Estimation of small intestinal bacterial overgrowth in children patients with different gastrointestinal symptoms

Authors

  • Dong Xi Department of Pediatrics, Brookdale University Hospital and Medical Center, One Brookdale Plaza, Brooklyn, NY 11212, USA
  • Roger Kim Department of Pediatrics, Brookdale University Hospital and Medical Center, One Brookdale Plaza, Brooklyn, NY 11212, USA
  • Yatian Zhang Department of Pediatrics, Brookdale University Hospital and Medical Center, One Brookdale Plaza, Brooklyn, NY 11212, USA
  • Fernanda Kupferman Department of Pediatrics, Brookdale University Hospital and Medical Center, One Brookdale Plaza, Brooklyn, NY 11212, USA
  • Radha Nathan Department of Pediatrics, Brookdale University Hospital and Medical Center, One Brookdale Plaza, Brooklyn, NY 11212, USA

DOI:

https://doi.org/10.18203/2349-3291.ijcp20161019

Keywords:

SIBO, LBT

Abstract

Background: Small intestinal bacterial overgrowth (SIBO) is a condition presenting with increased bacterial colonization. Lactulose breath test (LBT) is widely used for the diagnosis of SIBO. However the clinical symptom most likely to have positive LBT is still unknown. The objective of the study was to analyze the correlation between different gastrointestinal (GI) symptoms and positive LBT, and identify the symptom with highest positive LBT rate.

Methods: Retrospective study was performed in pediatric patients who underwent LBT from 2011 to 2014. Patients presented with one or multiple GI symptoms. LBT was performed and considered to be positive if hydrogen level was increased by 20ppm. The percentage of positive LBT in all the patients and patients with individual GI symptom was calculated. The symptom with highest positive LBT rate was identified.

Results: Totally 48 patients were tested. 34 patients (71%) were found to have positive LBT and 14 patients (29%) were negative. LBT was found to be positive in 85% of patients with failure to thrive, higher than other GI symptoms. Failure to thrive was identified to have highest positive LBT rate and less likely to be associated with multiple manifestations in patient with SIBO.

Conclusions: Our study showed strong correlation between positive LBT and failure to thrive, and less association of failure to thrive with multiple symptoms in SIBO. LBT should be considered in patients with failure to thrive and no other etiologies.

References

DuPont AW, DuPont HL. The intestinal microbiota and chronic disorders of the gut. Nat Rev Gastroenterol Hepatol. 2011;8:523-31.

Quigley EM. Small intestinal bacterial overgrowth: what it is and what it is not. Curr Opin Gastroenterol. 2014;30:141-6.

Schiller LR. Evaluation of small bowel bacterial overgrowth. Curr Gastroenterol Rep. 2007;9:373-7.

Malik BA, Xie YY, Wine E. Diagnosis and pharmacological management of small intestinal bacterial overgrowth in children with intestinal failure. Can J Gastroenterol. 2011;25:41-5.

Gutierrez IM, Kang KH, Calvert CE. Risk factors for small bowel bacterial overgrowth and diagnostic yield of duodenal aspirates in children with intestinal failure: a retrospective review. J Pediatr Surg. 2012;47:1150-4.

Abu-Shanab A, Quigley EM. Diagnosis of small intestinal bacterial overgrowth: the challenges persist! Expert Rev Gastroenterol Hepatol. 2009;3:77-87.

Bohm M, Siwiec RM, Wo JM. Diagnosis and management of small intestinal bacterial overgrowth. Nutr Clin Pract. 2013;28:289-99.

Bures J, Cyrany J, Kohoutova D. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010;16:2978-90.

Khoshini R, Dai SC, Lezcano S. A systematic review of diagnostic tests for small intestinal bacterial overgrowth. Dig Dis Sci. 2008;53:1443-54.

Leiby A, Mehta D, Gopalareddy V. Bacterial overgrowth and methane production in children with encopresis. J Pediatr. 2010;156:766-70, 770 e1.

Sieczkowska A, Landowski P, Kaminska B. Small Bowel Bacterial Overgrowth in Children: A Comprehensive Review. J Pediatr Gastroenterol Nutr. 2015.

Korterink JJ, Benninga MA, van Wering HM. Glucose hydrogen breath test for small intestinal bacterial overgrowth in children with abdominal pain-related functional gastrointestinal disorders. J Pediatr Gastroenterol Nutr. 2015;60:498-502.

Sieczkowska A, Landowski P, Zagozdzon P. Small Bowel Bacterial Overgrowth Associated with Persistence of Abdominal Symptoms in Children Treated with a Proton Pump Inhibitor. J Pediatr. 2015;166:1310-2.e1.

Quigley EM, Abu-Shanab A. Small intestinal bacterial overgrowth. Infect Dis Clin North Am 2010;24:943-59.viii-ix.

Collins BS, Lin HC. Double-blind, placebo-controlled antibiotic treatment study of small intestinal bacterial overgrowth in children with chronic abdominal pain. J Pediatr Gastroenterol Nutr 2011;52:382-6.

Tahan S, Melli LC, Mello CS. Effectiveness of trimethoprim-sulfamethoxazole and metronidazole in the treatment of small intestinal bacterial overgrowth in children living in a slum. J Pediatr Gastroenterol Nutr. 2013;57:316-8.

Downloads

Published

2016-12-28

Issue

Section

Original Research Articles