Small Bowel Bacterial Overgrowth in Children

Sieczkowska, Agnieszka; Landowski, Piotr; Kamińska, Barbara; Lifschitz, Carlos

doi:10.1097/mpg.0000000000000920

Cited by 36 publications

(43 citation statements)

References 121 publications

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“…A recently published review noted a high incidence of diarrhea reported in children with SIBO, with abdominal pain, bloating, and flatulence also commonly reported . Diarrhea and bloating have been found to be the most common symptoms in adults with duodenal culture‐proven SIBO .…”

Section: Discussionsupporting

confidence: 58%

“…Small intestinal aspirate and culture are not an appropriate test for children with mild nonspecific symptoms or for those who may need repeated testing due to associated risks (anesthetic/sedation and endoscopy) and is too invasive for most research purposes …”

Section: Discussionmentioning

confidence: 99%

“…These protective mechanisms include gastric acid secretion, small intestinal motility, ileocecal valve function, pancreatic and biliary secretion, and mucosal immunity. SIBO is traditionally defined as the overgrowth (>10 5 CFU/mL) of bacteria in a small intestinal aspirate, and some definitions include reference to the presence of colonic bacterial species . A recent systematic review suggested that these diagnostic criteria are too high and also require consideration of the presence of specific bacterial species …”

Section: Introductionmentioning

confidence: 99%

“…Protocols and result interpretation may differ between institutions, and SIBO may be missed as a consequence of overgrowth with nonhydrogen‐producing bacteria . Despite these limitations, there is evidence supporting this test for the diagnosis of SIBO in adults and older children …”

Section: Introductionmentioning

confidence: 99%

“…Different urinary tests have been used as indirect or surrogate markers for SIBO by detecting bacterial metabolites, indicating abnormal bacterial colonization in the small intestine (e.g. urinary phenol, indican, Cholyl‐PABA, and 4‐hydroxyphenylacetic acid) . Acetate, lactate, and formate have been shown to be significantly higher in upper gut aspirates of people with malabsorption syndrome and SIBO compared with malabsorption syndrome alone or a control group .…”

Section: Introductionmentioning

confidence: 99%

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Small intestinal bacterial overgrowth in children with intestinal failure on home parenteral nutrition

2019

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Background and Aim Children with intestinal failure (IF) have abnormal intestinal anatomy, secretion, or motility, which impairs homeostatic mechanisms and can lead to small intestinal bacterial overgrowth (SIBO). We sought to describe clinical features at the time of clinically suspected SIBO by experienced clinicians in children with IF on home parenteral nutrition (PN), review specific challenges of diagnostic testing in this population, and describe potential new diagnostic surrogate markers. Methods A descriptive single‐center retrospective chart review was performed during all episodes of clinically suspected SIBO over 33 months. Information was recorded on clinical symptoms, and diagnostic tests performed. Results Of all patients on home PN, 71% (12/17) had at least one episode of clinically suspected SIBO (mean 1 episode/year, range 1–7); 50% of patients had short bowel syndrome (SBS), and 50% had non‐SBS IF. The average reported symptoms per episode were 1.9 (range 1–5). Children with SBS reported fewer symptoms per episode (1.5) than children with non‐SBS IF (2.3). Diarrhea was the most commonly reported symptom, particularly in children with SBS. Conclusions Children with IF on home PN are a high‐risk group for SIBO. Clinical features of SIBO vary depending on the cause of IF and may mimic symptoms of the underlying condition. Diagnostic tests have innate challenges in this group, and a strong index of clinical suspicion is paramount. Further research is recommended into potential new surrogate markers (urinary metabolite screen, gastric aspirate) for this diagnostically challenging population.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Small intestinal bacterial overgrowth in children with intestinal failure on home parenteral nutrition

2019

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Factors Related to the Development of Small‐Bowel Bacterial Overgrowth in Pediatric Intestinal Failure: A Retrospective Cohort Study

Belza¹,

Betts²,

Silva³

et al. 2020

J Parenter Enteral Nutr

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Background Small bowel bacterial overgrowth (SBBO) is a challenge in the management of pediatric intestinal failure (PIF). Our goal was to determine the proportion of patients treated for SBBO and factors related to its development. Methods We completed a retrospective analysis of PIF patients referred between 2008 and 2014. Data were collected on factors related to intestinal failure (IF) and SBBO. The cohort was stratified on the diagnosis of SBBO and refractory SBBO. Statistical testing completed using t‐test, χ2 test, and logistic regression. Results Thirty‐five of 102 patients developed SBBO (34%), and 16 (16%) had refractory SBBO. SBBO was more likely in gastroschisis (40.0% vs 19.4%, P = .025), a shorter residual small bowel (SB) (45.4% vs 66.5%, P = .004), and patients were less likely to wean from parenteral nutrition (PN) (51.4% vs 85.1%, P < .0001). Refractory SBBO patients were likely to have gastroschisis (50.0% vs 22.1%, P = .020) and a shorter residual SB and large bowel remaining (23.2% vs 65.9%, P < .0001 and 60.6% vs 79.4%, P = .03, respectively) and less likely to wean from PN (37.5% vs 80.2%, P = .001). Logistic regression demonstrated that longer SB residual was protective (P = .001; odds ratio [OR], 0.95; 95% CI, 0.93–0.99), and short bowel syndrome (SBS) as a cause of IF was a risk factor (P = .001; OR, 0.04; 95% CI, 0.01–0.27). Conclusion A longer SB remnant was protective against SBBO. Patients with SBBO were more likely to have PIF caused by SBS.

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Nutrition support in the pediatric total pancreatectomy with islet autotransplantation recipient

Downs,

Brun,

Bellin

2023

Nut in Clin Prac

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For children with diminished quality of life and chronic pain caused by acute recurrent or chronic pancreatitis who are undergoing total pancreatectomy with islet autotransplantation, postoperative nutrition support has several unique characteristics. Surgical complications may lead to delays in nutrition support initiation or require modifications to the regimen. Early postoperative dysmotility requires the use of temporary enteral nutrition until this improves. The resultant complete exocrine pancreatic insufficiency necessitates lifelong pancreatic enzyme replacement therapy and fat‐soluble vitamin supplementation. A low‐oxalate diet is recommended to prevent kidney stones. Carbohydrate counting is needed for the provision of short‐term insulin dosing and possibly long‐term as well, depending on the transplanted islet yield. Children should have careful nutrition assessment and monitoring at several follow‐up visits during the first year, then annually, and at any time with concerns.

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Small Bowel Bacterial Overgrowth in Children

Abstract: Further research is needed to determine the clinical impact of SBBO and to establish diagnostic and therapeutic guidelines applicable to children.

Cited by 36 publications

References 121 publications

Small intestinal bacterial overgrowth in children with intestinal failure on home parenteral nutrition

Small intestinal bacterial overgrowth in children with intestinal failure on home parenteral nutrition

Factors Related to the Development of Small‐Bowel Bacterial Overgrowth in Pediatric Intestinal Failure: A Retrospective Cohort Study

Nutrition support in the pediatric total pancreatectomy with islet autotransplantation recipient

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