![]() Deficiencies in cobalamin ( 19 – 21), thiamine ( 22), riboflavin ( 18), pyridoxine ( 18), and nicotinamide ( 23) have been documented. SIBO in this setting has been associated with poor nutritional outcomes, including steatorrhea with loss of fat-soluble vitamins (excluding vitamin K) ( 2 – 9), carbohydrate malabsorption ( 10 – 13), and a protein-losing enteropathy ( 14 – 18). Traditionally, SIBO has been considered a secondary condition that develops in the setting of altered intestinal anatomy, slowed intestinal motility, or aberrant gastrointestinal function. SIBO can be measured by culture of endoscopically obtained upper gastrointestinal (GI) aspirates or noninvasively by hydrogen breath testing. Small intestine bacterial overgrowth (SIBO) is defined as greater than 10 5 CFU/ml upper intestinal aspirate as assessed by both anaerobic and aerobic cultures ( 1). SIBO is associated with intestinal inflammation but not increased permeability or systemic inflammation. These findings suggest linear growth faltering and poor sanitation are associated with SIBO independently of recent or frequent diarrheal disease. Measures of intestinal permeability and systemic inflammation did not differ between the groups. The markers of intestinal inflammation fecal Reg 1β (116.8 versus 65.6 µg/ml P = 0.02) and fecal calprotectin (1,834.6 versus 766.7 µg/g P = 0.004) were elevated in SIBO-positive children. Recent or frequent diarrheal disease did not predict SIBO. The strongest predictors of SIBO were decreased length-for-age Z score since birth (odds ratio, 0.13 95% confidence interval, 0.03 to 0.60) and an open sewer outside the home (OR, 4.78 95% CI, 1.06 to 21.62). A total of 16.7% (15/90) of the children had SIBO. Differences in concomitant inflammation and permeability between SIBO-positive and -negative children were compared with multiple comparison adjustment. Multivariable logistic regression was performed to investigate SIBO predictors. ![]() SIBO was diagnosed via glucose hydrogen breath testing, with a cutoff of a 12-ppm increase over baseline used for SIBO positivity. We performed a cross-sectional analysis of 90 Bangladeshi 2-year-olds monitored since birth from an impoverished neighborhood. Secondary objectives included determination of SIBO’s association with sanitation, diarrheal disease, and environmental enteropathy. Our objective was to determine the prevalence of SIBO in Bangladeshi children and its association with malnutrition. SIBO’s pathogenesis and effect in the developing world are unclear. All rights reserved.Recent studies suggest small intestine bacterial overgrowth (SIBO) is common among developing world children. One hopes that the application of an ever-expanding armamentarium of modern molecular microbiology to the human small intestinal microbiome in both health and disease will ultimately resolve this impasse and provide an objective basis for the diagnosis of SIBO.ĭysbiosis Gut Microbiome Gut Microbiota Malabsorption Maldigestion Small Bowel Small Intestinal Bacterial Overgrowth.Ĭopyright © 2022 AGA Institute. Furthermore, the pathophysiological plausibility that underpins SIBO as a cause of maldigestion/malabsorption is lacking in regard to its purported role in irritable bowel syndrome, for example. However, issues with the specificity of these same breath tests have clouded their interpretation and aroused some skepticism regarding the role of SIBO in this expanded clinical repertoire. The advent and ready availability of breath tests generated a dramatic expansion in both the rate of diagnosis of SIBO and the range of associated gastrointestinal and nongastrointestinal clinical scenarios. Coincident with advances in medical science, diagnostic testing evolved from small bowel culture to breath tests and on to next-generation, culture-independent microbial analytics. Such colonization resulted in clinical signs, symptoms, and laboratory abnormalities that were explicable within a coherent pathophysiological framework. The concept of small intestinal bacterial overgrowth (SIBO) arose in the context of maldigestion and malabsorption among patients with obvious risk factors that permitted the small bowel to be colonized by potentially injurious colonic microbiota.
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