Gut Liver.  2016 Nov;10(6):932-938. 10.5009/gnl15588.

Irritable Bowel Syndrome, Particularly the Constipation-Predominant Form, Involves an Increase in Methanobrevibacter smithii, Which Is Associated with Higher Methane Production

• Ghoshal U
• Shukla R
• Srivastava D
• Ghoshal UC

• KMID: 2412099
• DOI: http://doi.org/10.5009/gnl15588

Abstract

BACKGROUND/AIMS
Because Methanobrevibacter smithii produces methane, delaying gut transit, we evaluated M. smithii loads in irritable bowel syndrome (IBS) patients and healthy controls (HC).
METHODS
Quantitative real-time polymerase chain reaction for M. smithii was performed on the feces of 47 IBS patients (Rome III) and 30 HC. On the lactulose hydrogen breath test (LHBT, done for 25 IBS patients), a fasting methane result ≥10 ppm using 10 g of lactulose defined methane-producers.
RESULTS
Of 47, 20 had constipation (IBS-C), 20 had diarrhea (IBS-D) and seven were not sub-typed. The M. smithii copy number was higher among IBS patients than HC (Log₁₀5.4, interquartile range [IQR; 3.2 to 6.3] vs 1.9 [0.0 to 3.4], p<0.001), particularly among IBS-C compared to IBS-D patients (Log₁₀6.1 [5.5 to 6.6] vs 3.4 [0.6 to 5.7], p=0.001); the copy number negatively correlated with the stool frequency (R=−0.420, p=0.003). The M. smithii copy number was higher among methane-producers than nonproducers (Log₁₀6.4, IQR [5.7 to 7.4] vs 4.1 [1.8 to 5.8], p=0.001). Using a receiver operating characteristic curve, the best cutoff for M. smithii among methane producers was Log₁₀6.0 (sensitivity, 64%; specificity, 86%; area under curve [AUC], 0.896). The AUC for breath methane correlated with the M. smithii copy number among methane producers (r=0.74, p=0.008). Abdominal bloating was more common among methane producers (n=9/11 [82%] vs 5/14 [36%], p=0.021).
CONCLUSIONS
Patients with IBS, particularly IBS-C, had higher copy numbers of M. smithii than HC. On LHBT, breath methane levels correlated with M. smithii loads.

Keyword

Methanogenic flora; Real-time polymerase chain reaction; Lactulose hydrogen breath test; Gut transit

MeSH Terms

Adult
Aged
Area Under Curve
Breath Tests
Case-Control Studies
Constipation/*microbiology
Diarrhea/microbiology
Feces/chemistry
Female
Humans
Irritable Bowel Syndrome/complications/*microbiology
Lactulose
Male
Methane/*analysis
Methanobrevibacter/*physiology
Middle Aged
ROC Curve
Sensitivity and Specificity
Young Adult
Lactulose
Methane