Vega A B, Perelló A, Martos L, García Bayo I, García M, Andreu V, Abad A, Barenys M
Hospital Duran i Reynals, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona University, Barcelona, Spain.
Gastroenterology Department, Hospital de Viladecans, Barcelona, Spain.
Neurogastroenterol Motil. 2015 Jul;27(7):945-53. doi: 10.1111/nmo.12568. Epub 2015 May 7.
Colonic fermentation produces hydrogen (H2 ), and also produces methane (CH4 ) in subjects with methanogenic flora (M+). Methane production has been associated with chronic constipation (CC) and with changes in gut motility. To determine CH4 production in CC compared to controls, and to assess whether the therapeutic response to Ispaghula husk in CC differs between CH4 -producers and non-producers.
Forty-eight patients with functional constipation or irritable bowel syndrome-constipation and 19 healthy age-and-sex-matched volunteers (HV) filled in a 1-week symptom diary and a dietary questionnaire. They then underwent a lactulose breath test (LBT) to measure H2 and CH4 production (peak and area under the time-concentration curve, AUC-) and a colonic transit time (CTT) assessment. In patients, measurements were repeated after a 4-week treatment with Ispaghula husk.
Prevalence of M+ in patients was 60.5% vs 52.6% in HV (p = 0.37). Patients had significantly longer CTT and greater production of both H2 and CH4 during LBT. There was a significant correlation between CH4 production and CTT (r = 0.51; p = 0.07). Treatment response rate was similar for M+ and M- patients (58.3% vs 52.9%; p = 0.76) as were the increases in bowel movements and Bristol score, changes in abdominal discomfort and bloating. In M+, treatment reduced CTT (-10 ± 35 h; p = 0.029 vs baseline) and CH4 levels: peak CH4 (-13 ± 24 ppm; p = 0.014) and CH4 -AUC (-817 ± 3100 ppm/min; p = 0.04).
CONCLUSIONS & INFERENCES: Although CH4 production has been associated with CC pathophysiology, we found that CH4 status did not negatively affect the response to Ispaghula husk treatment. The measurement of CH4 levels as a biomarker tool for CC requires further appraisal.
结肠发酵会产生氢气（H₂），在具有产甲烷菌群（M⁺）的个体中还会产生甲烷（CH₄）。甲烷生成与慢性便秘（CC）以及肠道动力变化有关。为了确定与对照组相比CC患者的甲烷生成情况，并评估CC患者中甲烷产生者和非产生者对卵叶车前子壳治疗的反应是否存在差异。
48例功能性便秘或肠易激综合征便秘型患者以及19名年龄和性别匹配的健康志愿者（HV）填写了为期1周的症状日记和饮食问卷。然后他们接受了乳果糖呼气试验（LBT）以测量H₂和CH₄的产生（峰值以及时间 - 浓度曲线下面积，AUC-）以及结肠转运时间（CTT）评估。在患者中，接受4周卵叶车前子壳治疗后重复进行测量。
患者中M⁺的患病率为60.5%，而HV中为52.6%（p = 0.37）。患者在LBT期间的CTT明显更长，H₂和CH₄的产生量也更大。甲烷产生与CTT之间存在显著相关性（r = 0.51；p = 0.07）。M⁺和M⁻患者的治疗反应率相似（58.3%对52.9%；p = 0.76），排便次数和布里斯托大便分类法评分的增加、腹部不适和腹胀的变化也相似。在M⁺患者中，治疗使CTT缩短（-10 ± 35小时；与基线相比p = 0.029）以及CH₄水平降低：CH₄峰值（-13 ± 24 ppm；p = 0.014）和CH₄ - AUC（-817 ± 3100 ppm/min；p = 0.04）。
尽管甲烷生成与CC的病理生理学有关，但我们发现甲烷状态并未对卵叶车前子壳治疗的反应产生负面影响。将甲烷水平作为CC的生物标志物工具进行测量需要进一步评估。
