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Breath methane in functional constipation: response to treatment with Ispaghula husk
Author(s) -
Vega A. B.,
Perelló A.,
Martos L.,
García Bayo I.,
García M.,
Andreu V.,
Abad A.,
Barenys M.
Publication year - 2015
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/nmo.12568
Subject(s) - gastroenterology , bloating , lactulose , medicine , irritable bowel syndrome , functional constipation , breath test , constipation , defecation , abdominal pain , helicobacter pylori
Abstract Background Colonic fermentation produces hydrogen (H 2 ), and also produces methane ( CH 4 ) in subjects with methanogenic flora (M+). Methane production has been associated with chronic constipation ( CC ) and with changes in gut motility. To determine CH 4 production in CC compared to controls, and to assess whether the therapeutic response to Ispaghula husk in CC differs between CH 4 ‐producers and non‐producers. Methods Forty‐eight patients with functional constipation or irritable bowel syndrome‐constipation and 19 healthy age‐and‐sex‐matched volunteers ( HV ) filled in a 1‐week symptom diary and a dietary questionnaire. They then underwent a lactulose breath test ( LBT ) to measure H 2 and CH 4 production (peak and area under the time‐concentration curve, AUC ‐) and a colonic transit time ( CTT ) assessment. In patients, measurements were repeated after a 4‐week treatment with Ispaghula husk. Key Results Prevalence of M+ in patients was 60.5% vs 52.6% in HV ( p = 0.37). Patients had significantly longer CTT and greater production of both H 2 and CH 4 during LBT . There was a significant correlation between CH 4 production and CTT ( r = 0.51; p = 0.07). Treatment response rate was similar for M+ and M− patients (58.3% vs 52.9%; p = 0.76) as were the increases in bowel movements and Bristol score, changes in abdominal discomfort and bloating. In M+, treatment reduced CTT (−10 ± 35 h; p = 0.029 vs baseline) and CH 4 levels: peak CH 4 (−13 ± 24 ppm; p = 0.014) and CH 4 ‐ AUC (−817 ± 3100 ppm/min; p = 0.04). Conclusions & Inferences Although CH 4 production has been associated with CC pathophysiology, we found that CH 4 status did not negatively affect the response to Ispaghula husk treatment. The measurement of CH 4 levels as a biomarker tool for CC requires further appraisal.