Prevalence of small intestinal bacterial overgrowth in irritable bowel syndrome (IBS): Correlating H2 or CH4 production with severity of IBS

Philippe Onana Ndong, Hanae Boutallaka, Eugenia Marine-Barjoan, Dann Ouizeman, Raja Mroue, Rodolphe Anty, Geoffroy Vanbiervliet, Thierry Piche, Philippe Onana Ndong, Hanae Boutallaka, Eugenia Marine-Barjoan, Dann Ouizeman, Raja Mroue, Rodolphe Anty, Geoffroy Vanbiervliet, Thierry Piche

Abstract

Background and aim: The prevalence and the role of small intestinal bacterial overgrowth (SIBO) in irritable bowel syndrome (IBS) remain unclear, as the literature provides heterogeneous information on the subject. The aim of this study was to determine the prevalence of SIBO in IBS and to assess the correlation between methane and hydrogen levels measured during breath tests and the severity of IBS.

Method: Two-hundred and forty-seven patients with IBS were prospectively included. A glucose breath test (GBT) measured H2 and CH4 production to diagnose SIBO. A test was positive when H2 values exceeded 12 ppm in the first 90 min and/or when a CH4 value exceeded 10 ppm at any time. IBS severity (IBS-SSS), quality of life (GIQLI), and anxiety and depression (HAD) were assessed to investigate the correlation with H2 and CH4 production.

Results: The prevalence of SIBO in IBS was 36.4% (9.7% with H2, 26.7% with CH4). CH4 levels were significantly higher in the predominantly constipated patients (P = 0.00), while H2 levels were significantly higher within the diarrheal phenotype (P = 0.01). IBS severity was not correlated with either H2 levels (r = 0.02; P = 0.84) or CH4 levels (r = 0.05; P = 0.64). H2 production was inversely correlated with the quality of life (r = -0.24; P = 0.03) and significantly correlated with the HAD scale (r = 0.22; P = 0.03). The pain and discomfort experienced during GBT was not correlated with methane levels (r = -0.09, P = 0.40), hydrogen levels (r = -0.01, P = 0.93), or sum of both (r = 0.06, P = 0.58), but significantly associated with IBS severity (r = 0.50, P <0.00).

Conclusion: SIBO has a high prevalence in IBS but does not increase its severity. Individual susceptibility to pain may have a greater influence on the severity of IBS.

Keywords: gastrointestinal disorders; glucose breath test; hydrogen; irritable bowel syndrome; methane; small intestinal bacterial overgrowth.

© 2023 The Authors. JGH Open published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Figures

Figure 1
Figure 1
Examples of positive glucose breath tests. (a) Representation of a H2 positive test, with H2 production >12 ppm within the first 90 min of the test. (b) Representation of a positive CH4 test, with H2 production surpassing the 10 ppm threshold.
Figure 2
Figure 2
Gas production according to irritable bowel syndrome (IBS) phenotypes. (a) H2 production and IBS phenotypes. (b) CH4 production and IBS phenotypes. IBS‐C, irritable bowel syndrome with a predominantly constipated phenotype; IBS‐D, irritable bowel syndrome with a predominantly diarrheal phenotype; IBS‐M, irritable bowel syndrome with alternating phenotype. *Significant statistical difference.
Figure 3
Figure 3
Gas production and IBS‐SSS. (a) H2 production and IBS‐SSS. (b) CH4 production and IBS‐SSS.
Figure 4
Figure 4
Gas production and pain/incomfort reported during glucose breath test (GBT). (a) H2 production and pain occurring during GBT. (b) CH4 production and pain occurring during GBT. VAS, visual analog scale, with values from 0 to 10 mesured 12 times during the test (each 15 min), and then summed for statistical analysis.
Figure 5
Figure 5
Correlation between IBS severity and pain during GBT. VAS, visual analog scale, with values from 0 to 10 mesured 12 times during the test (each 15 min), and then summed for statistical analysis.

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