de Boissieu D, Chaussain M, Badoual J, Raymond J, Dupont C
Service de Pédiatrie, Hôpital Saint Vincent de Paul, Paris, France.
J Pediatr. 1996 Feb;128(2):203-7. doi: 10.1016/s0022-3476(96)70390-6.
To evaluate the frequency of small-bowel bacterial overgrowth (SBBO) as a cause of chronic digestive symptoms in a large cohort of children, using the glucose breath hydrogen test (BHT).
Patients were 53 children (aged 2 months to 12 years) with chronic diarrhea, abdominal pain, or both. Diagnosis of SBBO was defined with a BHT by a change in H2 concentration of 10 ppm H2 or more in expired air after an oral glucose load. Patients with a positive BHT result were included in group 1 and treated with a combination of colistin and metronidazole for 10 days; a second BHT was performed 1 month later. Group 2 comprised patients with a negative BHT result. Group 3 (n = 15) was a control group of healthy subjects, and group 4 (n = 6) a comparison group of subjects with bacteriologically documented SBBO.
Eighteen patients (34%) had a positive BHT result and 35 a negative result. The BHT results were comparable in groups 1 and 4 and in groups 2 and 3, respectively. Fasting H2 levels were higher in group 1 than in groups 2 (p < 0.001) and 3 (p < 0.01). In group 1, children were younger than in group 2 (1 +/- 1 year vs 3.9 +/- 3 years; p < 0.001) and diarrhea was frequent (83%), but 17% of patients had abdominal pain alone. Fetid stools (p < 0.01), mucus in stools (p < 0.01), and flatulence (p < 0.05) were more frequent in group 1 than in group 2. Antibiotic treatment of children in group 1 led to a rapid disappearance of symptoms and normalization of BHT results.
SBBO appears to be a frequent cause of chronic digestive symptoms in children, especially before the age of 2 years. The BHT provides a simple and noninvasive method of detecting it. The recognition of SBBO in children leads to effective treatment.
采用葡萄糖呼气氢试验（BHT）评估小肠细菌过度生长（SBBO）作为一大群儿童慢性消化症状病因的发生频率。
研究对象为53例患有慢性腹泻、腹痛或两者皆有的儿童（年龄2个月至12岁）。SBBO的诊断依据口服葡萄糖负荷后呼出气体中H2浓度变化≥10 ppm H2的BHT结果来确定。BHT结果阳性的患者纳入第1组，接受黏菌素和甲硝唑联合治疗10天；1个月后进行第二次BHT。第2组包括BHT结果阴性的患者。第3组（n = 15）为健康受试者对照组，第4组（n = 6）为经细菌学证实的SBBO受试者比较组。
18例患者（34%）BHT结果阳性，35例结果阴性。第1组和第4组、第2组和第3组的BHT结果分别具有可比性。第1组的空腹H2水平高于第2组（p < 0.001）和第3组（p < 0.01）。在第1组中，儿童比第2组更年幼（1±1岁对3.9±3岁；p < 0.001），腹泻频繁（83%），但17%的患者仅有腹痛。第1组中恶臭粪便（p < 0.01）、粪便中有黏液（p < 0.01）和气胀（p < 0.05）比第2组更常见。第1组儿童接受抗生素治疗后症状迅速消失，BHT结果恢复正常。
SBBO似乎是儿童慢性消化症状的常见病因，尤其是在2岁之前。BHT提供了一种简单且无创的检测方法。认识到儿童中的SBBO可带来有效的治疗。
