Respiratory hydrogen secretion: a simple test of bowel adaptation in infants with short gut syndrome.

The prime goal in the management of infants with short gut syndrome is the smooth transition from total parenteral alimentation to total gastrointestinal alimentation. Such transition is dependent upon early feeding to actively promote the intestinal mucosal hyperplasia that is the key to eventual oral alimentation. A modular hyposmolar formula was previously reported to be successful in promoting the intestinal adaptation in several infants with short gut syndrome. Progression of the daily diet was dependent upon the day's clinical response, i.e., whether a change in volume or substrate composition resulted in increased stooling or diarrhea. Diarrhea occurs when the substrate load exceeds the absorptive capacity of the intestine and may be severe enough to require a return to parenteral alimentation until intestinal recovery is complete. Monitoring of daily breath H2 has provided an early warning mechanism to indicate carbohydrate overload in the adapting bowel before clinical signs of malabsorption occur. It provides an accurate daily measure of the bowel's ability to utilize the specific volume and caloric density it is being presented, thereby allowing diet advancement in a controlled fashion. The use of the breath H2 test in three infants with short gut syndrome has assisted in the transition to oral alimentation in 3 to 20 wk without the complications of severe diarrhea.