Treatment strategies for small bowel bacterial overgrowth in short bowel syndrome

J Pediatr Gastroenterol Nutr. 1998 Aug;27(2):155-60. doi: 10.1097/00005176-199808000-00005.


Background: Small bowel bacterial overgrowth is a common complication of short bowel syndrome, and although it is often controlled with antimicrobial therapy, alternative strategies may occasionally be needed.

Methods: Six patients with bacterial overgrowth are described, who did not respond to antimicrobial therapy and required additional medical or surgical measures to control the overgrowth.

Results: Recalcitrant bacterial overgrowth was successfully treated with periodic small bowel irrigation with a balanced hypertonic electrolyte solution, colonic flushes, encouraging frequent stooling, intestinal lengthening procedure, or probiotic therapy with Lactobacillus plantarum 299V and Lactobacillus GG.

Conclusions: Small bowel bacterial overgrowth should be aggressively evaluated in patients with short bowel syndrome who are not progressing in a normal manner. Inadequate or incomplete response to antibiotic therapy is common, and several additional treatment possibilities are available.

Publication types

  • Case Reports

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Bacteria / growth & development*
  • Child, Preschool
  • Electrolytes
  • Enterocolitis, Necrotizing / therapy
  • Female
  • Gastroschisis / complications
  • Gastroschisis / therapy
  • Humans
  • Hypertonic Solutions
  • Intestinal Obstruction / complications
  • Intestinal Obstruction / therapy
  • Intestine, Small / microbiology*
  • Lactobacillus
  • Male
  • Parenteral Nutrition
  • Probiotics / therapeutic use
  • Short Bowel Syndrome / microbiology*
  • Therapeutic Irrigation


  • Anti-Bacterial Agents
  • Electrolytes
  • Hypertonic Solutions