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Intestinal Methanogen Overgrowth (IMO) Is Associated with Delayed Small Bowel and Colonic Transit Time (TT) on the
Sarah Talamantes1, Faye Steiner1, Sean Spencer1
1Division of Gastroenterology & Hepatology, Department of Medicine, Stanford University, Palo Alto, CA, USA.
Background:
Methanogens are associated with gut dysmotility in animal models but have not been robustly studied in humans. The WMC assesses regional transit time (TT) and pH in the GI tract.
Aims:
To study the segmental TT and pH among patients with SIBO or IMO utilizing WMC.
Methods:
We conducted a retrospective study of 207 patients who underwent a glucose or lactulose breath test (BT) and WMC from 2010 to 2022. Diagnosis of SIBO and IMO were based on the 2017 North American consensus criteria. TT and pH were extracted from WMC recordings. We tested for differences in means of continuous variables and frequencies of categorical variables using two-sample t tests, Wilcoxon Rank Sum test, Chi-square, and Fisher exact tests. We used R version 3.3.1 (2016-06-21) for all statistical analyses.
Results:
A total of 196 patients met criteria, mean age 47.4 years and 155 (79.1%) females. Of the 86 (43.9%) patients with a positive BT, 42 (58.3%) had IMO only (meeting only CH4 criteria) and 30 (34.9%) met both H2 and CH4 criteria. Colonic TT was longer in patients with a positive BT compared to negative patients (40 h:29 min vs 28 h:51 min, p = 0.028). Small bowel TT and colonic TT were longer in patients with IMO compared to negative patients (SBTT: 5 h:15 min vs 4 h:32 min, p = 0.021; CTT: 44 h:23 min vs 28 h:51 min, p = 0.030). There were no significant differences in segmental pH compared to negative patients.
Conclusion:
To our knowledge, this is the largest study of patients who have undergone both BT and WMC. A positive BT was associated with delayed CTT, while having IMO only was associated with both delayed CTT and SBTT, but neither with pH. Future investigation is needed to elucidate whether changes in intestinal microbiota affect gut transit.
Insights
A positive breath test (BT) for small intestinal bacterial overgrowth (SIBO) or intestinal methanogen overgrowth (IMO) was linked to slower colonic transit time. Intestinal methanogen overgrowth specifically correlated with delayed small bowel and colonic transit.
Area of Science:
- Gastroenterology
- Microbiology
- Physiology
Background:
- Methanogens are implicated in gut dysmotility in animal models, but human studies are limited.
- Wireless Motility Capsule (WMC) technology assesses gastrointestinal transit time (TT) and pH.
- Understanding methanogen impact on human gut motility is crucial.
Purpose of the Study:
- To investigate segmental transit time (TT) and pH in patients with small intestinal bacterial overgrowth (SIBO) or intestinal methanogen overgrowth (IMO) using WMC.
- To establish correlations between positive breath tests (BT) and WMC parameters.
- To analyze differences in gut transit and pH based on SIBO/IMO status.
Main Methods:
- Retrospective analysis of 207 patients undergoing BT and WMC (2010-2022).
- SIBO and IMO diagnoses based on 2017 North American consensus criteria.
- Statistical analysis of TT and pH data using R version 3.3.1.
Main Results:
- 196 patients met criteria; 43.9% had positive BT (58.3% IMO only, 34.9% H2 and CH4 positive).
- Positive BT associated with longer colonic TT (40h:29m vs 28h:51m, p=0.028).
- IMO patients showed longer small bowel TT (5h:15m vs 4h:32m, p=0.021) and colonic TT (44h:23m vs 28h:51m, p=0.030) compared to negative BT patients. No significant pH differences were observed.
Conclusions:
- This is the largest study correlating BT and WMC findings.
- Positive BT is linked to delayed colonic transit; IMO is associated with delayed small bowel and colonic transit.
- Further research is needed to understand the role of intestinal microbiota in gut transit.
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