Small Intestinal Bacterial Overgrowth

How common is it?

It is estimated the incidence of SIBO is estimated to be between 0-30% in healthy children. It is more common in children who have underlying sugar malabsoprtions (lactose/fructose/sucrose). It is also more common in children who have prolonged usage of antacids and antibiotics. Previous bowel surgery is also another known risk factor.

What are the signs and symptoms?

Children with SIBO have abdominal bloating, excessive flatulence, burping, halitosis, abdominal cramps and diarrhea. In severe cases, it can cause D-lactic acidosis causing drowsiness and lethargy. It can also cause malabsorption and nutrient deficiencies.

How is it diagnosed?

The gold standard for diagnosis of small intestinal bacterial overgrowth is to sample intestinal secretions from the small bowel. This is not practically done as children will need to undergo general anaesthesia for the gastroscopy.

Often, SIBO can be diagnosed by carrying out a glucose or lactulose hydrogen breath test. The patient consumes either glucose or lactulose and is asked to breathe into a straw which connects to the breath test machine every 15 to 30 minutes over a period of two hours. If there is an early rise of hydrogen level or methane level, this will signify small intestinal bacterial overgrowth.

What is the treatment?

The treatment for SIBO is to use Rifaximin or a combination of antibiotics Ciprofloxacin and Metronidazole. Rifaximin is preferable as it is an inert antibiotic. It is targeting specifically bacteria in the bowel. It has fewer side effects compared to conventional antibiotics.

Probiotics such as VSL#3 or BioGaia are important to maintain gut health. Avoidance of high sugar-containing food is also important to avoid further fermentation of the food content.