2001 · Goodman — Lactulose-induced pneumatosis intestinalis and pneumoperitoneum.
Super-Abstract
A 57-year-old patient with colonic inertia developed pneumatosis intestinalis and pneumoperitoneum after lactulose treatment, caused by a build-up of carbon dioxide and hydrogen gas from bacterial fermentation in a setting of altered gut flora. H₂ here is an endogenous gas produced by abnormal fermentation — not a therapeutic agent. (Digestive Diseases and Sciences, 2001.)
Commentary
This is a clinical case report describing a rare complication of lactulose therapy. Lactulose is a laxative used to treat hepatic encephalopathy; it works by promoting colonic fermentation. In this patient, prolonged colonic transit and altered (H₂-metabolizing bacteria-deficient) gut flora led to an excessive build-up of fermentation gases including H₂. The elevated intraluminal pressure caused pneumatosis intestinalis (gas cysts in the bowel wall) and pneumoperitoneum (free abdominal gas). The condition resolved after stopping lactulose. H₂ in this report is a dangerous endogenous accumulation — the opposite of the therapeutic administration of H₂ studied in H₂ medicine.
Key quotes
- „Retained lactulose and a build-up of carbon dioxide and hydrogen gas occurred in the setting of altered bacterial flora deficient in hydrogen metabolism.“ — the proposed pathomechanism: deficient H₂ metabolism by gut bacteria led to dangerous gas accumulation
- „The increased gas pressure caused extravasation of air into the intestine, causing PI with pneumoperitoneum.“ — the clinical consequence of the gas buildup
Our assessment
Assessment note: This study is not an H₂ therapy trial. It is a case report of a complication in which endogenously produced hydrogen and CO₂ accumulated to pathological levels. This is in fact an example of H₂ causing harm (through pressure-induced pneumatosis) rather than providing therapeutic benefit. No molecular hydrogen was administered. The study is not appropriate for inclusion in an H₂ therapy database without an explicit disclaimer.
Study design
- Type: case report · n: 1 patient (57-year-old with colonic inertia and liver cirrhosis) · H₂ delivery: none — H₂ is endogenously produced fermentation gas
- Result: pneumatosis intestinalis and pneumoperitoneum resolved after lactulose was discontinued; no therapeutic H₂ endpoint
Abstract
A case of PI in a 57-year-old patient with colonic inertia treated with lactulose for PSE secondary to cirrhosis is described. The colonic inertia led to longer transit time. Retained lactulose and a build-up of carbon dioxide and hydrogen gas occurred in the setting of altered bacterial flora deficient in hydrogen metabolism. The increased gas pressure caused extravasation of air into the intestine, causing PI with pneumoperitoneum. They both resolved with discontinuation of lactulose.
Source & links
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