Small intestinal bacterial overgrowth in spinal cord injury patients. / Sobrecrecimiento bacteriano del intestino delgado en pacientes con lesión medular.

AIM: Spinal cord injury (SCI) patients may have intestinal dysmotility and digestive symptoms that are associated with small intestinal bacterial overgrowth (SIBO). The aim of this study is to describe the prevalence of SIBO in SCI patients and the risk factors of its development. METHODS: Twenty-nine consecutive SCI patients were studied (10 women/19 men; mean age 47 years), 16 with subacute injuries (<9 months) and 13 with chronic injuries (>1 year). Nine patients were affected by tetraplegia and 15 by paraplegia. Each patient underwent a glucose breath test according to the North American Consensus and the presence of abdominal symptoms was evaluated during the test. The results were compared with 15 non-neurological patients with SIBO. RESULTS: Six patients tested positive for SIBO (21%), all of them affected by SCI in the subacute phase, 6/16 vs. 0/13 in the chronic phase (P<.05) and the majority with tetraplegia, 5/9 vs. 1/19 with paraplegia (P<.05). No statistically significant relationship was found with other clinical characteristics. All the tests were positive for methane or mixed (methane and hydrogen), while only 67% of the controls had methane-predominant production (P>.05). CONCLUSION: SCI patients can develop SIBO, more frequently in the subacute phase and in tetraplegic patients, highlighting a high production of methane. This complication should be considered in neurogenic bowel management.

Sobrecrecimiento bacteriano del intestino delgado en pacientes con lesión medular / Small intestinal bacterial overgrowth in spinal cord injury patients

Objetivo: Los pacientes con lesión medular (LM) pueden presentar alteraciones de la motilidad intestinal y síntomas digestivos que se asocian a sobrecrecimiento bacteriano del intestino delgado (SIBO). El objetivo de este estudio es investigar la prevalencia de SIBO en pacientes con LM y los factores asociados a su desarrollo. Métodos: Se estudió a 29 pacientes consecutivos con LM (10 mujeres/19 hombres; edad media 47 años), 16 con lesiones subagudas (< 9 meses) y 13 con lesiones crónicas (> 1 año). Nueve pacientes estaban afectados de tetraplejía y 15 de paraplejía. A cada paciente se realizó un test del aliento con glucosa de acuerdo con el Consenso Norteamericano y se evaluó la presencia de síntomas abdominales durante la prueba. Los resultados se compararon con los de 15 pacientes con SIBO sin enfermedad neurológica. Resultados: Seis pacientes fueros positivos para SIBO (21%), todos ellos afectados de LM en fase subaguda, 6/16 vs. 0/13 en fase crónica (p<0,05) y la mayoría afectados de tetraplejía, 5/9 vs. 1/19 con paraplejía (p<0,05). No se encontró relación estadísticamente significativa con otros parámetros clínicos. Todos los test fueron positivos para metano o mixto (metano e hidrógeno), mientras que solo el 67% de los controles tenían producción predominante de metano (p>0,05). Conclusión: Los pacientes con LM pueden desarrollar SIBO, siendo más frecuente en fase subaguda y en tetrapléjicos, destacando la alta producción de metano. Esta complicación debe tenerse en cuenta en el manejo del intestino neurógeno.(AU)

Aim: Spinal cord injury (SCI) patients may have intestinal dysmotility and digestive symptoms that are associated with small intestinal bacterial overgrowth (SIBO). The aim of this study is to describe the prevalence of SIBO in SCI patients and the risk factors of its development. Methods: Twenty-nine consecutive SCI patients were studied (10 women/19 men; mean age 47 years), 16 with subacute injuries (<9 months) and 13 with chronic injuries (>1 year). Nine patients were affected by tetraplegia and 15 by paraplegia. Each patient underwent a glucose breath test according to the North American Consensus and the presence of abdominal symptoms was evaluated during the test. The results were compared with 15 non-neurological patients with SIBO. Results: Six patients tested positive for SIBO (21%), all of them affected by SCI in the subacute phase, 6/16 vs. 0/13 in the chronic phase (P<.05) and the majority with tetraplegia, 5/9 vs. 1/19 with paraplegia (P<.05). No statistically significant relationship was found with other clinical characteristics. All the tests were positive for methane or mixed (methane and hydrogen), while only 67% of the controls had methane-predominant production (P>.05). Conclusion: SCI patients can develop SIBO, more frequently in the subacute phase and in tetraplegic patients, highlighting a high production of methane. This complication should be considered in neurogenic bowel management.(AU)