Small Intestinal Bacterial Overgrowth in Children: Clinical Features and Treatment Response

Maria Isabel Peinado Fabregat; Rebecca M Gardner; Maheen A Hassan; Kristopher Kapphahn; Ann Ming Yeh

doi:10.1097/PG9.0000000000000185

Small Intestinal Bacterial Overgrowth in Children: Clinical Features and Treatment Response

JPGN Rep. 2022 Mar 17;3(2):e185. doi: 10.1097/PG9.0000000000000185. eCollection 2022 May.

Authors

Maria Isabel Peinado Fabregat¹, Rebecca M Gardner², Maheen A Hassan³, Kristopher Kapphahn², Ann Ming Yeh³

Affiliations

¹ From the Department of Pediatrics, Division of General Pediatrics at Stanford University, Stanford, CA.
² Quantitative Sciences Unit, Stanford School of Medicine, Stanford, CA.
³ Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition at Stanford University, Stanford, CA.

Abstract

To characterize the population of children diagnosed with small intestinal bacterial overgrowth (SIBO) based on breath test (BT), correlate symptomatology, and describe SIBO treatments and treatment efficacy.

Methods: A retrospective cohort study of pediatric patients seen at Stanford Children's Health Gastroenterology Clinics from 2012 to 2018 who had a positive BT, defined by a rise in hydrogen by ≥20 ppm, a baseline hydrogen level ≥20 ppm, or a methane value ≥10 ppm. The main outcome was symptom resolution, defined as complete or partial improvement after a course of treatment. Absolute standardized differences and Chi-square tests were used to assess associations.

Results: From 98 children, 54 met inclusion and did not meet exclusion criteria (53.7% female). Lactulose substrate was used for 41 (75.9%) patients, whereas glucose was used for 13 (24.1%). Complete or partial resolution of symptoms was achieved in 13 of 16 (81.2%) patients who received probiotics with or without antibiotics versus 21 of 31 (67.7%) patients treated with antibiotics alone (P = 0.524). Metronidazole versus rifaximin versus other antibiotics showed no significant difference in symptom resolution (12 (63.2%), 13 (76.5%), 7 (77.8%), respectively, P = 0.601).

Conclusion: Seventy-two percent of patients experienced at least partial symptom relief after treatment. We did not find a strong correlation between specific symptoms and analyte elevation. There was no difference in effectiveness between metronidazole and rifaximin to treat SIBO symptoms. Further research needs to be done to determine effective treatments for SIBO in pediatrics.

Keywords: BT; SIBO; breath test; intestinal overgrowth; overgrowth.

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.