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( Changhwan Choi ),( Tamar Ringel Kulka ),( Daniel Temas ),( Ari Kim ),( Yehuda Ringel ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Dysbiosis leading to abnormal intestinal fermentation has been suggested as a possible etiological mechanism in Irritable bowel syndrome (IBS). We aimed to investigate the location and magnitude of altered intestinal bacterial fermentation in IBS and its clinical subtypes. Methods: 114 IBS patients who satisfi ed Rome III criteria and 33 healthy controls (HC) were investigated. Intestinal fermentation was assessed using two surrogate measures: Intestinal intraluminal pH and fecal short chain fatty acids (SCFAs). Intraluminal pHs were measured at four quartiles (Q1-4) in each small and large bowel using a wireless motility capsule (SmartPill™). Fecal SCFAs including acetate, propionate, butyrate and lactate were analyzed by capillary gas chromatography. Correlations between intestinal pH, fecal SCFAs, intestinal transit time and IBS symptom scores were analyzed. Results: Intraluminal pH levels in Q1, Q4, and total colon were signifi cantly lower in IBS compared to those in HC (6.83 for IBS vs. 7.29 for HC, P = 0.042). There were no differences in total and segmental pH levels in the small bowel between IBS and HC (6.84 vs. 6.83, P = NS). The intraluminal colonic pH differences were consistent in all IBS subtypes. Total SCFAs level was signifi cantly lower in C-IBS than in D-IBS and M-IBS. The total SCFAs level in all IBS was similar with that in HC. Colonic pH levels correlated positively with colon transit time (CTT) and IBS symptom severities. Total SCFAs levels correlated negatively with CTT, and positively with stool frequency. Conclusions: Bacterial fermentation is increased in IBS across all subtypes compared with HC. The altered intestinal fermentation in IBS appeared to be in the colon but not in the small bowel. Fecal SCFAs negatively correlated with CTT and may not be a sensitive marker to estimate intraluminal bacterial fermentation.