Elsevier

The Journal of Pediatrics

Volume 155, Issue 3, September 2009, Pages 416-420
The Journal of Pediatrics

Original Article
Prevalence of Small Intestinal Bacterial Overgrowth in Children with Irritable Bowel Syndrome: A Case-Control Study

https://doi.org/10.1016/j.jpeds.2009.03.033Get rights and content

Objective

To assess the prevalence of small intestinal bacterial overgrowth (SIBO) in children affected by irritable bowel syndrome (IBS).

Study design

Consecutive children affected by IBS according to Rome II criteria (n = 43) were enrolled at the Gemelli Hospital, Catholic University of Rome. The control population (n = 56) consisted of healthy subjects without IBS symptoms, similar to patients for age, sex, and social background. All subjects underwent lactulose/methane breath test (LBT) to assess small intestinal bacterial overgrowth.

Results

The prevalence of abnormal LBT result was significantly higher in patients with IBS (65%, 28/43) with respect to control subjects (7%, 4/56; OR 3.9, 95% CI 7.3-80.1, P < .00001). Patients with abnormal LBT showed a trend toward a worse visual analog scale score with respect to children with IBS without SIBO, but a significant statistical difference was observed only for bloating.

Conclusions

Results from this study suggest a significant epidemiologic association between SIBO and IBS in childhood. Placebo-controlled interventional studies with antibiotics used to treat bacterial overgrowth are warranted to clarify the real impact of the disease on IBS symptoms.

Section snippets

Methods

Consecutive children affected by IBS, according to Rome II criteria, were enrolled at the Pediatric Gastroenterology Outpatient Unit of Gemelli Hospital, Catholic University of Rome. Patients with IBS participating in the study were selected among children sent by pediatric primary care practices of Rome and surrounding area affiliated with our center for further evaluation of chronic gastrointestinal symptoms (Table I).

Patient symptoms were assessed by a visual analogic scale questionnaire

Results

A total of 43 patients with IBS and 56 healthy control subjects were enrolled; 15 patients (35%) were classified as diarrhea-predominant, 12 (28%) as constipation-predominant, and 16 (37%) as diarrhea-predominant. Eleven of 43 (25%) patients with IBS were classified as having PI-IBS.

Discussion

Several studies of adult patients suggest that SIBO may be a contributing factor in IBS. Both a high prevalence of SIBO in IBS populations and a significant improvement after decontamination therapy were reported.14, 15, 16, 17, 18

This case-control study assessed the prevalence of SIBO in children affected by IBS. We show that children with IBS have a significantly higher prevalence of SIBO, as assessed by LBT, with respect to a consistent control group. In addition, patients with IBS with

References (33)

  • A. Caplan et al.

    Validation of the pediatric Rome II criteria for functional gastrointestinal disorders using the questionnaire on pediatric gastrointestinal symptoms

    J Pediatr Gastroenterol Nutr

    (2005)
  • L.S. Walker et al.

    Recurrent abdominal pain: symptom subtypes based on the Rome II criteria for pediatric functional gastrointestinal disorders

    J Pediatr Gastroenterol Nutr

    (2004)
  • R.H. Hunt

    Evolving concepatients in the pathophysiology of functional gastrointestinal disorders

    J Clin Gastroenterol

    (2002)
  • E. Malinen et al.

    Analysis of the fecal microbiota of irritable bowel syndrome patients and healthy controls with real-time PCR

    Am J Gastroenterol

    (2005)
  • W.R. Treem et al.

    Fecal short-chain fatty acids in patients with diarrhea-predominant irritable bowel syndrome: in vitro studies of carbohydrate fermentation

    J Pediatr Gastroenterol Nutr

    (1996)
  • V.V. Singh et al.

    Small bowel bacterial overgrowth: presentation, diagnosis, and treatment

    Curr Treat Options Gastroenterol

    (2004)
  • Cited by (0)

    This work was supported by an unrestricted grant provided by Fondazione Ricerca in Medicina. The authors declare no potential conflict of interest.

    View full text