Relationship between intestinal gas and the development of right colonic diverticula

Abstract

Backgrounds/aims: High intraluminal pressure has been reported to cause left colonic diverticula. However, the pathophysiology of right colonic diverticula is still unclear. Methane gas has been reported to delay small intestinal transit and to increase intraluminal pressure. The aim of this study was to evaluate the relationship between right colonic diverticula and intestinal gas produced by enteric bacteria.

Methods: Lactulose breath tests were performed in 30 patients who were diagnosed with right colonic diverticula via colonoscopy. The control group consisted of 30 healthy adults with no specific symptoms or medical histories. A hydrogen or methane producer was defined in 2 ways: either one that exhibited a breath hydrogen level ≥ 20 ppm (methane ≥ 10 ppm) baseline or one that exhibited an increase in breath hydrogen ≥ 20 ppm (methane ≥ 10 ppm) above baseline within the first 90 minutes of the test.

Results: The lactulose breath test (LBT) positivity in the diverticular group and the control group were 40.0% and 33.3%, respectively, without a statistically significant difference. The concentrations of methane and hydrogen gas measured by LBT increased over time, but there was no significant difference between the control and the diverticular groups.

Conclusions: There was no significant relationship between right colonic diverticula and intestinal gases produced by enteric bacteria. However, time-dependent formation of diverticula should be taken into consideration, therefore long-term, large-scale follow-up studies may reveal further pathogenesis of right colonic diverticulosis.

Keywords: Diverticulum, colon; Hydrogen; Methane.

Figure 1

Comparison of breath methane and hydrogen concentrations over time between the diverticular group (solid line) and the control group (dashed line). The breath methane and hydrogen concentration was presented with mean ± SD at each time point and analysed using linear mix model. There was no statistically significant difference between the diverticular and control groups in breath methane (A) and hydrogen (B) concentration.

Figure 2

Comparison of breath methane/hydrogen concentrations ratio over time between the diverticular group (solid line) and the control group (dashed line). The proportion of breath methane to hydrogen concentration was higher in diverticular group than in control group after 80 minutes but statistically significant difference between the diverticular and control groups was not found.