Methanogenic Flora and its Effects on Regional and Whole Gut Transit and Small Bowel PH

Bhagatwala, Jigar; Sharma, Amol; Murugappan, A.; Mack, Arie; Rao, Satish S.

doi:10.1016/s0016-5085(17)30526-7

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“…This is in contrast to Rao et al who had demonstrated no significant relationship between methane gas and delay in small intestinal motility. [13] We hypothesize that Rao et al provided contrasting results because they utilized the WMC in assessment of intestinal motility, a method that has shown to be less reliable in terms of segmental transit when compared to radioisotope studies. [14] Our study is novel by evaluating correlation between WGTS and lactulose breath testing.…”

Section: Discussionmentioning

confidence: 99%

Elevated Methane Levels in Small Intestinal Bacterial Overgrowth Suggests Delayed Small Bowel and Colonic Transit

Suri

Kataria²,

Malik³

et al. 2017

Gastroenterology

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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.Abbreviations: BMI = body mass index, CT = colonic transit, H-SIBO = hydrogen type small intestinal bacterial overgrowth, IBD = inflammatory bowel disease, IBS = irritable bowel syndrome, LBT = lactulose breath test, M-SIBO = methane type small intestinal bacterial overgrowth, PAGI-SYM = Patient Assessment of Gastrointestinal Disorders Symptom Severity Index, PPM = parts per million, SBT = small bowel transit, SIBO = small intestinal bacterial overgrowth, WGTS = whole gut transit scintigraphy, WMC = wireless motility capsule.

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Section: Discussionmentioning

confidence: 99%