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Evaluating Breath Methane as a Diagnostic Test for Constipation-Predominant IBS

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Abstract

Studies suggest that subjects with IBS have altered gut flora. Among these findings, methane production is more commonly associated with constipation-predominant symptoms. In this study, we prospectively evaluated the role of methane as a diagnostic test. Consecutive Rome I positive IBS patients referred for a lactulose breath test were eligible to participate. After exclusion criteria, subjects completed a symptom questionnaire grading bloating, diarrhea, and constipation on a VAS scale (0–100 mm). Once completed, a physician interviewed the subjects and rated the subject accordingly, and also determined whether the patient had C-IBS, D-IBS, or neither. Subjects and physicians were blinded to the results of the breath test. The presence of methane in the breath test was compared to the results of the scoring by subjects and physicians. A total of 56 Rome I positive IBS subjects were enrolled. During breath testing, 28 subjects produced methane. Good agreement between physician’s evaluation and the patient’s was seen (diarrhea = 0.69; constipation = 0.69; bloating = 0.62). The severity of constipation was noted to be greater in the methane group (49.3 ± 28.7) than in the non-methane group (25.3 ± 31.47) (P < 0.01). In contrast, diarrhea was less severe in the methane group (12.3 ± 21.0) than the non-methane group (36.7 ± 32.4) (P < 0.01). Out of the 56 patients, 23 C-IBS subjects were identified by the physician. When methane was used to predict the assignment of C-IBS compared to non-C-IBS, it had a sensitivity of 91.7% and a specificity of 81.3% (OR = 47.7, CI = 9.4–232, P < 0.00001). In conclusion, methane is a potential diagnostic test for the identification of C-IBS and may guide treatment.

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Abbreviations

IBS:

Irritable bowel syndrome

C-IBS:

Constipation-predominant IBS

D-IBS:

Diarrhea-predominant IBS

LBT:

Lactulose breath test

SIBO:

Small intestinal bacterial overgrowth

References

  1. Bommelaer G, Poynard T, Le Pen C, et al. Prevalence of irritable bowel syndrome (IBS) and variability of diagnostic criteria. Gastroenterol Clin Biol. 2004;28:554–561. doi:10.1016/S0399-8320(04)95011-7. PMID: 15243388.

    PubMed  Google Scholar 

  2. Wilson S, Roberts L, Roalfe A, Bridge P, Singh S. Prevalence of irritable bowel syndrome: a community survey. Br J Gen Pract. 2004;54:495–502. PMID: 15239910.

    PubMed  Google Scholar 

  3. Gwee KA, Wee S, Wong ML, Png DJ. The prevalence, symptom characteristics, and impact of irritable bowel syndrome in an Asian urban community. Am J Gastroenterol. 2004;99:924–931. doi:10.1111/j.1572-0241.2004.04161.x. PMID: 15128362.

    Article  PubMed  Google Scholar 

  4. El-Serag HB. Impact of irritable bowel syndrome: prevalence and effect on health-related quality of life. Rev Gastroenterol Disord. 2003;3(Suppl 2):S3–S11. PMID: 12775997.

    PubMed  Google Scholar 

  5. Hungin AP, Whorwell PJ, Tack J, Mearin F. The prevalence, patterns and impact of irritable bowel syndrome: an international survey of 40,000 subjects. Aliment Pharmacol Ther. 2003;17:643–650. doi:10.1046/j.1365-2036.2003.01456.x. PMID: 12641512.

    Article  CAS  PubMed  Google Scholar 

  6. Agreus L, Svardsudd K, Nyren O, Tibblin G. Irritable bowel syndrome and dyspepsia in the general population: overlap and lack of stability over time. Gastroenterology. 1995;109:671–680. doi:10.1016/0016-5085(95)90373-9. PMID: 7657095.

    Article  CAS  PubMed  Google Scholar 

  7. Drossman DA, Richter JE, Talley NJ, et al., eds. Functional gastrointestinal disorders: diagnosis, pathophysiology and treatment: a multinational consensus. Boston: Little, Brown; 1994.

