Bacterial Overgrowth and Methane Production in Children with Encopresis

Division of Pediatric Gastroenterology and Nutrition, Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA.
The Journal of pediatrics (Impact Factor: 3.79). 05/2010; 156(5):766-70, 770.e1. DOI: 10.1016/j.jpeds.2009.10.043
Source: PubMed


To assess the prevalence of small intestinal bacterial overgrowth (SIBO) and methane production in children with encopresis.
Radiographic fecal impaction (FI) scores were assessed in children with secondary, retentive encopresis and compared with the breath test results. Breath tests with hypoosmotic lactulose solution were performed in both the study patients (n = 50) and gastrointestinal control subjects (n = 39) groups.
The FI scores were significantly higher in the patients with encopresis who were methane producers (P < .01). SIBO was diagnosed in 21 of 50 (42%) patients with encopresis and 9 of 39 (23%) of control subjects (P = .06). Methane was produced in 56% of the patients with encopresis versus 23.1% of the control subjects in the gastrointestinal group (P < .01). Fasting methane level was elevated in 48% versus 10.3 %, respectively (P < .01).
Children with FI and encopresis had a higher prevalence of SIBO, elevated basal methane levels, and higher methane production. Methane production was associated with more severe colonic impaction. Further study is needed to determine whether methane production is a primary or secondary factor in the pathogenesis of SIBO and encopresis.

Download full-text


Available from: Karoly Horvath
  • Source
    • "In the pediatric population, the presence of M. smithii in gut microbiota has not been carefully examined. There is little information about CH 4 production, which is found almost exclusively in children with fecal retentive incontinence secondary to chronic constipation [12] [13] [15]. A previous study [16] reported that a large proportion of children living in a slum near a sanitary landfill were breath CH 4 producers. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study evaluated the breath CH4 excretion and concentration of M. smithii in intestinal microbiota of schoolchildren from 2 slums. One hundred and eleven children from a slum near a sanitary landfill, 35 children of a slum located away from the sanitary landfill, and 32 children from a high socioeconomic level school were included in the study. Real-time PCR was performed to quantify the M. smithii nifH gene and it was present in the microbiota of all the participating children, with higher (P < 0.05) concentrations in those who lived in the slum near the landfill (3.16 × 10(7) CFU/g of feces), comparing with the children from the slum away from the landfill (2.05 × 10(6) CFU/g of feces) and those from the high socioeconomic level group (3.93 × 10(5) CFU/g of feces). The prevalence of children who present breath methane was 53% in the slum near the landfill, 31% in the slum further away from the landfill and, 22% in the high socioeconomic level group. To live near a landfill is associated with higher concentrations of M. smithii in intestinal microbiota, comparing with those who live away from the landfill, regardless of their socioeconomics conditions.
    Full-text · Article · Oct 2014 · Archaea (Vancouver, B.C.)
  • Source
    • "Consider the separate research on methane producing microbes within the intestines; these microbes have been consistently linked to constipation [41-43], and are now thought to directly mediate motility via methane production [44]. Recent investigations demonstrating small intestinal bacterial overgrowth (SIBO) and excess methane production in children with encopresis might suggest that the condition may not be exclusively psychogenic [45]. Constipation is 5 times more likely in children with the related condition of nocturnal enuresis [46], and intestinal pathogens have been associated with increased risk of enuresis in children [47]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Rapid scientific and technological advances have allowed for a more detailed understanding of the relevance of intestinal microbiota, and the entire body-wide micro biome, to human health and well-being. Rodent studies have provided suggestive evidence that probiotics (e.g. lactobacillus and bifidobacteria) can influence behavior. More importantly, emerging clinical studies indicate that the administration of beneficial microbes, via supplementation and/or fecal microbial transplant (FMT), can influence end-points related to mood state (glycemic control, oxidative status, uremic toxins), brain function (functional magnetic resonance imaging fMRI), and mental outlook (depression, anxiety). However, despite the advances in the area of gastro-biological psychiatry, it becomes clear that there remains an urgent need to explore the value of beneficial microbes in controlled clinical investigations. With the history explored in this series, it is fair to ask if we are now on the cusp of major clinical breakthroughs, or are we merely in the quicksand of Autointoxication II?
    Full-text · Article · Mar 2013 · Gut Pathogens
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Human intestinal microbiota create a complex polymicrobial ecology. This is characterised by its high population density, wide diversity and complexity of interaction. Any dysbalance of this complex intestinal microbiome, both qualitative and quantitative, might have serious health consequence for a macro-organism, including small intestinal bacterial overgrowth syndrome (SIBO). SIBO is defined as an increase in the number and/or alteration in the type of bacteria in the upper gastrointestinal tract. There are several endogenous defence mechanisms for preventing bacterial overgrowth: gastric acid secretion, intestinal motility, intact ileo-caecal valve, immunoglobulins within intestinal secretion and bacteriostatic properties of pancreatic and biliary secretion. Aetiology of SIBO is usually complex, associated with disorders of protective antibacterial mechanisms (e.g. achlorhydria, pancreatic exocrine insufficiency, immunodeficiency syndromes), anatomical abnormalities (e.g. small intestinal obstruction, diverticula, fistulae, surgical blind loop, previous ileo-caecal resections) and/or motility disorders (e.g. scleroderma, autonomic neuropathy in diabetes mellitus, post-radiation enteropathy, small intestinal pseudo-obstruction). In some patients more than one factor may be involved. Symptoms related to SIBO are bloating, diarrhoea, malabsorption, weight loss and malnutrition. The gold standard for diagnosing SIBO is still microbial investigation of jejunal aspirates. Non-invasive hydrogen and methane breath tests are most commonly used for the diagnosis of SIBO using glucose or lactulose. Therapy for SIBO must be complex, addressing all causes, symptoms and complications, and fully individualised. It should include treatment of the underlying disease, nutritional support and cyclical gastro-intestinal selective antibiotics. Prognosis is usually serious, determined mostly by the underlying disease that led to SIBO.
    Full-text · Article · Jun 2010 · World Journal of Gastroenterology
Show more