Anal gas evacuation and colonic microbiota in patients with flatulence: Effect of diet

Chaysavanh Manichanh, Anat Eck, Encarna Varela, Joaquim Roca, José C. Clemente, Antonio González, Dan Knights, Rob Knight, Sandra Estrella, Carlos Hernandez, Denis Guyonnet, Anna Accarino, Javier Santos, Juan R. Malagelada, Francisco Guarner, Fernando Azpiroz

Research output: Contribution to journalArticlepeer-review

55 Scopus citations

Abstract

Objective To characterise the influence of diet on abdominal symptoms, anal gas evacuation, intestinal gas distribution and colonic microbiota in patients complaining of flatulence. Design Patients complaining of flatulence (n=30) and healthy subjects (n=20) were instructed to follow their usual diet for 3 days (basal phase) and to consume a high-flatulogenic diet for another 3 days (challenge phase). Results During basal phase, patients recorded more abdominal symptoms than healthy subjects in daily questionnaires (5.8±0.3 vs 0.4±0.2 mean discomfort/ pain score, respectively; p=<0.0001) and more gas evacuations by an event marker (21.9±2.8 vs 7.4±1.0 daytime evacuations, respectively; p=0.0001), without differences in the volume of gas evacuated after a standard meal (262±22 and 265±25 mL, respectively). On flatulogenic diet, both groups recorded more abdominal symptoms (7.9±0.3 and 2.8±0.4 discomfort/ pain, respectively), number of gas evacuations (44.4±5.3 and 21.7±2.9 daytime evacuations, respectively) and had more gas production (656±52 and 673±78 mL, respectively; p<0.05 vs basal diet for all). When challenged with flatulogenic diet, patients' microbiota developed instability in composition, exhibiting variations in the main phyla and reduction of microbial diversity, whereas healthy subjects' microbiota were stable. Taxa from Bacteroides fragilis or Bilophila wadsworthia correlated with number of gas evacuations or volume of gas evacuated, respectively. Conclusions Patients complaining of flatulence have a poor tolerance of intestinal gas, which is associated with instability of the microbial ecosystem.

Original languageEnglish (US)
Pages (from-to)401-408
Number of pages8
JournalGut
Volume63
Issue number3
DOIs
StatePublished - Mar 2014

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