182 - Competitive Hydrogen Gas Utilization by Methane- and Hydrogen Sulfide-Producing Microorganisms and Associated Symptoms: Results of a Novel 4-Gas Breath Test Machine

Singer-Englar, T.; Rezaie, Ali; Gupta, K N; Pichetshote, Nipaporn; Sedighi, Rashin; Lin, Eugenia; Chua, Kathleen Shari; Pimentel, Mark

doi:10.1016/s0016-5085(18)30625-5

Cited by 10 publications

(8 citation statements)

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“…Microbial metabolic pathway analysis also identified enrichment of KEGG modules associated with H 2 S production, including dissimilatory and assimilatory sulfate reduction pathways, in IBS-D subjects. These findings are consistent with our previous findings linking diarrhea and breath H 2 S levels ( 10 ) and independent studies linking H 2 S to diarrheal disorders including ulcerative colitis ( 38 ). Supporting this, rat studies have shown that H 2 S acts as a smooth muscle relaxant, possibly through direct inhibition of L-type calcium channels ( 39 ).…”

Section: Discussionsupporting

confidence: 94%

Methanogens and Hydrogen Sulfide Producing Bacteria Guide Distinct Gut Microbe Profiles and Irritable Bowel Syndrome Subtypes

Villanueva-Millán¹,

Leite²,

Wang³

et al. 2022

Am J Gastroenterol

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INTRODUCTION:Irritable bowel syndrome (IBS) includes diarrhea-predominant (IBS-D) and constipation-predominant (IBS-C) subtypes. We combined breath testing and stool microbiome sequencing to identify potential microbial drivers of IBS subtypes.METHODS:IBS-C and IBS-D subjects from 2 randomized controlled trials (NCT03763175 and NCT04557215) were included. Baseline breath carbon dioxide, hydrogen (H2), methane (CH4), and hydrogen sulfide (H2S) levels were measured by gas chromatography, and baseline stool microbiome composition was analyzed by 16S rRNA sequencing. Microbial metabolic pathways were analyzed using Kyoto Encyclopedia of Genes and Genomes collection databases.RESULTS:IBS-C subjects had higher breath CH4 that correlated with higher gut microbial diversity and higher relative abundance (RA) of stool methanogens, predominantly Methanobrevibacter, as well as higher absolute abundance of Methanobrevibacter smithii in stool. IBS-D subjects had higher breath H2 that correlated with lower microbial diversity and higher breath H2S that correlated with higher RA of H2S-producing bacteria, including Fusobacterium and Desulfovibrio spp. The predominant H2 producers were different in these distinct microtypes, with higher RA of Ruminococcaceae and Christensenellaceae in IBS-C/CH4+ (which correlated with Methanobacteriaceae RA) and higher Enterobacteriaceae RA in IBS-D. Finally, microbial metabolic pathway analysis revealed enrichment of Kyoto Encyclopedia of Genes and Genomes modules associated with methanogenesis and biosynthesis of methanogenesis cofactor F420 in IBS-C/CH4+ subjects, whereas modules associated with H2S production, including sulfate reduction pathways, were enriched in IBS-D.DISCUSSION:Our findings identify distinct gut microtypes linked to breath gas patterns in IBS-C and IBS-D subjects, driven by methanogens such as M. smithii and H2S producers such as Fusobacterium and Desulfovibrio spp, respectively.

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Section: Discussionsupporting

confidence: 94%

Methanogens and Hydrogen Sulfide Producing Bacteria Guide Distinct Gut Microbe Profiles and Irritable Bowel Syndrome Subtypes

Villanueva-Millán¹,

Leite²,

Wang³

et al. 2022

Am J Gastroenterol

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“…Singer-Englar et al. described an association between diarrhea and levels of exhaled H 2 S ( 98 ). Whether there is also an association with IBS-D (the definition of which requires pain in addition to diarrhea) remains to be seen.…”

