surgery, Mathias Hospital Rheine, Rheine 48431, NRW, Germany

5 Department of Gastroenterology (Medicine B), University Hospital Münster, Münster 48149, NRW, Germany

6 Center for Clinical Trials, University Hospital Münster, Münster 48149, NRW, Germany

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BMC Pediatrics 2014, 14:59  doi:10.1186/1471-2431-14-59

Published: 27 February 2014



Hydrogen breath tests are noninvasive procedures frequently applied in the diagnostic workup of functional gastrointestinal disorders. Here, we review hydrogen breath test results and the occurrence of lactose, fructose and sorbitol malabsorption in pediatric patients; and determine the significance of the findings and the outcome of patients with carbohydrate malabsorption.


We included 206 children (88 male, 118 female, median age 10.7 years, range 3–18 years) with a total of 449 hydrogen breath tests (lactose, n = 161; fructose, n = 142; sorbitol, n = 146) into a retrospective analysis. Apart from test results, we documented symptoms, the therapeutic consequences of the test, the outcome and the overall satisfaction of the patients and families.


In total, 204 (46%) of all breath tests were positive. Long-term follow-up data could be collected from 118 patients. Of 79 patients (67%) who were put on a diet reduced in lactose, fructose and/or sorbitol, the majority (92%, n = 73) reported the diet to be strict and only 13% (n = 10) had no response to diet. Most families (96%, n = 113) were satisfied by the test and the therapy. There were only 21 tests (5%) with a borderline result because the criteria for a positive result were only partially met.


Hydrogen breath tests can be helpful in the evaluation of children with gastrointestinal symptoms including functional intestinal disorders. If applied for a variety of carbohydrates but only where indicated, around two-third of all children have positive results. The therapeutic consequences are successfully relieving symptoms in the vast majority of patients.

Carbohydrate intolerance; Gastrointestinal disease; Fructose; Lactose; Sorbitol