Chatterjee Soumya, Park Sandy, Low Kimberly, Kong Yuthana, Pimentel Mark
Cedars-Sinai Medical Center, Burns and Allen Research Institute, Los Angeles, California, USA.
Am J Gastroenterol. 2007 Apr;102(4):837-41. doi: 10.1111/j.1572-0241.2007.01072.x.
Recent work has demonstrated that among irritable bowel syndrome (IBS) subjects, methane on lactulose breath test (LBT) is nearly universally associated with constipation predominance. This work has been based on subjective constipation outcomes. In this study, methane is compared to constipation in another population of IBS subjects with constipation being determined both subjectively and objectively.
A nested study was conducted in subjects enrolled in a double-blind randomized placebo-controlled study. After consent, subjects were asked to complete a stool diary for 7 days. This included logging of all bowel movements that week as well as documenting the stool consistency for each during the same period using the Bristol Stool Score. After 7 days, subjects were asked to rate their symptoms on a visual analogue scale (VAS) score (0-100 mm) for diarrhea and constipation. They then had an LBT to evaluate both methane and hydrogen profiles over 180 min. Subjects with methane were compared to those without methane for Bristol Stool Score, stool frequency, as well as VAS scores for diarrhea and constipation. The degree of constipation was then compared to the quantity of methane production on LBT based on area under the curve.
Among 87 subjects, 20 (23.8%) produced methane. IBS subjects with methane had a mean constipation severity of 66.1 +/- 36.7 compared to 36.2 +/- 30.8 for nonmethane producers (P < 0.001). The opposite was noted for diarrhea (P < 0.01). On LBT, the quantity of methane seen on breath test was directly proportional to the degree of constipation reported (r = 0.60, P < 0.01). In addition, greater methane production correlated with a lower stool frequency (r =-0.70, P < 0.001) and Bristol Stool Score (r =-0.58, P < 0.01).
Methane on LBT is associated with constipation both subjectively and objectively. The degree of methane production on breath test appears related to the degree of constipation.
近期研究表明，在肠易激综合征（IBS）患者中，乳果糖呼气试验（LBT）检测出的甲烷几乎普遍与便秘为主型相关。这项研究基于主观便秘结果。在本研究中，将另一组IBS便秘患者群体中的甲烷情况与便秘情况进行比较，便秘情况通过主观和客观两种方式确定。
在一项双盲随机安慰剂对照研究的受试者中进行了一项嵌套研究。获得同意后，要求受试者完成7天的大便日记。这包括记录那一周的所有排便情况，以及使用布里斯托大便分类法记录同一时期每次排便的大便稠度。7天后，要求受试者在视觉模拟量表（VAS）上对腹泻和便秘症状进行评分（0 - 100毫米）。然后他们进行LBT以评估180分钟内的甲烷和氢气情况。将有甲烷的受试者与无甲烷的受试者在布里斯托大便分类法评分、排便频率以及腹泻和便秘的VAS评分方面进行比较。然后根据曲线下面积将便秘程度与LBT上的甲烷产生量进行比较。
在87名受试者中，20名（23.8%）产生甲烷。有甲烷的IBS受试者便秘严重程度平均为66.1±36.7，而无甲烷者为36.2±30.8（P < 0.001）。腹泻情况则相反（P < 0.01）。在LBT中，呼气试验中检测到的甲烷量与报告的便秘程度成正比（r = 0.60，P < 0.01）。此外，甲烷产生量增加与排便频率降低（r = -0.70，P < 0.001）和布里斯托大便分类法评分降低（r = -0.58，P < 0.01）相关。
LBT检测出的甲烷在主观和客观上均与便秘相关。呼气试验中的甲烷产生量似乎与便秘程度有关。
