My methane dropped from 42 ppm to 26 ppm, but the biggest turning point was treating digestion and motility

My Methane SIBO (IMO) Journey

My digestive symptoms began several years ago with GERD, eosinophilic esophagitis (EOE), and a hiatal hernia. Over time, my symptoms evolved from mainly reflux to bloating, abdominal discomfort, food intolerances, and changing bowel habits, eventually becoming more constipation-predominant.

A lactulose breath test diagnosed intestinal methanogen overgrowth (IMO), with methane levels starting around 32 ppm and peaking at approximately 42 ppm, while hydrogen remained low. I initially underwent treatment with neomycin alone, followed later by a combination of neomycin and rifaximin. Both treatments provided temporary relief, but my symptoms eventually returned. Because of concerns about neomycin’s potential ototoxicity, it was no longer considered a safe treatment option for me.

Rather than focusing only on treating the methane overgrowth, my physicians investigated possible underlying causes. Additional testing revealed gallbladder sludge despite a normal HIDA scan, mildly reduced pancreatic elastase (170), low short-chain fatty acid production, and evidence of gut barrier irritation. A GI-MAP test reported H. pylori, although a subsequent urea breath test was negative. My doctor concluded that impaired digestion, reduced pancreatic enzyme output, altered bile flow, decreased motility, and disruption of the intestinal microbiome were likely contributing to the persistence of methane overgrowth.

During this period, I carefully tracked my symptoms and experimented with different diets. I identified several trigger foods, including onions, garlic, wheat products, inulin, and apples, while consistently tolerating foods such as fish, poultry, beef, rice, zucchini, peppers, blueberries, nuts, and lactose-free dairy. I eventually adopted a Low Fermentation Diet as my primary nutritional approach.

Because neomycin was no longer an option, I later completed a treatment course consisting of rifaximin combined with metronidazole, along with N-acetylcysteine (NAC) as a biofilm disruptor, ginger and artichoke extract for motility support, magnesium citrate, Saccharomyces boulardii, Atrantil, and structured meal spacing to promote the migrating motor complex.

A follow-up breath test showed improvement, with peak methane decreasing from approximately 42 ppm to 26 ppm. Clinically, I experienced less bloating, improved bowel function, greater food tolerance, and stabilization of my weight. Based on this progress, my gastroenterologist felt that a colonoscopy was no longer indicated.

Today, my focus is no longer simply on eliminating methane but on preventing recurrence by supporting normal digestion, motility, pancreatic function, bile flow, and restoration of a healthy gut microbiome. While recovery has been gradual, I have made significant progress compared with where I started and continue to build on those improvements.