    Google Scholar 

  8. Thompson WG, Longstreth GF, Drossman DA, et al. Functional bowel disorders and functional abdominal pain. Gut. 1999;45:II43–II47.

    Article  PubMed  Google Scholar 

  9. Rome Foundation. Guidelines—Rome III diagnostic criteria for functional gastrointestinal disorders. J Gastrointestin Liver Dis. 2006;15:301–312.

    Google Scholar 

  10. Muller-Lissner SA, Fumagalli I, Bardhan KD, et al. Tegaserod, a 5-HT(4) receptor partial agonist, relieves symptoms in irritable bowel syndrome patients with abdominal pain, bloating and constipation. Aliment Pharmacol Ther. 2001;15:1655–1666. doi:10.1046/j.1365-2036.2001.01094.x.

    Article  CAS  PubMed  Google Scholar 

  11. Novick J, Miner P, Krause R, et al. A randomized, double-blind, placebo-controlled trial of tegaserod in female patients suffering from irritable bowel syndrome with constipation. Aliment Pharmacol Ther. 2002;16:1877–1888. doi:10.1046/j.1365-2036.2002.01372.x.

    Article  CAS  PubMed  Google Scholar 

  12. Camilleri M, Mayer EA, Drossman DA, et al. Improvement in pain and bowel function in female irritable bowel patients with alosetron, a 5-HT3 receptor antagonist. Aliment Pharmacol Ther. 1999;13:1149–1159. doi:10.1046/j.1365-2036.1999.00610.x.

    Article  CAS  PubMed  Google Scholar 

  13. Bardhan KD, Bodemar G, Geldof H, et al. A double-blind, randomized, placebo-controlled dose-ranging study to evaluate the efficacy of alosetron in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther. 2000;14:23–34. doi:10.1046/j.1365-2036.2000.00684.x.

    Article  CAS  PubMed  Google Scholar 

  14. Drossman DA, Toner BB, Whitehead WE, et al. Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. Gastroenterology. 2003;125(1):19–31. doi:10.1016/S0016-5085(03)00669-3.

    Article  PubMed  Google Scholar 

  15. Pimentel M, Chow EJ, Lin HC. Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol. 2000;95:3503–3506. doi:10.1111/j.1572-0241.2000.03368.x.

    Article  CAS  PubMed  Google Scholar 

  16. Nucera G, Gabrielli M, Lupascu A, et al. Abnormal breath tests to lactose, fructose and sorbitol in irritable bowel syndrome may be explained by small intestinal bacterial overgrowth. Aliment Pharmacol Ther. 2005;21:1391–1395. doi:10.1111/j.1365-2036.2005.02493.x.

    Article  CAS  PubMed  Google Scholar 

  17. Majewski M, McCallum RW. Results of small intestinal bacterial overgrowth testing in irritable bowel syndrome patients: clinical profiles and effects of antibiotic trial. Adv Med Sci. 2007;52:139–142.

    CAS  PubMed  Google Scholar 

  18. Lupascu A, Gabrielli M, Lauritano EC, et al. Hydrogen glucose breath test to detect small intestinal bacterial overgrowth: a prevalence case-control study in irritable bowel syndrome. Aliment Pharmacol Ther. 2005;22:1157–1160. doi:10.1111/j.1365-2036.2005.02690.x.

    Article  CAS  PubMed  Google Scholar 

  19. Posserud I, Stotzer PO, Björnsson ES, et al. Small intestinal bacterial overgrowth in patients with irritable bowel syndrome. Gut. 2007;56:802–808. doi:10.1136/gut.2006.108712.

    Article  PubMed  Google Scholar 

  20. Pimentel M, Chow EJ, Lin HC. Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome: a double-blind, randomized, placebo-controlled study. Am J Gastroenterol. 2003;98:412–419.

    PubMed  Google Scholar 

  21. Sharara A, Aoun E, Abdul-Baki H, Mounzer R, Sidani S, ElHajj I. A randomized double-blind placebo-controlled trial of rifaximin in patients with abdominal bloating and flatulence. Am J Gastroenterol. 2006;101:326–333. doi:10.1111/j.1572-0241.2006.00458.x.

