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

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.