{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T22:18:28Z","timestamp":1783981108715,"version":"3.55.0"},"reference-count":41,"publisher":"BMJ","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"accepted":{"date-parts":[[1997,5,29]]},"published-print":{"date-parts":[[1997,12,1]]},"abstract":"<jats:p>\n                    <jats:italic>Background and aims<\/jats:italic>\n                    \u2014The colons of patients with pneumatosis cystoides coli produce excessive H\n                    <jats:sub>2.<\/jats:sub>\n                    Exposure to alkyl halides could explain this. Six consecutive patients who had pneumatosis cystoides coli while taking chloral hydrate (1\u20135+ g\/day) are reported. Patients 2 and 3 were investigated after they had ceased chloral hydrate treatment. One produced methane, the other did not. (Pneumatosis cystoides coli patients are non-methanogenic according to the literature.) Both had overnight fasting breath H\n                    <jats:sub>2<\/jats:sub>\n                    of less than 10 ppm. A literature review disclosed just one patient who was using chloral at the time of diagnosed pneumatosis cystoides coli, but an epidemic of the disease in workers exposed to trichloroethylene.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Methods<\/jats:italic>\n                    \u2014(i) In vitro experiments with human faeces: chloral or closely related alkyl halides were added to anaerobic faecal cultures derived from four methane-producing and three non-methanogenic human subjects. H\n                    <jats:sub>2<\/jats:sub>\n                    and CH\n                    <jats:sub>4<\/jats:sub>\n                    gases were measured. (ii) In vivo animal experiment: chloral hydrate was added to drinking water of four Wistar rats, and faecal H\n                    <jats:sub>2<\/jats:sub>\n                    compared with control rats.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Results<\/jats:italic>\n                    \u2014Alkyl halides increased H\n                    <jats:sub>2<\/jats:sub>\n                    up to 900 times in methanogenic and 10 times in non-methanogenic faecal cultures. The K\n                    <jats:sub>i<\/jats:sub>\n                    of chloral was 0.2 mM. Methanogenesis was inhibited in concert with the increase in net H\n                    <jats:sub>2<\/jats:sub>\n                    . In the rat experiment, chloral hydrate increased H\n                    <jats:sub>2<\/jats:sub>\n                    10 times, but did not cause pneumatosis.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusions<\/jats:italic>\n                    \u2014Chloral and trichloroethylene are alkyl halides chemically similar to chloroform, a potent inhibitor of H\n                    <jats:sub>2<\/jats:sub>\n                    consumption by methanogens and acetogens. These bacteria are the most important H\n                    <jats:sub>2<\/jats:sub>\n                    -consuming species in the colon. It is postulated that exposure to these alkyl halides increases net H\n                    <jats:sub>2<\/jats:sub>\n                    production, which sets the scene for \u201ccounterperfusion supersaturation\u201d and the formation of gas cysts. In recent times, very low prescribing rates for chloral have caused primary pneumatosis cystoides to become extremely rare. As with primary pneumatosis, secondary pneumatosis cystoides, which occurs if there is small bowel bacterial overgrowth distal to a proximally located gut obstruction, is predicted by counterperfusion supersaturation. \u201cInherent unsaturation\u201d due to metabolism of O\n                    <jats:sub>2<\/jats:sub>\n                    is a safety factor, which could explain why gas bubbles do not form more often in tissue with high H\n                    <jats:sub>2<\/jats:sub>\n                    tension.\n                  <\/jats:p>","DOI":"10.1136\/gut.41.6.778","type":"journal-article","created":{"date-parts":[[2010,6,30]],"date-time":"2010-06-30T12:46:12Z","timestamp":1277901972000},"page":"778-784","source":"Crossref","is-referenced-by-count":29,"title":["Alkyl halides, super hydrogen production and the pathogenesis of pneumatosis cystoides coli"],"prefix":"10.1136","volume":"41","author":[{"given":"T H J","family":"Florin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1997,12,1]]},"reference":[{"key":"2025120519192713000_41.6.778.1","first-page":"125","article-title":"Pneumatosis cystoides intestinalis: bullous emphysema of the intestine.","volume":"56","author":"Ecker","year":"1971","journal-title":"Am