Patients With Irritable Bowel Syndrome Exhale More Hydrogen Than Healthy Subjects in Fasting State

Abstract

Background/AimsIrritable bowel syndrome (IBS) is a common disorder with significant morbidity and impairment of quality of life. Most patients (26%-83%) with IBS from Asia reported bloating. Bloating may result from increased amount or distribution of gas in the gut or exaggerated perception of distension. To evaluate whether patients with IBS produce more hydrogen even in fasting state, we conducted a study with the following aims: (1) to estimate fasting breath hydrogen levels among patients with IBS as compared with healthy controls (HC) and (2) to study relationship between symptoms of IBS and stool frequency and fasting breath hydrogen levels.MethodsEighty-one patients with IBS (Rome III criteria) and 123 HC were included. Hydrogen breath test was performed using a gas analyzer after an overnight (12 hours) fast. Both patients with IBS and HC had similar preparation before breath hydrogen estimation.ResultsOf 93 patients with symptoms of functional gastrointestinal disorders, 81 (87.1%) met Rome III criteria and 12 (12.9%) were negative and hence, excluded from the study. Patients with IBS were comparable in age (35 ± 11.8 years vs 37.5 ± 13.1 years, p = NS) and gender (male 61/81 [75.3%] vs 77/123 [62.6%], p=0.67) with HC. Average fasting breath hydrogen was higher in patients with IBS as compared to HC (mean 10.1 ± 6.5 ppm vs 5.5 ± 6.2 ppm, p < 0.0001). Number of stools per week correlated with average fasting breath hydrogen excretion in patients with IBS (r = 0.26, p = 0.02).ConclusionsInspite of similar preparation for the test, fasting breath hydrogen was higher in patients with IBS as compared to HC. Number of stools per week correlated with fasting breath hydrogen levels among patients with IBS.

Do Patients With Irritable Bowel Syndrome Exhale More Hydrogen Than Healthy Subjects in Fasting State?: Author's Reply

“…There are several reports, which showed that sub-typing IBS using Rome III criteria may not be appropriate in Asia in general and in India in particular 3-5. Though 95% patients in our study reported looser stools at onset of pain, this symptom is not the only determinant to subtype IBS 2. We reiterate that another study done previously, had limitations as they included non comparable patients with IBS and HS 6.…”

“…Choi suggested that the results of the present study comparing fasting breath hydrogen between constipation and diarrhea predominant IBS might have changed if we classified the IBS subtypes by Rome III criteria 2. We beg to differ on this issue.…”

Small Intestinal Bacterial Overgrowth in Patients with Refractory Functional Gastrointestinal Disorders

“…This hydrogen meter is widely used and validated for the assessment of SIBO. [28][29][30] Hydrogen gas concentration was expressed in parts per million (ppm) at that instant. After providing a baseline breath sample, the patient ingested 50 g of glucose in 300 mL of water.…”

Slow Transit Constipation Associated With Excess Methane Production and Its Improvement Following Rifaximin Therapy: A Case Report

“…Previous studies showed that methane production in IBS patients was almost universally associated with constipation and lumpy stools 2,10. In contrast, patients with diarrhea usually have higher excretion of hydrogen in breath both during fasting state and following administration of glucose 11,12. Methane was associated with presence and degree of constipation both subjectively and objectively in a study on 87 IBS patients, 20 (24%) of whom produced methane on lactulose hydrogen breath test 2.…”