![]() The average number of people living per room in homes was 3.8. The average monthly household income was 13,913 Bangladeshi taka (approximately $179 U.S. Mothers had an average age of 24.5 years, and 82 (91%) considered themselves housewives. Birth demographics of the children showed an average estimated gestational age of 37.3 weeks with an average length and weight at enrollment of 48.9 cm and 2.8 kg, respectively. Of the children tested, 46 (51%) were female. The average age of children tested was 24.6 months (range, 24.3 to 25.1 months). A total of 90 children successfully competed SIBO testing. Three children were unable to complete testing for the 3-h test period and were excluded from analysis. Nine children were excluded for a weight-for-age Z (WAZ) score of ≤−3 standard deviations (SD) and were referred for nutritional therapy. Of note, none had known chronic gastrointestinal disease. SIBO has recently been recognized as an underdiagnosed condition in children in the developed world with gastrointestinal symptoms ( 28).Ī total of 103 children were assessed for SIBO testing. SIBO has also been shown to lead to increased GI permeability ( 24, 25) and alteration of mucosal immunity, including an increase in IgA plasma cells and increased mucosal interleukin-6 (IL-6) ( 26, 27). 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. Recent studies suggest small intestine bacterial overgrowth (SIBO) is common among developing world children.
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