JPEN J Parenter Enteral Nutr. 2020 Sep;44(7):1280-1284. doi: 10.1002/jpen.1809.Epub 2020 Mar 13.

Christina Belza ¹, Zachary Betts ¹, Nicole de Silva ², Yaron Avitzur ^1 2, Paul W Wales ^1 3 4

Author information

• ¹Transplant and Regenerative Medicine Centre, Toronto, Canada.
• ²Division of Neonatology, Toronto, Canada.
• ³Division of Gastroenterology, Hepatology and Nutrition, Toronto, Canada.
• ⁴Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada.

Abstract

Background: Small bowel bacterial overgrowth (SBBO) is a challenge in the management of pediatric intestinal failure (PIF). Our goal was to determine the proportion of patients treated for SBBO and factors related to its development.

Methods: We completed a retrospective analysis of PIF patients referred between 2008 and 2014. Data were collected on factors related to intestinal failure (IF) and SBBO. The cohort was stratified on the diagnosis of SBBO and refractory SBBO. Statistical testing completed using t-test, χ² test, and logistic regression.

Results: Thirty-five of 102 patients developed SBBO (34%), and 16 (16%) had refractory SBBO. SBBO was more likely in gastroschisis (40.0% vs 19.4%, P = .025), a shorter residual small bowel (SB) (45.4% vs 66.5%, P = .004), and patients were less likely to wean from parenteral nutrition (PN) (51.4% vs 85.1%, P < .0001). Refractory SBBO patients were likely to have gastroschisis (50.0% vs 22.1%, P = .020) and a shorter residual SB and large bowel remaining (23.2% vs 65.9%, P < .0001 and 60.6% vs 79.4%, P = .03, respectively) and less likely to wean from PN (37.5% vs 80.2%, P = .001). Logistic regression demonstrated that longer SB residual was protective (P = .001; odds ratio [OR], 0.95; 95% CI, 0.93-0.99), and short bowel syndrome (SBS) as a cause of IF was a risk factor (P = .001; OR, 0.04; 95% CI, 0.01-0.27).

Conclusion: A longer SB remnant was protective against SBBO. Patients with SBBO were more likely to have PIF caused by SBS.