J Gastroenterol"},{"key":"2025120519192713000_41.6.778.2","first-page":"523","article-title":"Abdominal gas cysts (pneumatosis cystoides intestinalis hominis): an analysis with a report of a case and a critical review of the literature.","volume":"53","author":"Koss","year":"1952","journal-title":"Arch Pathol"},{"key":"2025120519192713000_41.6.778.3","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1097\/00000658-195904000-00024","article-title":"Pneumatosis cystoides intestinalis and regional enteritis.","volume":"149","author":"Reinhoff","year":"1959","journal-title":"Ann Surg"},{"key":"2025120519192713000_41.6.778.4","doi-asserted-by":"publisher","DOI":"10.1136\/gut.20.11.1008"},{"key":"2025120519192713000_41.6.778.5","first-page":"651","article-title":"Pneumatosis intestinalis in the newborn.","volume":"81","author":"Stiennon","year":"1951","journal-title":"Am J Dis Child"},{"key":"2025120519192713000_41.6.778.6","doi-asserted-by":"publisher","DOI":"10.1148\/76.5.733"},{"key":"2025120519192713000_41.6.778.7","first-page":"720","article-title":"The roentological pathology of so called pneumatosis cystoides intestinalis.","volume":"89","author":"Elliot","year":"1963","journal-title":"Am J Roentgenol"},{"key":"2025120519192713000_41.6.778.8","first-page":"334","article-title":"Pneumatosis intestinalis in a female patient with systemic lupus erythematosus.","volume":"47","author":"Derksen","year":"1978","journal-title":"Radiologia Clinica (Basel)"},{"key":"2025120519192713000_41.6.778.9","doi-asserted-by":"publisher","DOI":"10.1136\/gut.7.5.553"},{"key":"2025120519192713000_41.6.778.10","doi-asserted-by":"publisher","DOI":"10.1136\/gut.29.6.852"},{"key":"2025120519192713000_41.6.778.11","doi-asserted-by":"crossref","first-page":"1376","DOI":"10.1016\/0022-3468(91)91037-Y","article-title":"Pneumatosis cystoides intestinalis in children beyond the first year of life: manifestations and management.","volume":"26","author":"Reynolds","year":"1991","journal-title":"J Pediatr Surg"},{"key":"2025120519192713000_41.6.778.12","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.151.1.85"},{"key":"2025120519192713000_41.6.778.13","doi-asserted-by":"crossref","first-page":"991","DOI":"10.2214\/ajr.152.5.991","article-title":"Pneumatosis intestinalis in bone marrow transplantation patients: diagnosis on routine chest radiographs.","volume":"152","author":"Bates","year":"1989","journal-title":"Am J Roentgenol"},{"key":"2025120519192713000_41.6.778.14","doi-asserted-by":"publisher","DOI":"10.1136\/gut.25.8.839"},{"key":"2025120519192713000_41.6.778.15","first-page":"579","article-title":"Treatment of intestinal gas cysts by oxygen breathing.","volume":"i","author":"Forgacs","year":"1973","journal-title":"Lancet"},{"key":"2025120519192713000_41.6.778.16","doi-asserted-by":"crossref","first-page":"173","DOI":"10.3109\/00365527909179864","article-title":"Pneumatosis cystoides coli associated with high H2 excretion: treatment with an elemental diet.","volume":"14","author":"Van der Linden","year":"1979","journal-title":"Scand J Gastroenterol"},{"key":"2025120519192713000_41.6.778.17","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/0016-5085(93)90406-3","article-title":"Impaired hydrogen metabolism in pneumatosis cystoides intestinalis.","volume":"104","author":"Christl","year":"1993","journal-title":"Gastroenterology"},{"key":"2025120519192713000_41.6.778.18","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1111\/j.1365-2559.1984.tb02329.x","article-title":"Pneumatosis coli: a case report with ultrastructural study.","volume":"8","author":"Haboubi","year":"1984","journal-title":"Histopathology"},{"key":"2025120519192713000_41.6.778.19","unstructured":"Eastwood M Gillon J (1994) Pneumatosis cystoides intestinalis. in Diseases of the gut and pancreas, eds Misiewicz JJ Pounder RE Venables CW (Blackwell Scientific Publications, Oxford), 2nd ed. pp 1061\u20131064."