Open-Label Assessment of the Efficacy of Atrantil in the Treatment of Methane-Predominate Intestinal Bacterial Overgrowth.

Small Intestinal Bacterial Overgrowth (SIBO) is a common functional condition in which a patient has an excessive amount of bacteria in their small intestine resulting in abdominal pain, constipation, diarrhea, bloating, and occasional vitamin deficiencies or weight loss (1). Typically this condition is treated with antibiotics such as rifaximin which is FDA approved for IBS-D. However, symptoms reoccurred in over 64% of subjects who originally had a positive response to treatment (2). Recent work suggests that intraluminal methane production from archaebacteria may one source of microbial dysbiosis (3). A randomized control trial of Atrantil, a nutraceutical composed of polyphenols peppermint, quebracho tree bark, and horse chestnut demonstrated a reduction in bloating and constipation in patients with IBS-C (4) however, further study is needed given the small sample size. In our own retrospective review of SIBO patients, we found most were methane positive; therefore, a methane focused mechanism of action may prove beneficial to our population.