title: Chronic abdominal pain in children is associated with high prevalence of abnormal microbial fermentation.
abstract: BACKGROUND
  Chronic abdominal pain (CAP) in children, a condition that accounts for approximately 25% of pediatric gastroenterology office visits, may be a precursor to irritable bowel syndrome in adults. Recently, small intestinal bacterial overgrowth (SIBO) has been reported in 78-84% of IBS patients regardless of their abdominal symptoms, compared to 20% in healthy controls. Aims The aim of this study was, therefore, to assess the prevalence of SIBO in children with CAP.
  
  
  METHODS
  Seventy-five children aged 8-18 years diagnosed with CAP based on the Rome II criteria and 40 healthy controls were enrolled. All subjects underwent a lactulose breath hydrogen test (LBT) to assess for SIBO. Children with CAP also filled out symptom questionnaires.
  
  
  RESULTS
  There was a 91% prevalence of an abnormal LBT suggestive of SIBO in the children with CAP and 35% in controls (odds ratio = 16.7, 95% confidence interval 6.0-57.5, P < 0.0001). A comparison of CAP children with a positive LBT to CAP children with a negative LBT revealed the former had significantly more "urgency to have a bowel movement" (P = 0.049) and experienced less "soiling" (P = 0.016) than those with a negative LBT. No significant differences were found between the two groups in terms of the location of their pain or any other associated symptoms.
  
  
  CONCLUSIONS
  Similar to adults with IBS, there is a significantly higher prevalence of SIBO in children with CAP. Randomized controlled studies are needed to determine if eradication of SIBO will lead to symptom improvement in these patients.
authors.affiliation: Division of Gastroenterology and Nutrition, Childrens Hospital Los Angeles and Keck School of Medicine, University of Southern California, 4650 Sunset Blvd. MS #78, Los Angeles, CA 90027, USA. bcollins@chla.usc.edu
authors.forename: Brynie Slome
authors.initials: BS
authors.lastname: Collins
authors.forename: Henry C
authors.initials: HC
authors.lastname: Lin
mesh_terms: D015746:Abdominal Pain / Q000382:microbiology*; D000293:Adolescent; D001419:Bacteria / Q000254:growth & development* / Q000378:metabolism; D001944:Breath Tests; D002648:Child; D002908:Chronic Disease; D004415:Dyspepsia / Q000175:diagnosis / Q000382:microbiology; D005260:Female; D005285:Fermentation; D006801:Humans; D007421:Intestine, Small / Q000382:microbiology*; D043183:Irritable Bowel Syndrome / Q000175:diagnosis / Q000382:microbiology; D007792:Lactulose; D008297:Male
chemical_list: D007792:Lactulose