Abstract
There is evidence that children with malnutrition have an increased frequency of small intestinal bacterial overgrowth (SIBO) due to impaired gastric acidity, impaired intestinal motility, and dysbiosis. Children with malnutrition respond to antibiotic therapy but it is not clear if this effect is mediated by treatment of SIBO. We set out to determine the frequency of SIBO in children of varying nutritional status in a poor community in Lusaka, Zambia. Hydrogen breath testing, following a dose of 1g/kg oral glucose, was used to determine the presence of SIBO amongst the study participants. Forty nine children, 45 of whom had varying degrees of malnutrition, completed a full series of observations at 15, 30 and 60 minutes. Four children (8%) had a rise of 10ppm from baseline, consistent with SIBO. No correlation with nutritional status was observed. In this small study of Zambian children, SIBO was infrequent and unrelated to nutritional status.
Highlights
53% of child deaths worldwide are attributable to malnutrition [1] and HIV co-infection is associated with further increases in mortality
Three of the four (75%) participants positive for Small intestinal bacterial overgrowth (SIBO) had received amoxicillin at the clinic, though this pre-dated the four week antibiotic free window stipulated in the study inclusion criteria
SIBO was found in 8% of Zambian children living in a poor community, and was not related to nutritional status
Summary
53% of child deaths worldwide are attributable to malnutrition [1] and HIV co-infection is associated with further increases in mortality. Malnutrition in early life is associated with significant long-term morbidity, reduced socioeconomic status and cognitive ability. Small intestinal bacterial overgrowth (SIBO) has been associated with malnutrition for several decades [3]. The gold standard for diagnosis is culture of jejunal aspirates; a bacterial colony count ≥105CFU/ml is characteristic of SIBO. Studies have tended to use breath tests [6] or retrospectively diagnose SIBO following improvement with empirical treatment. An early study of Jamaican malnourished children [7] showed that the administration of antibiotics improved growth. More recently there have been attempts to characterise the overgrowth using DNA sequencing, but hydrogen breath testing is attractive for paediatric research. We aimed to test the hypothesis that there would be a high prevalence of bacterial overgrowth in malnourished children in our population and that it would be correlated with severity of malnutrition
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