Breath hydrogen and methane are associated with intestinal symptoms in patients with chronic pancreatitis

Pancreatology. 2015 Sep-Oct;15(5):514-518. doi: 10.1016/j.pan.2015.07.005. Epub 2015 Aug 1.


Backgrounds: 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.

Keywords: Breath test; Chronic pancreatitis; Hydrogen; Intestinal symptom; Methane.

MeSH terms

  • Adult
  • Aged
  • Bacterial Infections / complications*
  • Bacterial Infections / diagnosis
  • Bacterial Infections / epidemiology
  • Bacterial Infections / metabolism
  • Biomarkers / metabolism
  • Breath Tests
  • Case-Control Studies
  • Female
  • Humans
  • Hydrogen / metabolism*
  • Intestine, Small / microbiology*
  • Lactulose / metabolism
  • Male
  • Methane / metabolism*
  • Middle Aged
  • Pancreatitis, Chronic / complications*
  • Pancreatitis, Chronic / microbiology
  • Pancreatitis, Chronic / physiopathology
  • Prevalence
  • Retrospective Studies


  • Biomarkers
  • Lactulose
  • Hydrogen
  • Methane