Peer-reviewed article
Small intestinal bacterial overgrowth in children: An expert review by the ESPGHAN Gastroenterology Committee.
Maria Giovanna Puoti, Amit Assa, Marc A Benninga, Ilse Broekaert, Jenej Dolinsek et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This expert review examines small intestinal bacterial overgrowth (SIBO) in children, a condition causing excessive bacteria in the small bowel that leads to malabsorption, malnutrition, and symptoms like diarrhea, abdominal pain, and stunted growth. The review discusses how SIBO can develop from abnormal gut anatomy, dysmotility, and other conditions, and notes that diagnosis and treatment remain uncertain due to lack of universally accepted definitions and evidence. Current diagnostic methods include duodenal aspirate cultures and breath tests, but both have limitations. Treatment typically relies on antibiotics despite limited published evidence on appropriate dosing and duration, and the field lacks well-designed research to guide best practices in children.
Key points
- SIBO causes malabsorption and malnutrition symptoms including bloating, diarrhea, abdominal pain, and stunted growth
- SIBO can develop from abnormal gastrointestinal anatomy, dysmotility, gut-brain disorders, or chronic drug use
- No universally accepted definition of SIBO exists due to uncertainty about bacterial count thresholds
- Diagnostic tools (duodenal/jejunal aspirate culture and hydrogen breath tests) have significant limitations and pitfalls
- Antibiotic treatment is commonly used but lacks published evidence on appropriate dose and duration
Limitations
This is an expert review summarizing current knowledge rather than reporting original research or intervention evaluation, so it cannot provide evidence of treatment effectiveness. The review itself highlights that well-designed research on diagnostic and therapeutic approaches in children remains lacking.
Abstract
The aim of this review is to summarize the prevalence, etiology, pathogenesis, diagnosis, and treatments currently available for small intestinal bacterial overgrowth (SIBO) in children. SIBO is a clinical entity characterized by the presence of an excessive number of bacteria in the small bowel leading to several nonspecific gastrointestinal symptoms due to malabsorption and malnutrition, such as bloating, flatulence, belching, diarrhea, abdominal pain, nausea, steatorrhea, fatigue and stunted growth. Initially thought to develop specifically in the context of abnormal or postsurgical gastrointestinal anatomy, it has then been recognized that it can be associated with other nonsurgical conditions, such as gastrointestinal dysmotility, disorders of gut-brain interactions and chronic use of drugs. The uncertainty regarding the exact cut-off of excessive number of bacteria in the small bowel has led to the absence of a universally accepted definition of SIBO making well-designed research to assess the best diagnostic and therapeutic approaches challenging. Current available diagnostic tools includes duodenal/jejunal aspirate with culture and hydrogen breath tests, which all have some limitations and pitfalls that prevent accurate sampling. The treatment goal should be to treat the underlying causes, restore the healthy intestinal microflora, relieve the symptoms and address the associated complications. The use of antibiotics represents the treatment cornerstore. However, they are commonly used despite the scarce published evidence and the absence of agreement on the dose and duration of the treatment. Currently, data on best diagnostic and therapeutic strategies in children remain lacking. Novel diagnostic approaches for SIBO are emerging and may facilitate further research.