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Journal Article
Contributions of the microbial hydrogen economy to colonic homeostasis
2012
Overview
Colonic gases are integral to digestion, with changes in the volume and composition of these gases linked to bowel disorders. In this Review, the authors provide a comprehensive discussion of the clinical importance of colonic gases in health and disease, describing the microbes involved in production and utilization of these gases and the types of gastrointestinal diseases linked to them.
Colonic gases are among the most tangible features of digestion, yet physicians are typically unable to offer long-term relief from clinical complaints of excessive gas. Studies characterizing colonic gases have linked changes in volume or composition with bowel disorders and shown hydrogen gas (H
2
), methane, hydrogen sulphide, and carbon dioxide to be by-products of the interplay between H
2
-producing fermentative bacteria and H
2
consumers (reductive acetogens, methanogenic archaea and sulphate-reducing bacteria [SRB]). Clinically, H
2
and methane measured in breath can indicate lactose and glucose intolerance, small intestinal bacterial overgrowth and IBS. Methane levels are increased in patients with constipation or IBS. Hydrogen sulphide is a by-product of H
2
metabolism by SRB, which are ubiquitous in the colonic mucosa. Although higher hydrogen sulphide and SRB levels have been detected in patients with IBD, and to a lesser extent in colorectal cancer, this colonic gas might have beneficial effects. Moreover, H
2
has been shown to have antioxidant properties and, in the healthy colon, physiological H
2
concentrations might protect the mucosa from oxidative insults, whereas an impaired H
2
economy might facilitate inflammation or carcinogenesis. Therefore, standardized breath gas measurements combined with ever-improving molecular methodologies could provide novel strategies to prevent, diagnose or manage numerous colonic disorders.
Key Points
The colonic gases hydrogen (H
2
), carbon dioxide and methane (CH
4
) are end products of microbial fermentation; their concentrations depend on the interplay between host physiology and H
2
-producing (hydrogenogenic) and H
2
-using (hydrogenotrophic) microbes
Colonic H
2
production is most readily measured via excretion in breath; clinically, breath H
2
and CH
4
are commonly measured to assess lactose and glucose intolerance and small intestinal bacterial overgrowth, and increasingly IBS
Improved understanding of microbial H
2
metabolism and its relation to expired gas concentrations will reinforce the breath gas test as a widely applicable, easy and cost-effective diagnostic or prognostic tool
Use of breath gas tests in diagnosis could enable novel therapeutic or preventative measures for a wide array of colonic diseases
Although emphasis has been given to the potential inflammatory or carcinogenic properties of colonic gases, emerging evidence suggests these gases might have a beneficial effect in colonic health
Publisher
Nature Publishing Group UK,Nature Publishing Group
