Chronic abdominal pain in children is associated with high prevalence of abnormal microbial fermentation

Dig Dis Sci. 2010 Jan;55(1):124-30. doi: 10.1007/s10620-009-1026-7.


Background: Chronic abdominal pain (CAP) in children, a condition that accounts for approximately 25% of pediatric gastroenterology office visits, may be a precursor to irritable bowel syndrome in adults. Recently, small intestinal bacterial overgrowth (SIBO) has been reported in 78-84% of IBS patients regardless of their abdominal symptoms, compared to 20% in healthy controls. Aims The aim of this study was, therefore, to assess the prevalence of SIBO in children with CAP.

Methods: Seventy-five children aged 8-18 years diagnosed with CAP based on the Rome II criteria and 40 healthy controls were enrolled. All subjects underwent a lactulose breath hydrogen test (LBT) to assess for SIBO. Children with CAP also filled out symptom questionnaires.

Results: There was a 91% prevalence of an abnormal LBT suggestive of SIBO in the children with CAP and 35% in controls (odds ratio = 16.7, 95% confidence interval 6.0-57.5, P < 0.0001). A comparison of CAP children with a positive LBT to CAP children with a negative LBT revealed the former had significantly more "urgency to have a bowel movement" (P = 0.049) and experienced less "soiling" (P = 0.016) than those with a negative LBT. No significant differences were found between the two groups in terms of the location of their pain or any other associated symptoms.

Conclusions: Similar to adults with IBS, there is a significantly higher prevalence of SIBO in children with CAP. Randomized controlled studies are needed to determine if eradication of SIBO will lead to symptom improvement in these patients.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdominal Pain / microbiology*
  • Adolescent
  • Bacteria / growth & development*
  • Bacteria / metabolism
  • Breath Tests
  • Child
  • Chronic Disease
  • Dyspepsia / diagnosis
  • Dyspepsia / microbiology
  • Female
  • Fermentation
  • Humans
  • Intestine, Small / microbiology*
  • Irritable Bowel Syndrome / diagnosis
  • Irritable Bowel Syndrome / microbiology
  • Lactulose
  • Male


  • Lactulose