Abdominal pain is one of the most common diagnoses in hospitalised children and the leading symptom in child and adolescent GIT diseases. It is also a common symptom of SIBO. Therefore, researchers looked at the prevalence of childhood abdominal pain and correlating SIBO. They found a high occurrence of SIBO in these children.
To test whether SIBO was the cause of childhood abdominal pain, researchers performed hydrogen breath tests (HBTs) on 100 children aged from four to 17 years old (mean age was around seven to 14), over five years. Although this test has limitations, with the ‘gold standard’ still being microbial analysis of the small intestinal fluid, it is the least invasive, and a commonly used test in the paediatric population.
The results showed positive HBT results in 63% of the children presenting with abdominal pain. When looking at those under 10 years old, 46% had a SIBO positive result, with a similar result of 54% in those over 10 years old. There was a higher prevalence of SIBO in girls over the age of 10; however, this was nonsignificant (p=0.07). Overall, there were no significant gender differences.
All patients with a positive HBT were treated with the antibiotic rifaximin (Xifaxan). This antibiotic is a commonly used SIBO treatment due to its low absorption capacity and relatively few side effects compared to other antibiotics.
However, there are questions with its ability to maintain remission, as another study showed 44% of patients relapsed nine months after induction of remission with rifaximin.2 In this study 88% of those with a positive HBT achieved a normal HBT after antibiotic use.
Childhood conditions can affect the normal homeostatic mechanisms restricting bacterial colonisation in the small intestine leading to SIBO, such as congenital or acquired anatomical abnormalities, diminished gastric acid secretion, congenital alteration of intestinal motility or other acquired chronic diseases. SIBO may even be an unrecognised cause of paediatric morbidity.
This study demonstrates that SIBO is highly prevalent in childhood abdominal pain and should be considered as a cause that requires treatment. In a 2016 review, the authors noted that, “[o]wing to lack of established guidelines and few published interventional studies that assess the effectiveness of [SIBO] therapy, treatment of children with [SIBO] remains empiric and comprises antibiotic or probiotic therapy”.
- Siniewicz-Luzeńczyk K, Bik-Gawin A, Zeman K, et al. Small intestinal bacterial overgrowth syndrome in children. Prz Gastroenterol 2015;10(1):28-32. [Full text]
- Rezaie A, Pimentel M, Rao SS. How to test and treat small intestinal bacterial overgrowth: an evidence-based approach. Curr Gastroenterol Rep 2016;18(2):8. [Abstract]
- Sieczkowska A, Landowski P, Kaminska B, et al. Small bowel bacterial overgrowth in children. J Pediatr Gastroenterol Nutr 2016;62(2):196-207. [Abstract]