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Effect of predominant methanogenic flora on the outcome of lactose breath test in irritable bowel syndrome patients

European Journal of Clinical Nutrition volume 57, pages 1116–1119 (2003)Cite this article

Abstract

Background: The relationship between hydrogen and methane production is a possible confounding factor in the interpretation of H2 breath tests (HBT), but is usually disregarded for the interpretation of HBT and, in most instances, only H2 excretion is measured. The present study was designed to evaluate the effect of predominant fasting methane CH4 or H2 production on the outcome of lactose HBT, in a large, homogeneous series of adult patients with irritable bowel syndrome (IBS).

Patients and methods: A lactose HBT was performed in 237 IBS patients with predominant fasting methane production (CH4>H2), recording the outcome of the test, amount of gas excreted and occurrence of clinical symptoms. Data were compared to those of 237 age- and sex-matched IBS patients with low fasting CH4 excretion.

Results: The test was positive in 124 predominant CH4 producers (52.3%) (PMP), as compared to 201 (84.8%) low methane producers (LMP) (P<0.0001). Peak hydrogen concentration and area under the curve of H2 were significantly (P<0.001) lower, and the occurrence of symptoms during the test less frequent, in PMP vs LMP patients. During the test, CH4 excretion doubled in 57/113 (50.4%) patients with negative HBT, and in 49/124 (39.5%) with positive HBT.

Conclusions: Patients with predominant fasting methane production excrete less H2 than LMP, after an oral load of lactose. The lower prevalence of severe lactose intolerance in PMP, as well as lower incidence of symptoms during the test, is, indeed, related to lower and slower H2 excretion. The assumption that H2 excretion is an effective means of quantifying the amount of malabsorbed carbohydrates is questionable in PMP. Methane-producing patients likely have a higher ‘false negative’ rate as compared to LMP after an oral load of lactose. Nonetheless, as symptoms are related to the amount of gas produced in the colon, HBT identifies patients with ‘lactose intolerance’, irrespective of the presence of lactose malabsorption, and helps in predicting the effect of lactose-restricted diet.

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References

  • Bjorneklett A & Janssen E (1982): Relationship between hydrogen and methane production in man. Scand. J. Gastroenterol. 17, 985–992.

    CAS  PubMed  Google Scholar 

  • Bond JH & Levitt MD (1977): Use of breath hydrogen (H2) in the study of carbohydrate absorption. Dig. Dis. 22, 379–382.

    Article  CAS  Google Scholar 

  • Bozzani A, Penagini R, Velio P, Camboni G, Quatrini M & Conte D et al. (1986): Lactose malabsorption and intolerance in Italians. Dig. Dis. Sci. 31, 1313–1316.

    Article  CAS  Google Scholar 

  • Burgio GR, Flatz G, Barbera C, Patanè R, Boner A & Cajozzo C et al. (1984): Prevalence of primary adult lactose malabsorption and awareness of milk intolerance in Italy. Am. J. Clin. Nutr. 39, 100–104.

    Article  CAS  Google Scholar 

  • Cloarec D, Bornet F, Gouilloud S, Barry JL, Salim B & Galmiche JP (1990): Breath hydrogen response to lactulose in healty subjects: relationship to methane producing status. Gut. 31, 300–304.

    Article  CAS  Google Scholar 

  • Cloarec D, Gouilloud S, Bornet F, Bruley Des Varannes S, Bizais Y & Galmiche JP (1991): Deficit en lactase et symptomes d'intolerance au lactose dans une population adulte saine originaire de l'ouest de la France. Gastroenterol. Clin. Biol. 15, 588–593.

    CAS  PubMed  Google Scholar 

  • Corazza R, Benati G, Strocchi A, Malservisi S & Gasbarrini G (1994): The possible role of breath methane measurement in detecting carbohydrate malabsorption. J. Lab. Clin. Med. 124, 695–699.

    CAS  PubMed  Google Scholar 

  • Levitt MD & Bond JH (1970): Volume, composition, and source of intestinal gas. Gastroenterology 59, 921–929.

    CAS  PubMed  Google Scholar 

  • Mc Kay LF, Eastwood MA & Brydon WG (1985): Methane excretion in man—a study of breath, flatus and faeces. Gut. 26, 69–74.

    Article  CAS  Google Scholar 

  • Metz G, Gassull MA, Leeds AR, Blendis LM & Jenkins DJA (1976): A simple method for measuring hydrogen in carbohydrate malabsorption by end-expiratory sampling. Clin. Sci. Mol. Med. 50, 237–240.

    CAS  PubMed  Google Scholar 

  • Montes RG, Saavedra JM & Perman JA (1993): Relationship between production and breath hydrogen excretion in lactose-malabsorbing individuals. Dig. Dis. Sci. 38, 445–448.

    Article  CAS  Google Scholar 

  • Peled Y, Weinberg D, Hallak A & Gilat T (1987): Factors affecting methane production in humans. Dig. Dis. Sci. 32, 267–271.

    Article  CAS  Google Scholar 

  • Rosado JL & Solomons NW (1983): Sensitivity and specificity of the hydrogen breath-analysis test for detecting malabsorption of physiological doses of lactose. Clin. Chem. 29, 545–548.

    CAS  PubMed  Google Scholar 

  • Stephen AM, Wiggins HS, Englyst HN, Cole TJ, Wayman BJ & Cummings JH (1986): The effect of age, sex and level of intake of dietary fibre from wheat on large bowel function in thirty healthy subjects. Br. J. Nutr. 56, 349–361.

    Article  CAS  Google Scholar 

  • Strocchi A, Ellis CJ, Furne JK & Levitt MD (1994): Study of constancy of hydrogen-consuming flora of human colon. Dig. Dis. Sci. 39, 494–497.

    Article  CAS  Google Scholar 

  • Thompson WG, Dotevall G, Drossman DA, Heaton KW & Kruis W (1989): Irritable bowel syndrome: guidelines for the diagnosis. Gastroenterol. Int. 2, 92–95.

    Google Scholar 

  • Wolin MJ (1981): Fermentation in the lumen and large intestine. Science 213, 1463–1468.

    Article  CAS  Google Scholar 

Download references

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Authors and Affiliations

  1. Dipartimento Scienze Cliniche, Cattedra di Gastroenterologia 1, Università di Roma ‘La Sapienza ’, Rome, Italy

    P Vernia, M Di Camillo, V Marinaro & R Caprilli

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  1. P Vernia
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  2. M Di Camillo
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  3. V Marinaro
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  4. R Caprilli
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Contributions

Contributors: PV, designed the study, participated in the interpretation of results and wrote the paper. MDiC and VM performed the tests, participated in the analysis of data and the interpretation of results. RC provided scientific advice and critical review of the final results. All contributors took part in the planning of the design and the execution of the study, share the responsibility of the paper, which has been reviewed and approved by all authors.

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Correspondence to P Vernia.

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Vernia, P., Camillo, M., Marinaro, V. et al. Effect of predominant methanogenic flora on the outcome of lactose breath test in irritable bowel syndrome patients. Eur J Clin Nutr 57, 1116–1119 (2003). https://doi.org/10.1038/sj.ejcn.1601651

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