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

Spinal Cord. 2014 Jan;52(1):61-4. doi: 10.1038/sc.2013.131. Epub 2013 Nov 19.


Study design: Prospective study.

Objectives: The objective of this study was to assess the prevalence of small intestinal bacterial overgrowth (SIBO), methane (CH4) 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 H2/CH4 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 CH4. Interestingly, all myelomeningocele children who produced CH4 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 CH4 and constipation suggests that CH4 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, CH4, delayed OCTT and UTI. The intestinal decontamination with locally acting drugs in these children may reduce the number of UTIs and improve intestinal motility.

MeSH terms

  • Adolescent
  • Breath Tests
  • Constipation / complications*
  • Female
  • Flatulence / epidemiology*
  • Gastrointestinal Transit / physiology
  • Humans
  • Intestine, Small / microbiology*
  • Male
  • Meningomyelocele / complications*
  • Methane / economics*
  • Prevalence
  • Urinary Tract Infections / epidemiology


  • Methane