ABSTRACT
Small intestinal bacterial overgrowth (SIBO) in children
Small intestinal bacterial overgrowth (SIBO) is characterized by an excessive bacterial count in the small bowel, leading to a variety of gastrointestinal and extraintestinal symptoms. While its prevalence among children varies, it is reported to affect 0–35% children in healthy pediatric populations.
The presentation of SIBO is varied. Abdominal pain, bloating, gas, distension, flatulence and diarrhea are the most common symptoms described in patients with SIBO. In severe cases, nutritional deficiencies including vitamins, hypoproteinemia, weight loss and growth stunting can occur. SIBO’s presentation can often mimic conditions such as IBS, celiac, or Crohn’s disease.
Numerous risk factors contribute to SIBO, including strictures, ileocecal resections, and the use of opioids or PPIs. Comorbidities like diabetes, inflammatory bowel disease, cirrhosis, pancreatic insufficiency, and IBS are further predisposing factors.
Direct clinical diagnosis of SIBO is challenging, making noninvasive breath tests (hydrogen or methane) essential. These tests operate on the premise that human cells do not produce hydrogen or methane; thus, an increase in these gases post-glucose or lactulose consumption indicates microbial fermentation. Per European guidelines, a rise above 10 ppm from the baseline within 90 minutes confirms SIBO.
Antibiotic administration remains the primary treatment for symptomatic SIBO in children. Although this approach is conventional, its efficacy in pediatrics remains underexplored. Some suggest the use of prokinetics, probiotics, FMT, or herbal remedies; however, due to inconclusive evidence, these are not routinely recommended for children.
Piśmiennictwo
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