    Article  CAS  PubMed  Google Scholar 

  22. Pimentel M, Park S, Mirocha J, Kane S, Kong Y. The effect of a nonabsorbed oral antibiotic (Rifaximin) on the symptoms of the irritable bowel syndrome. Ann Intern Med. 2006;145(8):557–563.

    PubMed  Google Scholar 

  23. Lembo A, Zakko SF, Ferreira NL, et al. Rifaximin for the treatment of diarrhea-associated irritable bowel syndrome: short-term treatment leading to long-term sustained response. Gastroenterology. 2008;134:A545.

    Article  Google Scholar 

  24. Bratten JR, Spanier J, Jones MP. Lactulose breath testing does not discriminate patients with irritable bowel syndrome from healthy controls. Am J Gastroenterol. 2008;103:958–963. doi:10.1111/j.1572-0241.2008.01785.x.

    Article  CAS  PubMed  Google Scholar 

  25. Pimentel M, Mayer AG, Park S, et al. Methane production during lactulose breath test is associated with gastrointestinal disease presentation. Dig Dis Sci. 2003;48:86–92. doi:10.1023/A:1021738515885.

    Article  PubMed  Google Scholar 

  26. Grover M, Kanazawa M, Palsson OS, et al. Small intestinal bacterial overgrowth in irritable bowel syndrome: association with colon motility, bowel symptoms, and psychological distress. Neurogastroenterol Motil. 2008;20(9):998–1008. doi:10.1111/j.1365-2982.2008.01142.x.

    Article  CAS  PubMed  Google Scholar 

  27. Pimentel M, Lin HC, Enayati P, et al. Methane, a gas produced by enteric bacteria, slows intestinal transit and augments ileal contractile activity. Am J Physiol Gastrointest Liver Physiol. 2006;290:G1089–G1095. doi:10.1152/ajpgi.00574.2004.

    Article  CAS  PubMed  Google Scholar 

  28. Pimentel M, Chow EJ, Park S, Kong Y. Neomycin improves constipation in IBS in a fashion that is dependent on the presence of methane gas: sub-analysis of a double blind randomized controlled study. Dig Dis Sci. 2006;51:1297–1301. doi:10.1007/s10620-006-9104-6.

    Article  CAS  PubMed  Google Scholar 

  29. Khoshini R, Dai SC, Lezcano S, Pimentel M. A systematic review of diagnostic tests for small intestinal bacterial overgrowth. Dig Dis Sci. 2008;53:1443–1454. doi:10.1007/s10620-007-0065-1.

    Article  PubMed  Google Scholar 

  30. Chatterjee S, Park S, Low K, Kong Y, Pimentel M. The degree of breath methane production in IBS correlates with the severity of constipation. Am J Gastroenterol. 2007;102:837–841. doi:10.1111/j.1572-0241.2007.01072.x.

    Article  CAS  PubMed  Google Scholar 

  31. Schoenfeld P. Efficacy of current drug therapies in irritable bowel syndrome: what works and does not work. Gastroenterol Clin North Am. 2005;34:319–335. doi:10.1016/j.gtc.2005.02.002.

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported by Beatrice and Samuel A. Seaver Foundation.

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Authors and Affiliations

  1. GI Motility Program, Division of Gastroenterology, Cedars-Sinai Medical Center, 8730 Alden Drive, Suite 225E, Los Angeles, CA, 90048, USA

    Laura Hwang, Kimberly Low, Reza Khoshini, Gil Melmed, Ara Sahakian, Marc Makhani, Venkata Pokkunuri & Mark Pimentel

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  1. Laura Hwang
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  2. Kimberly Low
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  3. Reza Khoshini
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  7. Venkata Pokkunuri
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  8. Mark Pimentel
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Correspondence to Mark Pimentel.

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Hwang, L., Low, K., Khoshini, R. et al. Evaluating Breath Methane as a Diagnostic Test for Constipation-Predominant IBS. Dig Dis Sci 55, 398–403 (2010). https://doi.org/10.1007/s10620-009-0778-4

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  • DOI: https://doi.org/10.1007/s10620-009-0778-4

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