The prevalence of small intestinal bacterial overgrowth and methane production in patients with myelomeningocele and constipation

• Published in: Spinal cord Vol. 52; no. 1; pp. 61 - 64
• Main Authors: Ojetti, V, Bruno, G, Paolucci, V, Triarico, S, D'aversa, F, Ausili, E, Gasbarrini, A, Rendeli, C
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-01-2014; Nature Publishing Group
• Subjects: 692/698/2741/2135; 692/699/1503/2753/1400; 692/699/375/361; Adolescent; Anatomy; Bacteria; Biomedical and Life Sciences; Biomedicine; Breath Tests; Constipation - complications; Female; Flatulence - epidemiology; Gastrointestinal Transit - physiology; Human Physiology; Humans; Intestine, Small - microbiology; Male; Meningomyelocele - complications; Methane - economics; Neurochemistry; Neuropsychology; Neurosciences; original-article; Prevalence; Urinary Tract Infections - epidemiology; methane; myelomeningocele; breath test; small intestinal bacterial overgrowth
• ISSN: 1362-4393; 1476-5624
• DOI: 10.1038/sc.2013.131

Study design:
Prospective study.
Objectives:
The objective of this study was to assess the prevalence of small intestinal bacterial overgrowth (SIBO), methane (CH
4
) production and orocecal transit time (OCTT) in children affected by myelomeningocele.
Setting:
This study was conducted at the Catholic University in Rome, Italy.
Methods:
Eighteen (6M/12F; 16.4±7.6 years) children affected by myelomeningocele were enrolled. All subjects underwent H
2
/CH
4
lactulose breath tests to assess SIBO and OCTT. All patients performed a visual analog scale to investigate abdominal pain, bloating and flatulence, and maintained a diary of the frequency and consistency of the stool during the previous 7 days. A nephro-urological clinical evaluation of the number of urinary tract infections (UTIs) and neurogenic bowel disease score were also performed.
Results:
Thirty-nine percent (7/18) of the children showed SIBO and 61% (11/18) presented a delayed OCTT. Moreover 44.4% (8/18) produced high levels of CH
4
. Interestingly, all myelomeningocele children who produced CH
4
showed a delayed OCTT and a higher incidence of UTI, with a lower frequency of evacuation, compared with those with a normal or accelerated OCTT.
Conclusion:
The association between CH
4
and constipation suggests that CH
4
has an active role in the development of constipation. One of the most interesting features of our study is to identify a correlation between myelomeningocele, CH
4
, delayed OCTT and UTI. The intestinal decontamination with locally acting drugs in these children may reduce the number of UTIs and improve intestinal motility.