Section: Future Directionsmentioning

confidence: 99%

Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome – An Update

2020

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Small intestinal bacterial overgrowth (SIBO) is one manifestation of gut microbiome dysbiosis and is highly prevalent in IBS (Irritable Bowel Syndrome). SIBO can be diagnosed either by a small bowel aspirate culture showing ≥10 3 colony-forming units (CFU) per mL of aspirate, or a positive hydrogen lactulose or glucose breath test. Numerous pathogenic organisms have been shown to be increased in subjects with SIBO and IBS, including but not limited to Enterococcus, Escherichia coli, and Klebsiella. In addition, Methanobrevibacter smithii, the causal organism in a positive methane breath test, has been linked to constipation predominant irritable bowel syndrome (IBS-C). As M. smithii is an archaeon and can overgrow in areas outside of the small intestine, it was recently proposed that the term intestinal methanogen overgrowth (IMO) is more appropriate for the overgrowth of these organisms. Due to gut microbiome dysbiosis, patients with IBS may have increased intestinal permeability, dysmotility, chronic inflammation, autoimmunity, decreased absorption of bile salts, and even altered enteral and central neuronal activity. As a consequence, SIBO and IBS share a myriad of symptoms including abdominal pain, distention, diarrhea, and bloating. Furthermore, gut microbiome dysbiosis may be associated with select neuropsychological symptoms, although more research is needed to confirm this connection. This review will focus on the role of the gut microbiome and SIBO in IBS, as well as novel innovations that may help better characterize intestinal overgrowth and microbial dysbiosis.

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“…Bismuth can also bind H 2 S and has been shown to lower H 2 S production in the human colon. 15 Rifaximin is commonly used in other SIBO subtypes (i.e., hydrogen SIBO and methane SIBO/intestinal methanogen overgrowth) 7,17 and may work by reducing the substrate hydrogen needed for H 2 S production 3 .…”

Section: Discussionmentioning

confidence: 99%

Hydrogen sulfide small intestinal bacterial overgrowth case registry

Goldenberg¹,

Nevitt²,

Wentz³

et al. 2023

Preprint

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Background: There is growing interest in hydrogen sulfide small intestinal bacterial overgrowth (H2S SIBO). However, basic questions including how clinicians are making the diagnosis, what symptoms are present, and what clinicians are using for treatment, remain unanswered. Aims: To address this, we created an online, survey-based, clinical registry of H2S SIBO cases. Methods: Participants in this study were clinicians diagnosing and treating patients with H2S SIBO and input data on patient presentation, diagnosis, treatment, and treatment response. We describe the population and summarize our results using descriptive statistics. We use Pearson's chi-squared test and modified Poisson regression in exploratory analyses. Results: 131 total cases were submitted by 99 providers across a spectrum of health disciplines. The mean patient age was 45.6 (71.4% female). The most common symptoms were bloating (77.0%), constipation (50.8%) and abdominal pain (50.8%). Diagnosis was made based on flatline hydrogen in the 3rd hour of a lactulose breath test (42.5%), symptom presentation (empiric) (31.9%), or H2S levels (25.7%). The most common treatments used were a low sulfur diet (46.6%), oregano (44.0%), and bismuth (39.7%). Fifty-eight percent of cases were responders. Of the most common interventions used, only a low sulfur diet (73% responder; p=0.01) and bismuth (76% responder; p=0.01) were significantly associated with treatment response. Interestingly, response rates differed based on how H2S SIBO was diagnosed, with empiric underperforming flatline diagnoses (relative risk 0.60; p=0.04). Conclusions: This case registry represents the largest collection of H2S SIBO cases to-date, providing important early descriptive information on this emerging diagnosis.

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182 - Competitive Hydrogen Gas Utilization by Methane- and Hydrogen Sulfide-Producing Microorganisms and Associated Symptoms: Results of a Novel 4-Gas Breath Test Machine

Cited by 10 publications

References 0 publications

Methanogens and Hydrogen Sulfide Producing Bacteria Guide Distinct Gut Microbe Profiles and Irritable Bowel Syndrome Subtypes

Methanogens and Hydrogen Sulfide Producing Bacteria Guide Distinct Gut Microbe Profiles and Irritable Bowel Syndrome Subtypes

Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome – An Update

Hydrogen sulfide small intestinal bacterial overgrowth case registry

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