This protocol applies to patients with small intestinal bacterial overgrowth who have constipation and a confirmed positive methane breath test — defined as methane levels of 10 ppm or greater during breath testing.
The patient presents with constipation alongside a positive methane breath test (breath methane ≥10 ppm). Breath testing — using glucose or lactulose — is the recommended method to diagnose overgrowth of methane-producing organisms in symptomatic patients with constipation.
The primary target is reduction of breath methane to undetectable levels (below 3 ppm) on repeat breath testing, combined with improvement in constipation symptoms. Targeting methane-producing organisms may reduce methane production and relieve constipation.
Management involves a targeted antibiotic course directed at methane-producing organisms in the small intestine, typically administered over 10 days.
DOI: 10.14309/ajg.0000000000000501