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Factors Related to the Development of Small-Bowel Bacterial Overgrowth in Pediatric Intestinal Failure: A
Christina Belza1, Zachary Betts1, Nicole de Silva2
1Transplant and Regenerative Medicine Centre, Toronto, Canada.
Insights
Small bowel bacterial overgrowth (SBBO) affects one-third of pediatric intestinal failure (PIF) patients. A longer small bowel remnant is protective against SBBO, which is more common in short bowel syndrome.
Area of Science:
- Pediatric Gastroenterology
- Intestinal Failure Management
- Microbiome Research
Background:
- Small bowel bacterial overgrowth (SBBO) presents a significant clinical challenge in managing pediatric intestinal failure (PIF).
- Understanding the prevalence and contributing factors of SBBO is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the proportion of pediatric intestinal failure patients who develop small bowel bacterial overgrowth.
- To identify factors associated with the development of SBBO and refractory SBBO in this cohort.
Main Methods:
- Retrospective analysis of pediatric intestinal failure patients referred between 2008 and 2014.
- Data collection on intestinal failure causes, small bowel length, and parenteral nutrition weaning.
- Statistical analysis including t-tests, chi-squared tests, and logistic regression to identify risk factors and protective elements.
Main Results:
- 34% of patients developed SBBO, with 16% having refractory SBBO.
- SBBO was more prevalent in patients with gastroschisis, shorter residual small bowel, and less likelihood of weaning from parenteral nutrition.
- Logistic regression indicated that a longer small bowel remnant was protective, while short bowel syndrome was a significant risk factor for SBBO.
Conclusions:
- A longer residual small bowel length serves as a protective factor against the development of small bowel bacterial overgrowth in pediatric intestinal failure.
- Short bowel syndrome is a primary risk factor for small bowel bacterial overgrowth in patients with pediatric intestinal failure.
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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