Neurogastroenterology and motility · 2026
Methane Trajectory Phenotypes on Glucose Breath Testing Are Associated With Slow Colonic Transit: A Group-Based Trajectory Modeling Analysis.
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Sirimongkolkasem Jarongkorn, Valencia Briana, Becker Laren, Spencer Sean, Sonu Irene, Nguyen Linda, Neshatian Leila
Аннотация
BACKGROUND: Intestinal methanogen overgrowth (IMO) is defined by a single binary threshold of CH4 ≥ 10 ppm and is associated with slow transit constipation. We aimed to identify distinct breath methane trajectory phenotypes in patients with constipation and test their association with slow colonic transit.
METHODS: We retrospectively analyzed 188 adults with constipation who underwent glucose breath testing and colonic transit assessment. Group-based trajectory modeling was used to classify CH4 kinetics into phenotypes. Slow-transit prevalence and diagnostic performance were compared across phenotypes.
KEY RESULTS: Sixty-nine patients (36.7%) had slow colonic transit, and 61 (32.4%) met IMO criteria. Three CH4 phenotypes were identified: High-Producer (n = 29, 15.4%; baseline CH4 = 31 ppm (median) with a rapid rise and sustained elevation), Low-Producer (n = 24, 12.8%; flat, CH4 = 12 ppm), and Non-Producer (n = 135, 71.8%; flat, CH4 = 3 ppm). Prevalence of slow transit differed across phenotypes (High-Producer: 69.0%, Low-Producer: 41.7%, Non-Producer: 28.9%; p < 0.001). High-Producer phenotype was independently associated with slow transit (aOR 5.67, 95% CI 2.22-14.50; p < 0.001). Among IMO-positive patients, slow transit was more frequent in High-Producer than others (69.0% vs. 40.6%; adjusted OR 3.98, 95% CI 1.27-13.95; p = 0.022). Compared with the IMO positives, High-Producer pattern showed higher specificity (92.4% vs. 76.5%) and positive predictive value (69.0% vs. 54.1%) for slow transit.
CONCLUSIONS: CH4 trajectories identified distinct kinetic patterns in patients with chronic constipation. The High-Producer phenotype was most strongly associated with slow colonic transit and offered higher specificity than the IMO threshold.
METHODS: We retrospectively analyzed 188 adults with constipation who underwent glucose breath testing and colonic transit assessment. Group-based trajectory modeling was used to classify CH4 kinetics into phenotypes. Slow-transit prevalence and diagnostic performance were compared across phenotypes.
KEY RESULTS: Sixty-nine patients (36.7%) had slow colonic transit, and 61 (32.4%) met IMO criteria. Three CH4 phenotypes were identified: High-Producer (n = 29, 15.4%; baseline CH4 = 31 ppm (median) with a rapid rise and sustained elevation), Low-Producer (n = 24, 12.8%; flat, CH4 = 12 ppm), and Non-Producer (n = 135, 71.8%; flat, CH4 = 3 ppm). Prevalence of slow transit differed across phenotypes (High-Producer: 69.0%, Low-Producer: 41.7%, Non-Producer: 28.9%; p < 0.001). High-Producer phenotype was independently associated with slow transit (aOR 5.67, 95% CI 2.22-14.50; p < 0.001). Among IMO-positive patients, slow transit was more frequent in High-Producer than others (69.0% vs. 40.6%; adjusted OR 3.98, 95% CI 1.27-13.95; p = 0.022). Compared with the IMO positives, High-Producer pattern showed higher specificity (92.4% vs. 76.5%) and positive predictive value (69.0% vs. 54.1%) for slow transit.
CONCLUSIONS: CH4 trajectories identified distinct kinetic patterns in patients with chronic constipation. The High-Producer phenotype was most strongly associated with slow colonic transit and offered higher specificity than the IMO threshold.