The Degree of Breath Methane Production in IBS Correlates With the Severity of Constipation

BACKGROUND:Recent work has demonstrated that among irritable bowel syndrome (IBS) subjects, methane on lactulose breath test (LBT) is nearly universally associated with constipation predominance. This work has been based on subjective constipation outcomes. In this study, methane is compared to constipation in another population of IBS subjects with constipation being determined both subjectively and objectively.METHODS:A nested study was conducted in subjects enrolled in a double-blind randomized placebo-controlled study. After consent, subjects were asked to complete a stool diary for 7 days. This included logging of all bowel movements that week as well as documenting the stool consistency for each during the same period using the Bristol Stool Score. After 7 days, subjects were asked to rate their symptoms on a visual analogue scale (VAS) score (0–100 mm) for diarrhea and constipation. They then had an LBT to evaluate both methane and hydrogen profiles over 180 min. Subjects with methane were compared to those without methane for Bristol Stool Score, stool frequency, as well as VAS scores for diarrhea and constipation. The degree of constipation was then compared to the quantity of methane production on LBT based on area under the curve.RESULTS:Among 87 subjects, 20 (23.8%) produced methane. IBS subjects with methane had a mean constipation severity of 66.1 ± 36.7 compared to 36.2 ± 30.8 for nonmethane producers (P < 0.001). The opposite was noted for diarrhea (P < 0.01). On LBT, the quantity of methane seen on breath test was directly proportional to the degree of constipation reported (r = 0.60, P < 0.01). In addition, greater methane production correlated with a lower stool frequency (r = −0.70, P < 0.001) and Bristol Stool Score (r = −0.58, P < 0.01).CONCLUSION:Methane on LBT is associated with constipation both subjectively and objectively. The degree of methane production on breath test appears related to the degree of constipation.

[1]  P. Openshaw,et al.  Towards positive diagnosis of the irritable bowel. , 1978, British medical journal.

[2]  S. Fiedorek,et al.  Breath Methane Production in Children With Constipation and Encopresis , 1990, Journal of pediatric gastroenterology and nutrition.

[3]  Henry C. Lin,et al.  Normalization of Lactulose Breath Testing Correlates With Symptom Improvement in Irritable Bowel Syndrome: A Double-Blind, Randomized, Placebo-Controlled Study , 2003, American Journal of Gastroenterology.

[4]  T. Cole,et al.  The effect of age, sex and level of intake of dietary fibre from wheat on large-bowel function in thirty healthy subjects , 1986, British Journal of Nutrition.

[5]  S. Lewis,et al.  Stool form scale as a useful guide to intestinal transit time. , 1997, Scandinavian journal of gastroenterology.

[6]  M. Pimentel,et al.  Methane Production During Lactulose Breath Test Is Associated with Gastrointestinal Disease Presentation , 2004, Digestive Diseases and Sciences.

[7]  T. Miller,et al.  Incidence of methanogenic bacteria in a sigmoidoscopy population: an association of methanogenic bacteria and diverticulosis. , 1986, Gut.

[8]  A. Bjørneklett,et al.  Relationships between hydrogen (H2) and methane (CH4) production in man. , 1982, Scandinavian journal of gastroenterology.

[9]  A. Gasbarrini,et al.  Hydrogen glucose breath test to detect small intestinal bacterial overgrowth: a prevalence case–control study in irritable bowel syndrome , 2005, Alimentary pharmacology & therapeutics.

[10]  D. Drossman,et al.  The Functional Gastrointestinal Disorders: Diagnosis, Pathophysiology, and Treatment : A Multinational Consensus , 1994 .

[11]  M. B. de Morais,et al.  Breath Methane Associated With Slow Colonic Transit Time in Children With Chronic Constipation , 2005, Journal of clinical gastroenterology.

[12]  T C Stadtman,et al.  Methane fermentation. , 1967, Annual Review of Microbiology.

[13]  J. Bond,et al.  FACTORS INFLUENCING PULMONARY METHANE EXCRETION IN MAN , 1971, The Journal of experimental medicine.

[14]  A. Gasbarrini,et al.  Abnormal breath tests to lactose, fructose and sorbitol in irritable bowel syndrome may be explained by small intestinal bacterial overgrowth , 2005, Alimentary pharmacology & therapeutics.

[15]  J. Bond,et al.  Volume, composition, and source of intestinal gas. , 1970, Gastroenterology.

[16]  K W Heaton,et al.  Functional bowel disorders and functional abdominal pain , 1999, Gut.

[17]  M. Levitt.  Production and excretion of hydrogen gas in man. , 1969, The New England journal of medicine.

[18]  F. Ingelfinger,et al.  HYDROGEN AND METHANE PRODUCTION IN MAN * , 1968, Annals of the New York Academy of Sciences.

[19]  E. Bjornsson,et al.  Small intestinal bacterial overgrowth is not of major importance in the irritable bowel syndrome , 2003 .

[20]  L. Blendis,et al.  Studies on breath methane: the effect of ethnic origins and lactulose. , 1980, Gut.

[21]  M. Pimentel,et al.  Neomycin Improves Constipation-Predominant Irritable Bowel Syndrome in a Fashion That Is Dependent on the Presence of Methane Gas: Subanalysis of a Double-Blind Randomized Controlled Study , 2006, Digestive Diseases and Sciences.

[22]  Henry C. Lin,et al.  Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome , 2000, American Journal of Gastroenterology.

[23]  D. Calloway,et al.  THE USE OF EXPIRED AIR TO MEASURE INTESTINAL GAS FORMATION , 1968, Annals of the New York Academy of Sciences.

[24]  F. Bornet,et al.  Breath hydrogen response to lactulose in healthy subjects: relationship to methane producing status. , 1990, Gut.

[25]  Henry C. Lin,et al.  Methane, a gas produced by enteric bacteria, slows intestinal transit and augments small intestinal contractile activity. , 2006, American journal of physiology. Gastrointestinal and liver physiology.