Reduction in breath methane and relief of constipation


Background: Detection of the gas methane (CH4) in exhaled breath is positively correlated to constipation, according to some research. Intestinal CH4 can slow intestinal transit time, and directly inhibit gut motility. Whether these alterations are a cause or a consequence of constipation is unknown.

This is an open trial, investigating the effect of L. reuteri Protectis DSM 17938 on the frequency of bowel movements and the level of methane in exhaled breath. The subjects were 20 constipated adults, all presenting with methane in their breath. Lactulose breath test was used at baseline and after 4 weeks of consumption of L. reuteri Protectis (2 tablets per day)

Positive detection of CH4 was defined as: production of > 5 ppm of CH4 at any time during four hours after oral ingestion of a 200-ml solution with 10 g of lactulose (= lactulose breath test).



Conclusion: Methane production in constipated adults can be reduced by daily ingestion of L. reuteri Protectis for four weeks. Reduced production of methane was associated with normalized number of weekly bowel movements. Ingestion of L. reuteri Protectis seems to modify the composition or the metabolism of methane producers of the gut microbiota.

Effect of L. reuteri Protectis in constipated adults

This randomized, placebo-controlled, double-blind trial was performed to evaluate the effects of Lactobacillus reuteri Protectis in adults with functional constipation.

40 patients diagnosed with functional constipation according to the Rome III criteria, were randomly assigned to supplementation with two chewable tablets of either Lactobacillus reuteri Protectis (2×10^8 cfu, n=20) or corresponding placebo (n=20) daily for 28 days.

At the end of treatment at week 4, the mean increase in bowel movements/week was 2.6 (SD ±1.14, 95% CI:1.6-3.6) in the L. reuteri group and 1.0 (SD ±1, 95% CI:0.12-1.88) in the placebo group (p=0.046). The mean number of bowel movements/week was 5.3 ±1.93 in the L. reuteri group and 3.9 ±1.79 in the placebo group. There was no difference in stool consistency between the two groups.

L. reuteri Protectis was more effective than placebo in improving the frequency of bowel movements in adult patients with functional constipation, as previously demonstrated in children, while it did not seem to affect stool consistency.

L. reuteri Protectis equal to lactulose in relief of constipation in children

The aim of this study was to compare effects of daily administration of L. reuteri DSM 17938 (L. reuteri Protectis) and lactulose on children with functional constipation.

This was an open, randomised trial in 53 children with functional constipation, diagnosed according to Rome III criteria. 25 children were given L. reuteri Protectis 10^8 CFU per day (5 drops), and 28 were given lactulose, 1 ml/kg/day, i.e. a common treatment of constipation in children.

Outcome measures were:

  • Frequency of weekly bowel movements
  • Consistency of bowel movements
  • Changes in other constipation-associated symptoms
  • Quality of Life (QoL) of children
  • Perception of Disease by the children
  • Parents’ view on QoL of the child
  • Parents’ perception of disease

Results show that L. reuteri Protectis was equivalent to lactulose in effects on functional constipation. L. reuteri Protectis and lactulose both increased the frequency of defecation and faecal consistency over four weeks. Abdominal pain and flatulence were reduced by L. reuteri Protectis compared to lactulose. Quality of life increased in both treatment groups to the level of the healthy controls.

L. reuteri Protectis was equal to lactulose in effects on bowel movements and faecal consistency in children with functional constipation.

In addition, L. reuteri Protectis:
• Reduced the incidence of abdominal pain and flatulence significantly compared to lactulose
• Restored Quality of Life scores to the level of healthy, age-matched children

Lactobacillus reuteri in infants with functional chronic constipation

This double blind, randomised, placebo-controlled study aimed to evaluate the efficacy of Lactobacillus reuteri DSM 17938 supplementation in infants with chronic constipation. 44 infants were enrolled, 6-12 months old and all weaned from breast-feeding. Lactobacillus reuteri was administered for 8 weeks at a dose of 10^8 CFU, once daily and 30 minutes after feeding.

In the active group the frequency of bowel movements (BM) was 2.82 per week at week 0, compared with 4.77 at week 8 (P = 0.0001). Compared to those given placebo, the BM frequency in the Lactobacillus reuteri group was significantly increased at 2, 4 and 8 weeks of treatment. In the Lactobacillus reuteri group, the stool consistency was reported as hard in 19/22 (86%) infants at baseline, in 11 (50%) at week 2 and in 4 (18%) at both weeks 4 and 8, with significant difference at weeks 4 and 8 (P = 0.01). However, there was no significant difference in stool consistency between the two groups at any of the time points.

Constipated infants supplemented with Lactobacillus reuteri had a significantly higher frequency of bowel movements by time compared to the placebo group. Stool consistency also improved significantly in the Lactobacillus reuteri group, although no significant difference was seen compared to placebo.

Fig. 1 Frequency of BMs in the Lactobacillus reuteri and placebo groups. Infants treated with Lactobacillus reuteri had a significantly higher defecation frequency than infants in the placebo group at week 2 of treatment (P = .042), at week 4 (P = .008), and at week 8 (P = .027).

Conclusion: Constipated infants supplemented with Lactobacillus reuteri had a significantly higher frequency of bowel movements by time compared to the placebo group. Stool consistency also improved significantly in the Lactobacillus reuteri group, although no significant difference was seen compared to placebo.

Lactobacillus reuteri in constipation in the elderly

An open, parallel study on elderly persons (70-96 years) living in an institution and suffering from constipation. The aim was to study whether orange juice with probiotics could reduce constipation.

The control group (n=6) ingested ordinary juice throughout the 10-week study period. Two groups were given probiotics, but began with ordinary juice for 3 weeks, then 4 weeks with probiotic juice and 3 follow-up weeks with ordinary juice. One group (n=12) was given juice containing Lactobacillus reuteri ATCC 55730 and another group (n=8) was given juice with a bacteria blend of Propioniibacterium freudenreichii and Lactobacillus rhamnosus.

A modest positive effect on increased frequency of defecation was seen in both probiotic groups: during the active treatment period in the group ingesting the bacteria blend and during the follow-up period in the Lactobacillus reuteri group.

Conclusion: The ingestion of a probiotic-containing orange juice by elderly in an institution had a modest effect on relief of constipation.