Brynie Slome Collins1, Henry C Lin. 1. Division of Gastroenterology and Nutrition, Childrens Hospital Los Angeles and Keck School of Medicine, University of Southern California, 4650 Sunset Blvd. MS #78, Los Angeles, CA 90027, USA. bcollins@chla.usc.edu
Abstract
BACKGROUND: Chronic abdominal pain (CAP) in children, a condition that accounts for approximately 25% of pediatric gastroenterology office visits, may be a precursor to irritable bowel syndrome in adults. Recently, small intestinal bacterial overgrowth (SIBO) has been reported in 78-84% of IBS patients regardless of their abdominal symptoms, compared to 20% in healthy controls. Aims The aim of this study was, therefore, to assess the prevalence of SIBO in children with CAP. METHODS: Seventy-five children aged 8-18 years diagnosed with CAP based on the Rome II criteria and 40 healthy controls were enrolled. All subjects underwent a lactulose breath hydrogen test (LBT) to assess for SIBO. Children with CAP also filled out symptom questionnaires. RESULTS: There was a 91% prevalence of an abnormal LBT suggestive of SIBO in the children with CAP and 35% in controls (odds ratio = 16.7, 95% confidence interval 6.0-57.5, P < 0.0001). A comparison of CAP children with a positive LBT to CAP children with a negative LBT revealed the former had significantly more "urgency to have a bowel movement" (P = 0.049) and experienced less "soiling" (P = 0.016) than those with a negative LBT. No significant differences were found between the two groups in terms of the location of their pain or any other associated symptoms. CONCLUSIONS: Similar to adults with IBS, there is a significantly higher prevalence of SIBO in children with CAP. Randomized controlled studies are needed to determine if eradication of SIBO will lead to symptom improvement in these patients.
BACKGROUND: Chronic abdominal pain (CAP) in children, a condition that accounts for approximately 25% of pediatric gastroenterology office visits, may be a precursor to irritable bowel syndrome in adults. Recently, small intestinal bacterial overgrowth (SIBO) has been reported in 78-84% of IBSpatients regardless of their abdominal symptoms, compared to 20% in healthy controls. Aims The aim of this study was, therefore, to assess the prevalence of SIBO in children with CAP. METHODS: Seventy-five children aged 8-18 years diagnosed with CAP based on the Rome II criteria and 40 healthy controls were enrolled. All subjects underwent a lactulose breathhydrogen test (LBT) to assess for SIBO. Children with CAP also filled out symptom questionnaires. RESULTS: There was a 91% prevalence of an abnormal LBT suggestive of SIBO in the children with CAP and 35% in controls (odds ratio = 16.7, 95% confidence interval 6.0-57.5, P < 0.0001). A comparison of CAP children with a positive LBT to CAP children with a negative LBT revealed the former had significantly more "urgency to have a bowel movement" (P = 0.049) and experienced less "soiling" (P = 0.016) than those with a negative LBT. No significant differences were found between the two groups in terms of the location of their pain or any other associated symptoms. CONCLUSIONS: Similar to adults with IBS, there is a significantly higher prevalence of SIBO in children with CAP. Randomized controlled studies are needed to determine if eradication of SIBO will lead to symptom improvement in these patients.
Authors: P E Hyman; J A Napolitano; A Diego; S Patel; A F Flores; B B Grill; S N Reddy; T Q Garvey; T Tomomasa Journal: Pediatrics Date: 1990-07 Impact factor: 7.124
Authors: B Starfield; R A Hoekelman; M McCormick; P Benson; R C Mendenhall; C Moynihan; S Radecki Journal: Pediatrics Date: 1984-12 Impact factor: 7.124
Authors: Richard A Schatz; Qing Zhang; Nilesh Lodhia; Jonathan Shuster; Phillip P Toskes; Baharak Moshiree Journal: World J Gastroenterol Date: 2015-04-21 Impact factor: 5.742
Authors: David Avelar Rodriguez; Paul MacDaragh Ryan; Erick Manuel Toro Monjaraz; Jaime Alfonso Ramirez Mayans; Eamonn Martin Quigley Journal: Front Pediatr Date: 2019-09-04 Impact factor: 3.418
Authors: Alexandre Neves da Rocha Santos; Ana Cristina Fontenele Soares; Ricardo Palmero Oliveira; Mauro Batista de Morais Journal: Rev Paul Pediatr Date: 2020-01-13