Original Article
Bacterial Overgrowth and Methane Production in Children with Encopresis

https://doi.org/10.1016/j.jpeds.2009.10.043Get rights and content

Objectives

To assess the prevalence of small intestinal bacterial overgrowth (SIBO) and methane production in children with encopresis.

Study design

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.

Results

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).

Conclusions

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.

Section snippets

Methods

The study was conducted at the Gastroenterology and Nutrition Outpatient Clinic of the Alfred I. duPont Hospital for Children in Wilmington, DE, from January 2005 to June 2008. The study enrolled otherwise healthy school age children (6 to 12 years) with normal general intellectual functioning who had a history and physical examination consistent with secondary retentive encopresis. All patients had daily or weekly episodes of fecal soiling for a minimum of 2 months before evaluation. Patients

Results

The mean fecal impaction (FI) radiographic score was 1.9 ± 0.65 for the entire encopretic group. There was a significant difference (P < .01) in the mean FI score between methane producers (2.03 ± 0.32; n = 24) and non-methane–producing patients (1.72 ± 0.44; n = 26). The mean FI scores of the SIBO-positive patients (1.9 ± 0.49) and the SIBO-negative patients (1.89 ± 0.39) were not different (P = .06).

SIBO was found in 21 of the 50 (42%) children with encopresis. The prevalence of SIBO was

Discussion

Because the bacterial flora in the small intestine is controlled by motility and methane production is associated with slower motility, patients with encopresis and methane production are at risk for SIBO. We hypothesized that methane production increases the risk for SIBO by slowing small intestinal transit time. SIBO was diagnosed more frequently in our patients with encopresis compared with the children with other gastrointestinal disorders, but this did not reach significance (P = .06).

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    Funding for the project was obtained through the Nemours Foundation. The authors declare no conflicts of interest.

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