Small-bowel bacterial overgrowth in children with chronic diarrhea, abdominal pain, or both.
OBJECTIVE
To evaluate the frequency of small-bowel bacterial overgrowth (SBBO) as a cause of chronic digestive symptoms in a large cohort of children, using the glucose breath hydrogen test (BHT).


METHODS
Patients were 53 children (aged 2 months to 12 years) with chronic diarrhea, abdominal pain, or both. Diagnosis of SBBO was defined with a BHT by a change in H2 concentration of 10 ppm H2 or more in expired air after an oral glucose load. Patients with a positive BHT result were included in group 1 and treated with a combination of colistin and metronidazole for 10 days; a second BHT was performed 1 month later. Group 2 comprised patients with a negative BHT result. Group 3 (n = 15) was a control group of healthy subjects, and group 4 (n = 6) a comparison group of subjects with bacteriologically documented SBBO.


RESULTS
Eighteen patients (34%) had a positive BHT result and 35 a negative result. The BHT results were comparable in groups 1 and 4 and in groups 2 and 3, respectively. Fasting H2 levels were higher in group 1 than in groups 2 (p < 0.001) and 3 (p < 0.01). In group 1, children were younger than in group 2 (1 +/- 1 year vs 3.9 +/- 3 years; p < 0.001) and diarrhea was frequent (83%), but 17% of patients had abdominal pain alone. Fetid stools (p < 0.01), mucus in stools (p < 0.01), and flatulence (p < 0.05) were more frequent in group 1 than in group 2. Antibiotic treatment of children in group 1 led to a rapid disappearance of symptoms and normalization of BHT results.


CONCLUSIONS
SBBO appears to be a frequent cause of chronic digestive symptoms in children, especially before the age of 2 years. The BHT provides a simple and noninvasive method of detecting it. The recognition of SBBO in children leads to effective treatment.
de Boissieu
D
D
Service de Pédiatrie, Hôpital Saint Vincent de Paul, Paris, France.
Chaussain
M
M
Badoual
J
J
Raymond
J
J
Dupont
C
C
D015746:Abdominal Pain / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001944:Breath Tests; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D016360:Clostridioides difficile / Q000302:isolation & purification*; D015897:Comorbidity; D003967:Diarrhea / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D005243:Feces / Q000382:microbiology; D005260:Female; D016829:Giardia lamblia / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D007421:Intestine, Small / Q000382:microbiology*; D008297:Male; D013211:Staphylococcus aureus / Q000302:isolation & purification*
D000900:Anti-Bacterial Agents