Bacterial Overgrowth and Methane Production in Children with Encopresis

Leiby, Alycia; Mehta, Devendra; Gopalareddy, Vani; Jackson-Walker, Susan; Horvath, Karoly

doi:10.1016/j.jpeds.2009.10.043

« Previous Next »The Journal of Pediatrics
Volume 156, Issue 5 , Pages 766-770.e1, May 2010

Bacterial Overgrowth and Methane Production in Children with Encopresis

Alycia Leiby, MD
- Division of Pediatric Gastroenterology and Nutrition, Alfred I. duPont Hospital for Children, Wilmington, DE
- Thomas Jefferson University, Philadelphia, PA
Devendra Mehta, MD
- Division of Pediatric Gastroenterology and Nutrition, Alfred I. duPont Hospital for Children, Wilmington, DE
- Thomas Jefferson University, Philadelphia, PA
Vani Gopalareddy, MD
- Division of Pediatric Gastroenterology and Nutrition, Alfred I. duPont Hospital for Children, Wilmington, DE
- Thomas Jefferson University, Philadelphia, PA
Susan Jackson-Walker, PhD
- Division of Behavioral Health, Alfred I. duPont Hospital for Children, Wilmington, DE
- Thomas Jefferson University, Philadelphia, PA
Karoly Horvath, MD, PhD
- Division of Pediatric Gastroenterology and Nutrition, Alfred I. duPont Hospital for Children, Wilmington, DE
- Thomas Jefferson University, Philadelphia, PA
- Reprint requests: Karoly Horvath, MD, PhD, Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19803.

Received 22 June 2009; received in revised form 14 September 2009; accepted 30 October 2009. published online 28 December 2009.

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.

FI, Fecal impaction, LBT, Lactulose breath test, SIBO, Small intestinal bacterial overgrowth