![]() When one or more of these mechanisms fail, SIBO can occur. 3 In general, SIBO is prevented by the presence of the ileocecal valve, by the action of gastric acid and pancreatic enzymes, as well as by small intestinal motility. Small intestinal bacterial overgrowth (SIBO) is defined by the presence of 1 × 10 6 CFU ml −1 of intestinal aspirate and/or the presence of colonic-type species. It is well documented in literature that delayed orocecal transit time (OCTT) predisposes to small bowel bacterial overgrowth, because of the stasis, which, in turn, promotes excess bacterial proliferation and inflammation. In fact, a majority of UTIs is caused by gastrointestinal organisms (such as Escherichia coli), thus a successful treatment of constipation may avoid the reinfection of the urinary tract from the rectal reservoir. 5 Moreover, the treatment of neuropathic constipation is crucial for reducing the risk of urinary tract infections (UTIs), which frequently occur in these patients. Neuropathic bowel has a great impact on social integration of patients with MMC, which benefit from a well-organized treatment plan of constipation with stool softeners, oral laxatives, digital evacuation, enemas or transanal irrigation. The injury in the lumbosacral spine compromises the sensory and motor functions of the perianal region, leading to a delayed colonic motility and anorectal dysfunction, which result in functional obstruction and severe constipation. 2 The level of neurological impairment influences muscle innervations, motor development, sensory and sphincter dysfunction. MMC is a frequent form of SB with lifelong disabilities, characterized by the extrusion of spinal cord and by the development of Arnold-Chiari type II malformations and hydrocephalus in the central nervous system. The open SB, called myelomeningocele (MMC), is characterized by a visible protrusion of spinal cord and/or meninges through the defect in the vertebral arch. 2 The multifactorial etiology of SB involves both genetic and environmental factors, for example, socioeconomic status, geographic area, maternal obesity, epilepsy or diabetes, maternal exposure to drugs, alcohol or radiations. The incidence of SB is around 0.1–0.3% and the risk for parents with SB of having an affected baby is estimated to be about 4%. The term spina bifida (SB) refers to a group of congenital neural tube defects with a variety of clinical manifestations, resulting from the lack of vertebral arches in the median line during the third and fourth week of gestational age. The intestinal decontamination with locally acting drugs in these children may reduce the number of UTIs and improve intestinal motility. One of the most interesting features of our study is to identify a correlation between myelomeningocele, CH 4, delayed OCTT and UTI. The association between CH 4 and constipation suggests that CH 4 has an active role in the development of constipation. 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. Moreover 44.4% (8/18) produced high levels of CH 4. ![]() Thirty-nine percent (7/18) of the children showed SIBO and 61% (11/18) presented a delayed OCTT. A nephro-urological clinical evaluation of the number of urinary tract infections (UTIs) and neurogenic bowel disease score were also performed. ![]() 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. All subjects underwent H 2/CH 4 lactulose breath tests to assess SIBO and OCTT. Methods:Įighteen (6M/12F 16.4☗.6 years) children affected by myelomeningocele were enrolled. This study was conducted at the Catholic University in Rome, Italy. 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. ![]()
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