Kids With Chronic Abdominal Pain Have Very High Rates Of Gut Bacterial Overgrowth

Using lactulose breath hydrogen test (LBT) to diagnose Small Intestinal Bacterial Ovewrgrowth (SIBO), 91% of children with chronic abdominal pain had evidence of bacterial overgrowth versus 35% of controls.

Dig Dis Sci. 2010 Jan;55(1):124-30.
Chronic abdominal pain in children is associated with high prevalence of abnormal microbial fermentation.
Collins BS, Lin HC. abstract here

• Guts with too many bugs will generate alot of gas if given certain sugars – hence the test – It measures how much of this gas is breathed out after a certain sugar (lactulose) load.
• They refer to a study that found bacerial overgrowth in  78-84% of irritable bowel cases regardless of their abdominal symptoms, compared to 20% of healthy controls

• In study, 75 children aged 8-18 years
• almost 3 times incidence abnormal breath test in children with chronic abdominal pain – 91% abdominal pain group versus 35% controls

• Those with positive tests had more “urgency to have a bowel movement” (P = 0.049) and had less “soiling” (P = 0.016)

There was a previous article that discussed this issue:

Pediatr. 1996 Feb;128(2):203-7.
Small-bowel bacterial overgrowth in children with chronic diarrhea, abdominal pain, or both.
de Boissieu D, Chaussain M, Badoual J, Raymond J, Dupont C.  abstract here

• 53 children  (2 months to 12 years) with chronic diarrhea or abdominal pain
• Diarrhea defined by age:
  • before age 6 months> 1 liquid stool after each meal  x 30+ days
  • older – 3+ loose stools/day x 30+ days
• Abdominal pain –  at least 3 days/wk for > 1 month. In infants bad enough to cause “intense periods of crying lasting several hours each day”, with pain facies, and no response to comfort measures plus normal examination.
• Hydrogen breath test used – 34% were positive
• Symptoms in positive:
  • early onset <3 months of age in 10 (55 %)
  • persisted for 6 -+ 5 months
  • abdominal pain and diarrhea combo in 55%
  • isolated diarrhea in 28%
  • isolated abdominal pain in 17%
  • Abdominal pain in 100% of children 5 months of age or younger,
  • adbominal pain in 54% of children more than 5 months of age (p <0.05).
  • Abdominal pain was noticed during or after feeding in 80%
  • abdominal pain during sleep in 47%.
  • Fetid stools, mucus in stools, and flatulence more common
• Those with positive test were given “combination of colistin, 250,000 IU/kg per day, and metronidazole, 30 mg/kg per day, for 10 days.”
• With treatment 60% better in 3 days; all better in 7
• the following site talks about giving metronidazole (Flagyl) to kids:
  http://www.aboutkidshealth.ca/healthaz/Metronidazole.aspx?articleID=10895&categoryID=AZ1e

Comment – well, we know there is bacterial issues in babies because colic can be treated by probiotics.

Neomycin has been shown to help constipation predominant irritable bowel:
Dig Dis Sci. 2006 Aug;51(8):1297-301.
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.
Pimentel M, Chatterjee S, Chow EJ, Park S, Kong Y. abstract here
IBS also Discussed here:
Restless Legs and Interstitial Cystitis Related to Gut Bacterial Overgrowth?

That link also describes the high rate of bacterial overgrowth in irritable bowel as well as abstract below:
Pimentel, M., Chow, E.J., Lin, H.C.
Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome: A double-blind, randomized, placebo-controlled study
(2003) American Journal of Gastroenterology, 98 (2), pp. 412-419  abstract here

Any comments or suggestions? Those that suggest yogurt better hope child does not have a lactose intolerance because 50% of those cannot tolerate yogurt well.

available to be done at home in Toronto here: (articles say you can do over 6 months but I don’t know if they will take your money for a 6 month old…

https://www.torontonaturopathicmedicine.ca/breath-testing-for-diagnosis-of-sibo-small-intestine-bacterial-overgrowth/