Division of Gastroenterology and Nutrition, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA.
J Pediatr Gastroenterol Nutr. 2011 Apr;52(4):382-6. doi: 10.1097/MPG.0b013e3181effa3b.
Chronic abdominal pain (CAP) in children may be a precursor to irritable bowel syndrome (IBS) in adults. The prevalence of abnormal lactulose breath tests (LBT) suggesting small intestinal bacterial overgrowth (SIBO) has been reported as 91% in children with CAP and 35% in healthy controls. In addition, patients with IBS with SIBO who responded to nonabsorbable antibiotic treatment with normalization of LBT reported 75% global improvement in symptoms. The aim of the study was to test whether treatment with a nonabsorbable antibiotic may reduce symptoms in children with CAP.
Seventy-five children ages 8 to 18 years with CAP based on Rome II criteria were enrolled. Subjects underwent baseline LBT and completed symptom-based questionnaires. They were then randomized in a 2:1, double-blind fashion to receive a 10-day course of 550 mg of rifaximin or placebo 3 times per day (t.i.d.). LBT and questionnaires were repeated 2 weeks after treatment.
Forty-nine children received rifaximin and 26 received placebo. There were no differences in demographics between groups. Ninety-four percent who received rifaximin and 92% who received placebo had abnormal baseline LBT, suggesting SIBO (not significant [NS]). There was no significant difference in symptom improvement between groups; however, only 20% of children treated with rifaximin achieved a normalized repeat LBT, demonstrating successful treatment of SIBO.
Similar to adults with IBS, the prevalence of abnormal LBT suggesting SIBO in children with CAP is high; however, treatment with 10 days of rifaximin has low efficacy in normalizing LBT in this group. Additional studies are needed to determine whether a treatment approach with higher efficacy would lead to improvement in children with CAP.
儿童慢性腹痛（CAP）可能是成人肠易激综合征（IBS）的前兆。有研究报道，患有 CAP 的儿童异常乳果糖呼气试验（LBT）提示小肠细菌过度生长（SIBO）的患病率为 91%，而健康对照组为 35%。此外，SIBO 所致 IBS 患者接受非吸收性抗生素治疗后，LBT 恢复正常，75%的患者症状得到整体改善。本研究旨在验证非吸收性抗生素治疗能否减轻 CAP 患儿的症状。
本研究共纳入 75 例符合 Rome II 标准的 CAP 患儿，年龄 8 至 18 岁。受试者接受基线 LBT 并完成基于症状的问卷调查，然后以 2:1 的比例随机分组，接受为期 10 天的 550 mg 利福昔明或安慰剂，每日 3 次（tid）。治疗 2 周后重复 LBT 和问卷调查。
49 例患儿接受利福昔明治疗，26 例患儿接受安慰剂治疗。两组间的人口统计学特征无差异。94%接受利福昔明治疗和 92%接受安慰剂治疗的患儿基线 LBT 异常，提示 SIBO（无统计学意义[NS]）。两组患儿症状改善无显著差异；然而，仅 20%接受利福昔明治疗的患儿重复 LBT 恢复正常，表明 SIBO 得到成功治疗。
与成人 IBS 类似，CAP 患儿异常 LBT 提示 SIBO 的患病率较高；然而，10 天利福昔明治疗对该组 LBT 正常化的疗效较低。需要进一步研究确定疗效更高的治疗方法是否会改善 CAP 患儿的症状。
