Abstract
It has recently been determined that there is an increased prevalence of bacterial overgrowth in IBS. Since there are two gases (hydrogen and methane) measured on lactulose breath testing, we evaluated whether the different gas patterns on lactulose breath testing coincide with diarrhea and constipation symptoms in IBS and IBD. Consecutive patients referred to the gastrointestinal motility program at Cedars-Sinai Medical Center for lactulose breath testing were given a questionnaire to evaluate their gastrointestinal symptoms. Symptoms were graded on a scale of 0–5. Upon completion of the breath test, the results were divided into normal, hydrogen only, hydrogen and methane, and methane only positive breath tests. A comparison of all subjects and IBS subjects was undertaken to evaluate diarrhea and constipation with regards to the presence or absence of methane. This was further contrasted to Crohn's and ulcerative colitis (UC) patients in the database. After exclusion criteria, 551 subjects from the database were available for comparison. Of the 551 subjects (P < 0.05, one-way ANOVA) and in a subgroup of 296 IBS subjects (P < 0.05, one-way ANOVA), there was a significant association between the severity of reported constipation and the presence of methane. The opposite was true for diarrhea (P < 0.001). If a breath test was methane positive, this was 100% associated with constipation predominant IBS. Furthermore, IBS had a greater prevalence of methane production than Crohn's or UC. In fact, methane was almost nonexistent in the predominantly diarrheal conditions of Crohn's and UC. In conclusion, a methane positive breath test is associated with constipation as a symptom.
Similar content being viewed by others
REFERENCES
Pimentel M, Chow EJ, Lin HC: Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenteral 95:3503-3506, 2000
Rutgeerts P, Ghoos Y, Vantrappen G, Eyssen H: Ileal dysfunction and bacterial overgrowth in patients with Crohn's disease. Eur J Clin Invest 11:199-206, 1981
Funayama Y, Sasaki I, Naito H, Fukushima K, Shibata C, Masuko T, Takahashi K, Ogawa H, Sato S, Ueno T, Noguchi M, Hiwatashi N, Matsumo S: Monitoring and antibacterial treatment for postoperative bacterial overgrowth in Crohn's disease. Dis Colon Rectum 42:1072-1077, 1999
Castiglione F, Del Vecchio Blanco G, Rispo A, Petrelli G, Amalfi G, Gozzolino A, Cuccaro I, Mazzacca G: Orocecal transit time and bacterial overgrowth in patients with Crohn's disease. J Clin Gastroenterol 31:63-6, 2000
Joseph F, Jr., Rosenberg AJ: Breath hydrogen testing: diseased versus normal patients. J Pediatr Gastroenterol Nutr 7:787-8, 1988 (letter)
Levitt MD, Ingelfinger FJ: Hydrogen and methane production in man. Ann NY Acad Sci 150:75-81, 1968
McCay LF, Eastwood MA, Brydon WG: Methane excretion in man-a study of breath, flatus, and faeces. Gut 26:69-74, 1985
Peled Y, Weinberg D, Hallak A, et al: Factors affecting methane production in humans. Gastrointestinal diseases and alterations of colonic flora. Dig Dis Sci 32:267-71, 1987
Melcher EA, Levitt MD, Slavin JL: Methane production and bowel function parameters in healthy subjects on low-and high fiber diets. Nutr Cancer 16:85-92, 1991
Weaver GA, Krause JA, Miller TL, Wolin MJ: Incidence of methanogenic bacteria in a sigmoidoscopy population: an association of methanogenic bacteria and diverticulosis. Gut 27:698-704, 1986
Fiedorek SC, Pumphrey CL, Casteel HB: Breath methane excretion in children with constipation and encopresis. J Pediatr Gastroenterol Nutr 10:473-77, 1990
Pimentel M, Chow EJ, Lin HC: Neomycin leads to dramatic improvement in IBS symptoms that depend on lactulose breath test findings: A double blind randomized placebo controlled study. Am J Gastroenterol 2002 (in press)
Miller TL, Wolin MJ: Enumeration of Methanobrevibacter smithii in human feces. Arch Microbiol 131:14-18, 1982
Bond JH Jr. Levitt MD: Investigation of small bowel transit time in man utilizing pulmonary hydrogen (H2) measurements. J Lab Clin Med 85:546-555, 1975
Rhodes JM, Middleton P, Jewell DP: The lactulose hydrogen breath test as a diagnostic test for small intestinal bacterial overgrowth. Scand J Gastroenterol 14:333-6, 1979
Joseph F Jr, Rosenberg AJ: Breath testing: diseased versus normal patients. J Pediatr Gastroenterol 7:787-8, 1988
Kerlin P, Wong L: Breath hydrogen testing in bacterial overgrowth of the small intestine. Gastroenterology 95:982-8, 1988
Bond JH, RR Engel, Levitt MD: Factors influencing pulmonary methane excretion in man. J Exp Med 133:572-588, 1971
Miller TL, Wolin MJ, de Macario EC, Macario AJ: Isolation of Methanobrevibacter smithii from human feces. Appl Environ Microbiol 43:227-32, 1982
Miller TL, Weaver GA, Wolin MJ: Methanogens and anaerobes in a colon segment isolated from the normal fecal stream. Appl Environ Microbiol 48:449-50, 1984
Pochart P, Lemann F, Flourie B, Pellier P, Goderol I, Rambaud JC: Pyxigraphic sampling to enumerate methanogens and anaerobes in the right colon of healthy humans. Gastroenterology 105:1281-1285,1993
Macfarlane GT, Gibson GR, Cummings JH: Comparison of fermentation reactions in different regions of the human colon. J Appl Bacteriol 72:57-64, 1992
McKay LF, Holbrook WP, Eastwood MA: Methane and hydrogen production by human intestinal anaerobic bacteria. Acta Path of Microbiol Immun Scand 90B:257-260, 1982
Kajs TM, Fitzgerald JA, Buckner BS, Coyle GA, Stinson BS, Morel JG, Levitt MD: Influence of methanogenic flora on the breath H2 and symptom response to ingestion of sorbitol or oat fiber. Am J Gastroenterol 92:89-94, 1997
Gibson GR, Macfarlane GT, Cummings JH: Occurrence of sulphatereducing bacteria in human faeces and the relationship of dissimilatory sulphate reduction to methanogenesis in the large gut. J Appl Bacteriol 65:103-11, 1988
Gibson GR, Cummings JH, Macfarlane GT: Competition for hydrogen between sulphate-reducing bacteria and methanogenic bacteria from the human large intestine. J Appl Bacteriol 65:241-7, 1988
Gibson GR, Cummings JH, Macfarlane GT, Allison C, Segal I, Vorster HH, Walker AR: Alternative pathways for hydrogen disposal during fermentation in the human colon. Gut 31:679-83, 1990
Roediger WEW, Duncan A, Kapaniris O, Millard S: Reducing sulfur compounds of the colon impair colonocyte nutrition: implications for ulcerative colitis. Gastroenterology 104:802-9, 1993
Pitcher MCL, Cummings JH: Hydrogen sulfide: a bacterial toxin in ulcerative colitis. Gut 39:1-4, 1996
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Pimentel, M., Mayer, A.G., Park, S. et al. Methane Production During Lactulose Breath Test Is Associated with Gastrointestinal Disease Presentation. Dig Dis Sci 48, 86–92 (2003). https://doi.org/10.1023/A:1021738515885
Issue Date:
DOI: https://doi.org/10.1023/A:1021738515885