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Do Interventions Which Reduce Colonic Bacterial Fermentation Improve Symptoms of Irritable Bowel Syndrome?

Digestive Diseases and Sciences volume 50, pages 758–766 (2005)Cite this article

Abstract

Abnormal fermentation may be an important factor in irritable bowel syndrome (IBS). Gastroenteritis or antibiotic therapy may damage the colonic microflora, leading to increased fermentation and the accumulation of gas. Gas excretion may be measured by whole-body calorimetry but there has only been one such study on IBS to date. We aimed to assess the relationship between IBS symptoms and fermentation rates in IBS. A purpose-built, 1.4-m3, whole-body calorimeter was used to assess excretion of H2 and CH4 in IBS subjects while consuming a standard diet and, again, after open randomization on either the standard diet together with the antibiotic metronidazole or a fiber-free diet to reduce fermentation. Metronidazole significantly reduced the 24-hr excretion of hydrogen (median value compared to the control group, 397 vs 230 ml/24 hr) and total gas (H2 + CH4; 671 vs 422 ml/min) and the maximum rate of gas excretion (1.6 vs 0.8 ml/min), as did a no-fiber polymeric diet (hydrogen, 418 vs 176 ml/min; total gas, 564 vs 205 ml/min; maximum rate of gas excretion, 1.35 vs 0.45 ml/min), with a significant improvement in abdominal symptoms. IBS may be associated with rapid excretion of gaseous products of fermentation, whose reduction may improve symptoms.

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Authors and Affiliations

  1. Department of Gastroenterology, Addenbrooke’s Hospital NHS Trust, Cambridge

    Keith L. E. Dear MD & John O. Hunter MD, FRCP, FACG

  2. Institute of Human Nutrition, University of Southampton, Southampton, UK

    Marinos Elia MD

  3. Box 262, Addenbrooke’s NHS Trust, Hills Road, Cambridge, CB2 2QQ, UK

    John O. Hunter MD, FRCP, FACG

Authors
  1. Keith L. E. Dear MD
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  2. Marinos Elia MD
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  3. John O. Hunter MD, FRCP, FACG
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Correspondence to John O. Hunter MD, FRCP, FACG.

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Dear, K.L.E., Elia, M. & Hunter, J.O. Do Interventions Which Reduce Colonic Bacterial Fermentation Improve Symptoms of Irritable Bowel Syndrome?. Dig Dis Sci 50, 758–766 (2005). https://doi.org/10.1007/s10620-005-2570-4

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  • DOI: https://doi.org/10.1007/s10620-005-2570-4

Keywords

  • irritable bowel syndrome
  • bacterial fermentation
  • antibiotics
  • enteral feeds
  • calorimetry
  • hydrogen
  • methane