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Exploring small intestinal bacterial overgrowth in functional upper gastrointestinal disorder: A comprehensive
Bhaswati C Acharyya1,2, Meghdeep Mukhopadhyay1
1Department of Pediatric Gastroenterology and Hepatology, Institute of Child Health, Kolkata 700017, West Bengal, India.
Background:
Small intestinal bacterial overgrowth (SIBO) is suspected and excluded frequently in functional gastrointestinal (GI) disorders. Children presenting with various esophago-gastro-duodenal (upper GI) symptoms are rarely subjected to investigations for SIBO.
Aim:
To estimate the frequency of SIBO in children having functional upper GI symptoms (as cases) and to compare the result of the SIBO status to that of the controls.
Methods:
Children aged 6 to 18 who presented with upper GI symptoms were selected for the study. All children were subjected to upper GI endoscopy before being advised of any proton pump inhibitors (PPIs). Children with normal endoscopy were assigned as cases, and children having any endoscopic lesion were designated as controls. Both groups were subjected to a glucose-hydrogen breath test by Bedfont Gastrolyser.
Results:
A total of 129 consecutive children who were naive to PPIs and had normal baseline investigations were included in the study. Among them, 67 patients had endoscopic lesions and served as the control group, with six cases being excluded due to the presence of Helicobacter pylori in gastric biopsies. Sixty-two children with normal endoscopy results formed the case group. In the case group, 35 children (59%) tested positive for hydrogen breath tests, compared to 13 children (21%) in the control group. The calculated odds ratio was 5.38 (95% confidence interval: 2.41-12.0), which was statistically significant. Further analysis of symptoms revealed that nausea, halitosis, foul-smelling eructation, and epigastric fullness were positive predictors of SIBO.
Conclusion:
It is worthwhile to investigate and treat SIBO in all children presenting with upper GI symptoms that are not explained by endoscopy findings.
Insights
Small intestinal bacterial overgrowth (SIBO) is common in children with unexplained upper GI symptoms. Investigating SIBO in these pediatric patients is recommended, even with normal endoscopic findings.
Area of Science:
- Pediatric Gastroenterology
- Microbiome Research
- Diagnostic Accuracy
Background:
- Small intestinal bacterial overgrowth (SIBO) is frequently suspected in functional gastrointestinal disorders.
- Children with upper GI symptoms are often not tested for SIBO.
Purpose of the Study:
- To determine the prevalence of SIBO in children with functional upper GI symptoms.
- To compare SIBO status in children with and without endoscopic lesions.
Main Methods:
- 129 children (6-18 years) with upper GI symptoms underwent endoscopy before proton pump inhibitors (PPIs).
- Cases had normal endoscopy; controls had endoscopic lesions.
- Glucose-hydrogen breath tests diagnosed SIBO in both groups.
Main Results:
- SIBO was diagnosed in 59% of children with normal endoscopy (cases) versus 21% with lesions (controls).
- The odds ratio for SIBO in cases was 5.38, indicating a significant association.
- Nausea, halitosis, and epigastric fullness predicted SIBO in children.
Conclusions:
- SIBO investigation is valuable for children with upper GI symptoms unexplained by endoscopy.
- Early SIBO diagnosis and treatment can improve pediatric GI health outcomes.
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