Breath hydrogen and methane are associated with intestinal symptoms in patients with chronic pancreatitis.
BACKGROUND
The bacterial overgrowth might be associated with chronic pancreatitis. This study was to evaluate the prevalence and characteristics of small intestinal bacterial overgrowth (SIBO) in patients with chronic pancreatitis.


METHODS
36 patients with chronic pancreatitis and 49 healthy controls undergoing the hydrogen (H2)-methane (CH4) lactulose breath test (LBT) were reviewed. The LBT positivity (+) indicating the presence of SIBO, gas types, bowel symptom questionnaire, laboratory and radiologic results were surveyed. The LBT+ was (1) an increase in the breath H2 (≥20 ppm) or CH4 (≥10 ppm) over the baseline or (2) a baseline H2 (≥20 ppm) or CH4 (≥10 ppm) within 90 min after lactulose load.


RESULTS
LBT+ was significantly higher in the patients (17/36) than in controls (13/49) (47.2% vs. 26.5%, P < 0.05). During LBT, the H2 levels between 0 and 105 min were significantly higher in patients than in controls. Among LBT+ patients, 11 (64.7%), 1 (5.9%), 5 (29.4%) were in the LBT (H2)+, (CH4)+, (mixed)+ groups, respectively. The LBT+ group had significantly higher scores of flatus than those of the LBT- group. Considering the subtypes of LBT, the LBT (mixed)+ group had higher symptom scores of significance or tendency in hard stool, strain, urgency, and flatus than LBT- group The laboratory and radiologic features were not significantly different between LBT+ and LBT- groups.


CONCLUSIONS
SIBO is common in patients in chronic pancreatitis. Especially, excretions of mixed H2 and CH4 appear to be related with deterioration of intestinal symptoms.
Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea.
Dae Bum
DB
Kim
Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea. Electronic address: cmcu@catholic.ac.kr.
Chang-Nyol
CN
Paik
Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea.
Hea Jung
HJ
Sung
Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea.
Woo Chul
WC
Chung
Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea.
Kang-Moon
KM
Lee
Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea.
Jin-Mo
JM
Yang
Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Myung-Gyu
MG
Choi
D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D001944:Breath Tests; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006859:Hydrogen / Q000378:metabolism*; D007421:Intestine, Small / Q000382:microbiology*; D007792:Lactulose / Q000378:metabolism; D008297:Male; D008697:Methane / Q000378:metabolism*; D008875:Middle Aged; D050500:Pancreatitis, Chronic / Q000150:complications* / Q000382:microbiology / Q000503:physiopathology; D015995:Prevalence; D012189:Retrospective Studies
D015415:Biomarkers; D007792:Lactulose; D006859:Hydrogen; D008697:Methane
Breath test; Chronic pancreatitis; Hydrogen; Intestinal symptom; Methane