Incidence of Predominant Methanogenic Flora in Irritable Bowel Syndrome Patients and Apparently Healthy Controls from North India

  • S. V. Rana
  • S. Sharma
  • S. K. Sinha
  • H. Kaur
  • A. Sikander
  • K. Singh
Original Paper


Background Flatulence is a common symptom in patients with irritable bowel syndrome (IBS). This may be due to production of hydrogen by intestinal flora. With the presence of methanogenic flora, 4 mol of hydrogen (H2) are used with 1 mol of carbon dioxide (CO2) to produce 1 mol of methane (CH4), a process greatly reducing the volume of gas in the colon. However, the prevalence of methanogenic flora has not yet been reported in healthy and IBS patients from North India. Therefore, this study was planned. Methods This study was conducted prospectively and included 345 patients with irritable bowel syndrome (fulfilling Rome II criteria) and 254 age- and gender-matched apparently healthy controls. Each subject underwent a hydrogen breath test using 10 g lactulose after an overnight fast. An SC Microlyser from Quintron, USA, was used to measure methane and hydrogen at baseline and at every 30 min for 4 h. Subjects with fasting methane concentration <10 p.p.m. were labeled as low methane producers (LMPs) and > 10 p.p.m. as predominant methane producers (PMPs). Results The IBS and control groups included 66.78% and 67.53% men, respectively. Mean age in the two groups was 48.52 ± 30.54 years (range 15–68 years) and 45.67 ± 30.54 years (range 15–78 years), respectively. Prevalence of predominant methanogenic flora in IBS and control groups was 14.5% (50/345) and 34.6% (88/254), respectively (P < 0.001). Fifty-two out of 254 (20.6 %) were PMPs and 36 out of 254 (14.0%) were LMPs in controls. In contrast to this, IBS patients had 17 out of 354 (4.9%) that were PMPs and 33 out of 345 (9.6%) that were LMPs. Conclusion Methanogenic flora was significantly lower in IBS patients from North India than in apparently healthy subjects. This may be one of the causes of flatulence in IBS patients.


Hydrogen Methane Breath test Irritable bowel syndrome 


  1. 1.
    Pimentel M, Lezcano S (2007) Irritable bowel syndrome: bacterial overgrowth—what’s known and what to do. Curr Treat Options Gastroenterol 10:328–337. doi:10.1007/s11938-007-0076-1 PubMedCrossRefGoogle Scholar
  2. 2.
    Riordan SM, Kim R (2006) Bacterial overgrowth as a cause of irritable bowel syndrome. Curr Opin Gastroenterol 22:669–673. doi:10.1097/01.mog.0000245544.80160.46 PubMedCrossRefGoogle Scholar
  3. 3.
    Lee HR, Pimentel M (2006) Bacteria and irritable bowel syndrome: the evidence for small intestinal bacterial overgrowth. Curr Gastroenterol Rep 8:305–311. doi:10.1007/s11894-006-0051-3 PubMedCrossRefGoogle Scholar
  4. 4.
    Tormo R, Bertaccini A, Conde M, Infante D, Cura I (2001) Methane and hydrogen exhalation in normal children and in lactose malabsorption. Early Hum Dev 65 [Suppl]:S165–S172. doi:10.1016/S0378-3782(01)00219-5 PubMedCrossRefGoogle Scholar
  5. 5.
    Montes RG, Saavedra JM, Perman JA (1993) Relationship between methane production and breath hydrogen excretion in lactose-malabsorbing individuals. Dig Dis Sci 38:445–448. doi:10.1007/BF01316497 PubMedCrossRefGoogle Scholar
  6. 6.
    Myo-Khin, Bolin TD, Khin-Mar-Oo, Tin-Oo, Kyaw-Hla S, Thein-Myint T (1999) Ineffectiveness of breath methane excretion as a diagnostic test for lactose malabsorption. J Pediatr Gastroenterol Nutr 28:474–479. doi:10.1097/00005176-199905000-00006
  7. 7.
    Vernia P, Camillo MD, Marinaro V, Caprilli R (2003) Effect of predominant methanogenic flora on the outcome of lactose breath test in irritable bowel syndrome patients. Eur J Clin Nutr 57:1116–1119. doi:10.1038/sj.ejcn.1601651 PubMedCrossRefGoogle Scholar
  8. 8.
    Corazza GR, Benati G, Strocchi A, Malservisi S, Gasbarrini G (1994) The possible role of breath methane measurement in detecting carbohydrate malabsorption. J Lab Clin Med 124:695–700PubMedGoogle Scholar
  9. 9.
    Bond JH, Levitt MD (1997) Use of breath hydrogen (H2) to quantitate small bowel transit time following partial gastrectomy. J Lab Clin Med 90:30–36Google Scholar
  10. 10.
    Bond JH Jr, Engel RR, Levitt MD (1971) Factors influencing pulmonary methane excretion in man. An indirect method of studying the in situ metabolism of the methane-producing colonic bacteria. J Exp Med 133:572–588. doi:10.1084/jem.133.3.572 PubMedCrossRefGoogle Scholar
  11. 11.
    Wolin MJ (1981) Fermentation in the lumen and large intestine. Science 213:1463–1468. doi:10.1126/science.7280665 PubMedCrossRefGoogle Scholar
  12. 12.
    Peled Y, Weinberg D, Hallak A, Gilat T (1987) Factors affecting methane production in humans. Gastrointestinal diseases and alterations of colonic flora. Dig Dis Sci 32(3):267–271. doi:10.1007/BF01297052 PubMedCrossRefGoogle Scholar
  13. 13.
    Bratten JR, Spanier J, Jones MP (2008) Lactulose breath testing does not discriminate patients with irritable bowel syndrome from healthy controls. Am J Gastroenterol 103:1–6. doi:10.1111/j.1572-0241.2008.01785.x CrossRefGoogle Scholar
  14. 14.
    Chatterjee S, Park S, Low K, Kong Y, Pimentel M (2007) The degree of breath methane production in IBS correlates with the severity of constipation. Am J Gastroenterol 102:837–841. doi:10.1111/j.1572-0241.2007.01072.x PubMedCrossRefGoogle Scholar
  15. 15.
    Piqué JM, Pallarés M, Cusó E, Vilar-Bonet J, Gassull MA (1984) Methane production and colon cancer. Gastroenterology 87:601–605PubMedGoogle Scholar
  16. 16.
    Pitt P, de Bruijn KM, Beeching MF, Goldberg E, Blendis LM (1980) Studies on breath methane: the effect of ethnic origins and lactulose. Gut 21:951–954. doi:10.1136/gut.21.11.951 PubMedCrossRefGoogle Scholar
  17. 17.
    Wolfe RS (1971) Microbial formation of methane. Adv Microb Physiol 6:107–146PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • S. V. Rana
    • 1
    • 2
  • S. Sharma
    • 1
  • S. K. Sinha
    • 1
  • H. Kaur
    • 1
  • A. Sikander
    • 1
  • K. Singh
    • 1
  1. 1.Department of GastroenterologyPostgraduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
  2. 2.ChandigarhIndia

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