Colonic hydrogen absorption: quantification of its effect on hydrogen accumulation caused by bacterial fermentation of carbohydrates

Abstract

The aim of the study was to assess (quantitatively) colonic hydrogen absorption. Hydrogen volumes in flatus and breath were measured over periods of six hours in normal subjects during fasting and after ingestion of the non-absorbable carbohydrate lactulose to simulate the effect of fermentable dietary fibres. If less than 76 ml/6 h of hydrogen accumulated in the colon then all of it was absorbed, as suggested by the intercept of the regression line of the correlation between hydrogen volumes in flatus and breath after ingestion of lactulose. As total flatus volume increased, efficiency of colonic hydrogen absorption decreased from 90% to 20%. The positive correlation between hydrogen volumes of flatus and breath showed that the eightfold interindividual differences in flatus volume after ingestion of 12.5 g of lactulose were caused by differences in bacterial net gas production, not gas absorption. Differences in colonic gas emptying rate are the consequence rather than the cause of interindividual differences in flatus volume.

In conclusion: (1) colonic hydrogen absorption is highly effective at low colonic hydrogen accumulation rates, but not at higher accumulation rates; (2) ineffective colonic gas absorption is the consequence and not the cause of high colonic gas accumulation rate after ingestion of non-absorbable carbohydrates; and (3) future therapeutic approaches to the large interindividual variability in colonic gas accumulation after ingestion of poorly absorbable fermentable carbohydrates, such as some kinds of dietary fibres, should be directed towards altering colonic bacterial metabolism.