B0269 - Effects of an Herbal Supplement on Intestinal Methanogenic Overgrowth

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Joy Liu, MD

Northwestern University
Chicago, IL

Joy Liu, MD¹, Emerald Adler, BS², Darren Brenner, MD³
¹Northwestern University, Chicago, IL; ²University of Chicago, Chicago, IL; ³Northwestern Medical Group, Chicago, IL

Introduction: Intestinal methanogenic overgrowth (IMO) refers to overproduction of methane (CH₄) in the GI tract. To date, there is no consensus on treatment for IMO and it is unclear if reducing CH₄ improves symptoms. The aims of this pilot study were to: (1) describe symptoms in individuals with IMO; (2) investigate the effects of a quebracho/horse chestnut/peppermint oil neutraceutical (Atrantil®) on CH₄levels and symptoms.

Methods: Successive patients with positive breath tests (CH₄ ≥10³ ppm) were recruited from a single academic center. Subjects were provided the manufacturer-recommended dose for 4 weeks and completed weekly PROMIS GI symptom questionnaires and daily Likert scales for pain, discomfort, bloating, and distention. Post-treatment breath tests and assessments of adequate relief were performed at trial completion. PROMIS GI t-scores were analyzed using fixed effect regression models (RStudio: Boston, MA). A change in t-score ≥5 was considered a positive minimal clinically important difference.

Results: 46 subjects were recruited, and 39 subjects (76.9% female, mean age 44.8 years) completed the study. The most common baseline symptoms were bloating (85%), constipation (46.3%), and pain/discomfort (39%). 12.2% of subjects had IBS; 17.7% had been diagnosed with dyssynergia. Treatment was associated with significant improvements in weekly measures of belly pain (-5.75, 95% CI -8.46 to -3.05) and gas/bloating (-5.27, 95% CI -7.41 to -3.12) (Table 1). There were no significant changes in daily symptoms. Median baseline CH₄levels decreased from 30 at baseline to 26 post-treatment. The median change in CH₄ was -5 (Figure 1). Despite 86.11% of breath tests remaining positive for IMO after treatment, 56% of subjects reported adequate relief. No correlations between overall symptom improvement and reductions in CH₄ (p=0.387) or normalization of CH₄ levels were identified (p=0.181). There were no treatment-related adverse events.

Discussion: Atrantil® was associated with clinically and statistically significant improvement in key abdominal symptoms (pain and bloating) at 4 weeks. Symptom improvement and adequate relief did not appear to be related to changes in CH₄levels. Results from this pilot study will be used to guide a forthcoming placebo-controlled, randomized trial.

Figure: Figure: Median methane levels at baseline, after treatment, and median change in methane level. The median baseline methane level was 30 p.p.m., 26 p.p.m. after treatment, and the median change was 5 p.p.m.

Scale	t-score	Change at 4 weeks
Belly pain	59.07 (56.40-61.74)	-5.75 (-8.46 to -3.05)
Gas/bloating	62.81 (61.02-64.60)	-5.27 (-7.41 to -3.12)
Constipation	53.34 (51.04-55.65)	-3.66 (-5.47 to -1.85)
Reflux	46.67 (44.37-48.96)	-1.62 (-3.59-0.35)
Nausea/vomiting	49.48 (47.01-51.96)	-2.60 (-4.23 to -0.97)

Disclosures:

Joy Liu indicated no relevant financial relationships.

Emerald Adler indicated no relevant financial relationships.

Darren Brenner: Salix Pharmaceuticals – Consultant. Vibrant – Advisor or Review Panel Member.

Joy Liu, MD¹, Emerald Adler, BS², Darren Brenner, MD³. B0269 - Effects of an Herbal Supplement on Intestinal Methanogenic Overgrowth, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.