},{"key":"2025120519192713000_41.6.778.20","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(95)91996-1"},{"key":"2025120519192713000_41.6.778.21","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197106242842502"},{"key":"2025120519192713000_41.6.778.22","doi-asserted-by":"crossref","first-page":"2723","DOI":"10.1128\/aem.54.11.2723-2727.1988","article-title":"Acetate production from hydrogen and [13C]carbon dioxide by the microflora of human feces.","volume":"54","author":"Lajoie","year":"1988","journal-title":"Appl Environ Microbiol"},{"key":"2025120519192713000_41.6.778.23","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1111\/j.1440-1746.1994.tb01228.x","article-title":"A possible role for bile acid in the control of methanogenesis and accumulation of hydrogen gas in the human colon.","volume":"9","author":"Florin","year":"1994","journal-title":"J Gastroenterol Hepatol"},{"key":"2025120519192713000_41.6.778.24","doi-asserted-by":"publisher","DOI":"10.1016\/0378-1097(92)90160-P"},{"key":"2025120519192713000_41.6.778.25","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(92)90765-Q"},{"key":"2025120519192713000_41.6.778.26","doi-asserted-by":"publisher","DOI":"10.1136\/gut.34.6.818"},{"key":"2025120519192713000_41.6.778.27","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(93)90144-2"},{"key":"2025120519192713000_41.6.778.28","first-page":"1","article-title":"Absorption, excretion and metabolic fate of chloral hydrate and trichloroethanol.","volume":"95","author":"Marshall","year":"1954","journal-title":"Bulletin of Johns Hopkins Hospital"},{"key":"2025120519192713000_41.6.778.29","first-page":"147","article-title":"Chloral hydrate and triclofos metabolism.","volume":"14","author":"Sellers","year":"1973","journal-title":"Clin Pharmacol Ther"},{"key":"2025120519192713000_41.6.778.30","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1002\/jps.2600620404","article-title":"Pharmacokinetics of trichloroethanol and metabolites and interconversions among variously referenced pharmacokinetic parameters.","volume":"62","author":"Garrett","year":"1973","journal-title":"J Pharm Sci"},{"key":"2025120519192713000_41.6.778.31","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1080\/00039896.1987.9935812","article-title":"A new health problem due to trichloroethylene: pneumatosis cystoides intestinalis.","volume":"42","author":"Sato","year":"1987","journal-title":"Arch Environ Health"},{"key":"2025120519192713000_41.6.778.32","doi-asserted-by":"publisher","DOI":"10.1136\/gut.37.3.418"},{"key":"2025120519192713000_41.6.778.33","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1002\/bjs.1800650118","article-title":"Pneumatosis coli: a familial association.","volume":"65","author":"Underwood","year":"1978","journal-title":"Br J Surg"},{"key":"2025120519192713000_41.6.778.34","doi-asserted-by":"publisher","DOI":"10.1136\/gut.35.8.1098"},{"key":"2025120519192713000_41.6.778.35","first-page":"985","article-title":"Relationships between hydrogen and methane production in man.","volume":"17","author":"Bjorneklett","year":"1982","journal-title":"Scand J Gastroenterol"},{"key":"2025120519192713000_41.6.778.36","unstructured":"Whitman WB Bowen TL Boone DR (1990) The methanogenic bacteria. in The prokaryotes, eds Balows A Truper HG Dworkin M Harder W Schleifer K-H (Springer-Verlag, New York), 2nd ed. pp 719\u2013767."},{"key":"2025120519192713000_41.6.778.37","unstructured":"Diekert G (1990) The acetogenic bacteria. in The prokaryotes, eds Balows A Truper HG Dworkin M Harder W Schleifer K-H (Springer-Verlag, New York), 2nd ed. pp 517\u2013533."},{"key":"2025120519192713000_41.6.778.38","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1055\/s-2007-1021484","article-title":"Pneumatosis cystoides coli: a rare complication of colonoscopy.","volume":"15","author":"Heer","year":"1983","journal-title":"Endoscopy"},{"key":"2025120519192713000_41.6.778.39","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(95)90707-6"},{"key":"2025120519192713000_41.6.778.40","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1016\/0016-5085(93)90168-C","article-title":"The third dimension [Editorial].","volume":"105","author":"Pope","year":"1993","journal-title":"Gastroenterology"},{"key":"2025120519192713000_41.6.778.41","first-page":"185","article-title":"Unsaturation in living tissue relative to pressure and composition of inhaled gas and its significance in decompression theory.","volume":"36","author":"Hills","year":"1969","journal-title":"Clin Sci"}],"container-title":["Gut"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/gut.41.6.778","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T03:19:36Z","timestamp":1764991176000},"score":1,"resource":{"primary":{"URL":"https:\/\/gut.bmj.com\/lookup\/doi\/10.1136\/gut.41.6.778"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1997,12,1]]},"references-count":41,"journal-issue":{"issue":"6","published-online":{"date-parts":[[1997,12,1]]},"published-print":{"date-parts":[[1997,12,1]]}},"alternative-id":["10.1136\/gut.41.6.778"],"URL":"https:\/\/doi.org\/10.1136\/gut.41.6.778","relation":{},"ISSN":["0017-5749","1468-3288"],"issn-type":[{"value":"0017-5749","type":"print"},{"value":"1468-3288","type":"electronic"}],"subject":[],"published":{"date-parts":[[1997,12,1]]}}}