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The prevalence and impact of small intestine bacterial overgrowth in biliary atresia patients

  • Clinical Research Article
  • Published:
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Abstract

Background

Acute cholangitis is an ominous complication in biliary atresia (BA) patients. We investigated the prevalence of small intestine bacterial overgrowth (SIBO) in BA patients and its role in predicting acute cholangitis.

Methods

There are 69 BA patients with native liver recruited into this study prospectively. They received hydrogen and methane-based breath testing (HMBT) to detect SIBO after recruitment and were followed prospectively in our institute.

Results

There are 16 (23.19%) subjects detected to have SIBO by HMBT. BA subjects with SIBO were noted to have higher serum alanine aminotransferase levels than others without SIBO (P = 0.03). The risk of acute cholangitis is significantly higher in BA patients with SIBO than in others without SIBO (62.50% vs. 15.09%, P < 0.001). The logistic regression analysis demonstrated that BA subjects with SIBO have a higher risk of acute cholangitis than others without SIBO (odds ratio = 9.38, P = 0.001). Cox’s proportional hazard analysis further confirmed the phenomena in survival analysis (hazard ratio = 6.43, P < 0.001).

Conclusions

The prevalence of SIBO in BA patients is 23.19% in this study. The presence of SIBO is associated with the occurrence of acute cholangitis in BA patients.

Impact

  • What is the key message of your article?

Acute cholangitis is common in BA, and is associated with SIBO after hepatoportoenterostomy in this study.

  • What does it add to the existing literature?

This study demonstrated that SIBO is common in BA after hepatoportoenterostomy, and is predictive of acute cholangitis and elevated serum ALT levels in BA.

  • What is the impact?

This prospective cohort study provides data regarding the significance of SIBO on the risk of acute cholangitis in BA patients.

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Fig. 1: The risk of acute cholangitis in BA patients.
Fig. 2: The risk of acute cholangitis in BA subjects without prophylatic antibiotics.

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Data availability

Data are available on request and the approval of the local ethic committee.

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Funding

This work is supported by grants from the National Taiwan University Hospital (NTUH.110-T05, NTUH.111-T0009, NTUH. 112-E0009). The funding agencies had no role in the design, and conduct of the study; in the collection, analysis and interpretation of the data; or in the preparation, review, or approval of the manuscript.

Author information

Authors and Affiliations

  1. Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan

    Jia-Feng Wu, Hsiu-Hao Chang, Che-Ming Chiang & Mei-Hwei Chang

  2. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Ping-Huei Tseng

  3. Department of Pediatrics, Tri‐Service General Hospital, National Defense Medical Center, Taipei, Taiwan

    Che-Ming Chiang

  4. Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan

    Wen-Hsi Lin & Wen-Ming Hsu

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  1. Jia-Feng Wu
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Contributions

J.-F.W., the first author of the study, is responsible for the study design, data management, and manuscript writing. P.-H.T., H.-H.C., C.-M.C., W.-H.L., W.-M.H., and M.-H.C. are responsible for long-term patient follow, recruitment, and critical review of the manuscript. P.-H.T. is responsible for the study design, hydrogen breath test interpretation, and critical review of the manuscript. M.-H.C., the corresponding author, is responsible for patient recruitment, study design, critical review of the article, and is the principal investigator of this study. All authors have seen and approved the final version. The corresponding author had full access to all the data in this study and had final responsibility for the decision to submit it for publication.

Corresponding author

Correspondence to Mei-Hwei Chang.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

The study protocol was approved by the institutional review board of National Taiwan University Hospital. All participants or their parents signed the informed consent approved by the institutional review board.

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Wu, JF., Tseng, PH., Chang, HH. et al. The prevalence and impact of small intestine bacterial overgrowth in biliary atresia patients. Pediatr Res 95, 302–307 (2024). https://doi.org/10.1038/s41390-023-02818-5

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