Elevated methane levels in small intestinal bacterial overgrowth suggests delayed small bowel and colonic transit

Jaspreet Suri, Rahul Kataria, Zubair Malik, Henry P Parkman, Ron Schey, Jaspreet Suri, Rahul Kataria, Zubair Malik, Henry P Parkman, Ron Schey

Abstract

Limited research exists regarding the relationship between small intestinal bacterial overgrowth (SIBO), small bowel transit (SBT), and colonic transit (CT). Furthermore, symptom analysis is limited between the subtypes of SIBO: hydrogen producing (H-SIBO) and methane producing (M-SIBO). The primary aims of this study are to: compare the SBT and CT in patients with a positive lactulose breath test (LBT) to those with a normal study; compare the SBT and CT among patients with H-SIBO or M-SIBO; compare the severity of symptoms in patients with a positive LBT to those with a normal study; compare the severity of symptoms among patients with H-SIBO or M-SIBO.A retrospective review was performed for 89 patients who underwent a LBT and whole gut transit scintigraphy (WGTS) between 2014 and 2016. Seventy-eight patients were included. WGTS evaluated gastric emptying, SBT (normal ≥40% radiotracer bolus accumulated at the ileocecal valve at 6 hours), and CT (normal geometric center of colonic activity = 1.6-7.0 at 24 hours, 4.0-7.0 at 48 hours, 6.2-7.0 at 72 hours; elevated geometric center indicates increased transit). We also had patients complete a pretest symptom survey to evaluate nausea, bloating, constipation, diarrhea, belching, and flatulence.A total of 78 patients (69 females, 9 males, mean age of 48 years, mean BMI of 25.9) were evaluated. Forty-seven patients had a positive LBT (H-SIBO 66%, M-SIBO 34%). Comparison of SBT among patients with a positive LBT to normal LBT revealed no significant difference (62.1% vs 58.6%, P = .63). The mean accumulated radiotracer was higher for H-SIBO compared to M-SIBO (71.5% vs 44.1%; P < .05). For CT, all SIBO patients had no significant difference in geometric centers of colonic activity at 24, 48, and 72 hours when compared to the normal group. When subtyping, H-SIBO had significantly higher geometric centers compared to the M-SIBO group at 24 hours (4.4 vs 3.1, P < .001), 48 hours (5.2 vs 3.8, P = .002), and at 72 hours (5.6 vs 4.3, P = .006). The symptom severity scores did not differ between the positive and normal LBT groups. A higher level of nausea was present in the H-SIBO group when compared to the M-SIBO group.Overall, the presence of SIBO does not affect SBT or CT at 24, 48, and 72 hours. However, when analyzing the subtypes, M-SIBO has significantly more delayed SBT and CT when compared to H-SIBO. These results suggest the presence of delayed motility in patients with high methane levels on LBT.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Representation of exhaled gas composition for a patient with a normal lactulose breath test.
Figure 2
Figure 2
Representation of a patient with “double-peak” pattern displaying premature rise in exhaled hydrogen gas with subsequent expected rise in exhaled hydrogen later on in the time course of the LBT.
Figure 3
Figure 3
Representation of typical exhaled gas composition for a patient with hydrogen type SIBO.
Figure 4
Figure 4
Typical exhaled pattern of gases for patient with methane type SIBO displaying rise in exhaled methane.

References

    1. Ghoshal U, Ghoshal U. Small intestinal bacterial overgrowth and other intestinal disorders. Gastroenterol Clin North Am 2017;46:103–20.
    1. Khoshini R, Dai S, Lezcano S, et al. A systematic review of diagnostic tests for small intestinal bacterial overgrowth. Dig Dis Sci 2008;53:1443–54.
    1. Riordan SM, McIver CJ, Walker BM, et al. The lactulose breath hydrogen test and small intestinal bacterial overgrowth. Am J Gastroenterol 1996;91:1795–803.
    1. Rezaie A, Pimentel M, Rao SSC. How to test and treat small intestinal bacterial overgrowth: an evidence-based approach. Curr Gastroenterol Rep 2016;18:8.
    1. Erdogan A, Rao SS, Gulley D, et al. Small intestinal bacterial overgrowth: duodenal aspiration vs glucose breath test. Neurogastroenterol Motil 2015;27:481–9.
    1. Pimentel M, Mayer AG, Park S, et al. Methane production during lactulose breath test is associated with gastrointestinal disease presentation. Dig Dis Sci 2003;48:86–92.
    1. Attaluri A, Jackson M, Paulson J, et al. Methanogenic flora is associated with altered colonic transit but not stool characteristics in constipation without IBS. Am J Gastroenterol 2009;105:1407–11.
    1. Pimentel M, Lin HC, Enayati P, et al. Methane, a gas produced by enteric bacteria, slows intestinal transit and augments small intestinal contractile activity. Am J Physiol 2006;290:G1089–95.
    1. Saad RJ, Chey WD. Breath tests for gastrointestinal disease: the real deal or just a lot of hot air? Gastroenterology 2007;133:1763–6.
    1. Romagnuolo J, Schiller D, Bailey RJ. Using breath tests wisely in a gastroenterology practice: an evidence-based review of indications and pitfalls in interpretation. Am J Gastroenterol 2002;97:1113–26.
    1. Erdogan A, Lee YY, Badger C, et al. What is the optimal threshold for an increase in hydrogen and methane levels with glucose breath test (GBT) for detection of small intestinal bacterial overgrowth (SIBO)? Gastroenterology 2014;146(suppl 1): S-532.
    1. Maurer AH, Camilleri M, Donohoe K, et al. The SNMMI and EANM practice guideline for small-bowel and colonic transit 1.0. J Nucl Med 54, 2004–2013.
    1. Bhagatwala J, Sharma A, Murugappan A, et al. Methanogenic flora and its effects on regional and whole gut transit and small bowel PH. Gastroenterology 2017;152: doi:10.1016/s0016-5085(17)30526-7.
    1. Southwell BR, Clarke MCC, Sutcliffe J, et al. Colonic transit studies: normal values for adults and children with comparison of radiological and scintigraphic methods. Pediatr Surg Int 2009;25:559–72.
    1. Triantafyllou K, Chang C, Pimentel M, et al. Methane and gastrointestinal motility. J Neurogastroenterol Motil 2014;20:31–40.
    1. Pimentel M, Kong Y, Park S. IBS subjects with methane on lactulose breath test have lower postprandial serotonin levels than subjects with hydrogen. Dig Dis Sci 2004;49:84–7.
    1. Gottlieb K, Wacher V, Sliman J, et al. Review article: inhibition of methanogenic archaea by statins as a targeted management strategy for constipation and related disorders. Aliment Pharmacol Ther 2015;43:197–212.
    1. Dukowicz AC, Lacy BE, Levine GM. Small intestinal bacterial overgrowth: a comprehensive review. Gastroenterol Hepatol 2007;3:112–22.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다