Chronic Abdominal Pain in Children Is Associated with High Prevalence of Abnormal Microbial Fermentation
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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.
The aim of this study was, therefore, to assess the prevalence of SIBO in children with CAP.
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.
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.
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.
KeywordsChronic abdominal pain Functional abdominal pain Functional dyspepsia Irritable bowel syndrome Small intestinal bacterial overgrowth
- 9.Camilleri M. Evolving concepts of the pathogenesis of irritable bowel syndrome: To treat the brain or the gut (review)? J Pediatr Gastroenterol Nutr. 2009; 48[Suppl 2]:S46–48Google Scholar
- 12.Pimental M, Chow EJ, Lin HC. Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome: A double blind, randomized controlled study. Am J Gastroenterol. 2003;98:412–419.Google Scholar
- 24.Chronic abdominal pain in children: a technical report of the American Academy of Pediatrics and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition. Pediatrics. 2005;115: e370–e381.Google Scholar
- 35.Tillman R, King C, Toskes P. Continued experience with the xylose breath test: Evidence that the small bowel culture as a gold standard for bacterial overgrowth may be tarnished. Gastroenterology. 1981;80:1304.Google Scholar
- 37.Pimentel M, Chatterjee S, Chow EJ, Park S, Kong Y. Neomycin improves constipation-predominant irritable bowel syndrome in a fashion that is dependent on the presence of methane gas: Subanalysis of a double-blind randomized controlled study. Dig Dis Sci. 2006;51(8):1297–1301.CrossRefPubMedGoogle Scholar