Polyethylene glycol 4000 vs. lactulose for the treatment of neurogenic constipation in myelomeningocele children: a randomized‐controlled clinical trial

Rendeli, Claudia; Ausili, Emanuele; Tabacco, F; Focarelli, Benedetta; Pantanella, A.; Rocco, Concezio Di; Genovese, Orazio; Fundarò, C.

doi:10.1111/j.1365-2036.2006.02872.x

Cited by 48 publications

(43 citation statements)

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“…Even in young patients, the colonic transit time is significantly more prolonged in constipated children who produce CH 4 . 20 On the other hand, the presence of methanogenic flora associated with a slowing down of transit time can be a cause or consequence of deterioration in the constipation of these children.…”

Section: Discussionmentioning

confidence: 99%

“…11 ( 4 , produced by methanogenic flora, was able to slow down small intestinal transit. 17 The more interesting data are that half of the children analyzed excrete CH 4 through a breath test.…”

Section: Discussionmentioning

confidence: 99%

“…The CH 4 intestinal decontamination with locally acting drugs without systemic effects in these children may, in fact, reduce the number of UTIs and improve intestinal motility.…”

Section: Discussionmentioning

confidence: 99%

“…3 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. 4 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. 5 Moreover, the treatment of neuropathic constipation is crucial for reducing the risk of urinary tract infections (UTIs), which frequently occur in these patients.…”

Section: Introductionmentioning

confidence: 99%

“…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. [4][5][6] 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. 3 Small intestinal bacterial overgrowth (SIBO) is defined by the presence of 1 Â 10 6 CFU ml À1 of intestinal aspirate and/or the presence of colonic-type species.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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Study design: Prospective study. Objectives: 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. 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 H 2 /CH 4 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 nephrourological 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 CH 4 . 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. Conclusion: The association between CH 4 and constipation suggests that CH 4 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, CH 4 , delayed OCTT and UTI. INTRODUCTIONThe 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. 1 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%. 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. 3 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. 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. 2 The level of neurological impairment influences muscle innervations, motor development, sensory and sphincter dysfunction. 3 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. 4

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The CH 4 intestinal decontamination with locally acting drugs without systemic effects in these children may, in fact, reduce the number of UTIs and improve intestinal motility.…”

Section: Discussionmentioning

confidence: 99%