Early ReportAbnormal colonic fermentation in irritable bowel syndrome
Introduction
Irritable bowel syndrome (IBS) is common, but of unknown cause.1 It is not a single condition, but a collection of disorders causing similar symptoms of abdominal pain and abnormal bowel habit. Food intolerance is a recognised exacerbating factor of IBS and may affect as many as 50% of patients.2, 3 However, there is no evidence of food allergy.4 A range of fermentable substrates may provoke gastrointestinal symptoms,5, 6 as may inhibitors of carbohydrate digestion.7 IBS frequently follows gastroenteritis8 or use of antibiotics,9 and the gut flora has been shown to be unstable.10 We postulated that abnormal colonic fermentation could be a factor in the pathogenesis of IBS. We investigated this hypothesis by assessing rates and patterns of colonic-gas production on standard and exclusion diets.
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Methods
Patients with IBS fulfilling the Rome criteria1 were recruited from outpatients. Other gastrointestinal diseases were excluded by blood and stool analysis, sigmoidoscopy, lactose-hydrogen breath test, and, in patients older than 40 years, by barium enema. Controls came from a group of symptom-free individuals recruited for dietary studies. Exclusion criteria were previous gastrointestinal disease, and the use of laxatives, antibiotics, or other medication within the preceding 6 weeks. All
Results
Six female patients and six female controls took part. The median age of the patients was 45 years (IQR 42–58) of the controls 53 (51–54). All patients experienced stool frequency and looseness with abdominal pain on a daily basis. None showed evidence of anxiety before entry into the study, as assessed by the Eysenck personality questionnaire. One of each group admitted single violations of their diets, both more than 1 week before calorimetry.
On the standard diet, IBS patients excreted
Discussion
Our findings are consistent with the suggestion that the IBS may be caused by abnormal colonic fermentation. Maximum rates of gas excretion (mainly hydrogen) were much greater in IBS patients than in controls. On an exclusion diet, which significantly improved symptoms, gas excretion (hydrogen and methane) fell dramatically, but no such change occurred in controls.
Changes in hydrogen excretion do not result from differences in the rate of expulsion of gas after production, because the relation
References (20)
- et al.
Irritable bowel syndrome
Lancet
(1997) Food allergy—or enterometabolic disorder?
Lancet
(1991)- et al.
Effect of resistant starch on faecal bulk and fermentation dependent events in humans
Am J Clin Nutr
(1995) - et al.
Psychometric scores and persistence of irritable bowel syndrome after infectious diarrhoea
Lancet
(1996) - et al.
Impaired hydrogen metabolism in pneumatosis cystoides intestinalis
Gastroenterology
(1993) - et al.
Perception and reflex responses to intestinal distension in humans are modified by simultaneous or previous stimulation
Gastroenterology
(1995) - et al.
Food intolerance and the irritable bowel syndrome
Gut
(1989) - et al.
Management of patients with food intolerance in irritable bowel syndrome: the development and use of an exclusion diet
J Hum Nutrit Diet
(1995) - et al.
Fructose: incomplete intestinal absorption in humans
Gastroenterology
(1983) - et al.
An evalulation of the potential side effects of alpha glucosidase inhibitors used for the management of diabetes mellitus
Eur J Clin Invest
(1994)
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