The amounts of hydrogen produced from starch and lactulose were compared to assess the accuracy of the hydrogen breath test with lactulose as standard to quantify starch malabsorption. The mean amounts of hydrogen produced from starch and lactulose were not different in fecal homogenates and in breath excretion after carbohydrate infusions into the cecum. Known amounts of starch infused into the cecum of 18 subjects were compared with amounts calculated from the total excess excretion of hydrogen in breath computed in relation to hydrogen production after the ingestion of 10 g lactulose; calculated amounts were 3.6 +/- 1.0, 9.9 +/- 1.3, and 22.0 +/- 3.4 g for the infusion of 5, 10, and 25 g of starch, respectively. The lactulose hydrogen breath test based on total excess hydrogen volume provides a valid measurement of the mean amount of starch metabolized in the colon in a group of subjects. However, large individual variations preclude its use in a given subject.
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