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

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.

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

Fig. 1

(A) Copy numbers of Methanobrevibacter smithii among patients with irritable bowel syndrome (IBS) and healthy controls (HC). (B) Copy numbers of M. smithii among patients with constipation-predominant IBS (IBS-C), diarrhea-predominant IBS (IBS-D), and HC. (C) Correlation between copy numbers of M. smithii and number of stools per week. p<0.05 was considered as significant. *Bonferroni corrected p-value.

Fig. 2

(A) Copy numbers of Methanobrevibacter smithii among methane producers and nonproducers. (B) Receiver operating characteristic curve showing the area under the curve (AUC). (C) Correlation between copy numbers of M. smithii and the AUC. p<0.05 was considered as significant.