Acharyya BC, Mukhopadhyay M. Exploring small intestinal bacterial overgrowth in functional upper gastrointestinal disorder: A comprehensive case-control study. World J Clin Pediatr 2025; 14(3): 99395 [DOI: 10.5409/wjcp.v14.i3.99395]
Corresponding Author of This Article
Bhaswati C Acharyya, MD, Professor, Department of Pediatric Gastroenterology and Hepatology, Institute of Child Health, 11, Dr Biresh Guha Street, Kolkata 700017, West Bengal, India. bacharyya21@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Control Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Pediatr. Sep 9, 2025; 14(3): 99395 Published online Sep 9, 2025. doi: 10.5409/wjcp.v14.i3.99395
Exploring small intestinal bacterial overgrowth in functional upper gastrointestinal disorder: A comprehensive case-control study
Bhaswati C Acharyya, Meghdeep Mukhopadhyay
Bhaswati C Acharyya, Meghdeep Mukhopadhyay, Department of Pediatric Gastroenterology and Hepatology, Institute of Child Health, Kolkata 700017, West Bengal, India
Bhaswati C Acharyya, Department of Paediatric Gastroenterology, Manipal Hospital, Kolkata 700099, West Bengal, India
Author contributions: Acharyya BC planned, structured, and wrote the draft of the study; Mukhopadhyay M contributed to the conduction, result analysis, statistical calculation and writing of the final draft.
Institutional review board statement: The institutional Ethics Committee of AMRI Hospital approved the study (Approval No. AMRIMKP-EC/AP-10/2022-23).
Informed consent statement: Informed consent and assent have been obtained from the parents and subjects.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at bacharyya21@gmail.com. Participants gave informed consent for data sharing.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bhaswati C Acharyya, MD, Professor, Department of Pediatric Gastroenterology and Hepatology, Institute of Child Health, 11, Dr Biresh Guha Street, Kolkata 700017, West Bengal, India. bacharyya21@gmail.com
Received: July 21, 2024 Revised: December 15, 2024 Accepted: March 13, 2025 Published online: September 9, 2025 Processing time: 329 Days and 17.3 Hours
Abstract
BACKGROUND
Small intestinal bacterial overgrowth (SIBO) is suspected and excluded frequently in functional gastrointestinal (GI) disorders. Children presenting with various esophago-gastro-duodenal (upper GI) symptoms are rarely subjected to investigations for SIBO.
AIM
To estimate the frequency of SIBO in children having functional upper GI symptoms (as cases) and to compare the result of the SIBO status to that of the controls.
METHODS
Children aged 6 to 18 who presented with upper GI symptoms were selected for the study. All children were subjected to upper GI endoscopy before being advised of any proton pump inhibitors (PPIs). Children with normal endoscopy were assigned as cases, and children having any endoscopic lesion were designated as controls. Both groups were subjected to a glucose-hydrogen breath test by Bedfont Gastrolyser.
RESULTS
A total of 129 consecutive children who were naive to PPIs and had normal baseline investigations were included in the study. Among them, 67 patients had endoscopic lesions and served as the control group, with six cases being excluded due to the presence of Helicobacter pylori in gastric biopsies. Sixty-two children with normal endoscopy results formed the case group. In the case group, 35 children (59%) tested positive for hydrogen breath tests, compared to 13 children (21%) in the control group. The calculated odds ratio was 5.38 (95% confidence interval: 2.41-12.0), which was statistically significant. Further analysis of symptoms revealed that nausea, halitosis, foul-smelling eructation, and epigastric fullness were positive predictors of SIBO.
CONCLUSION
It is worthwhile to investigate and treat SIBO in all children presenting with upper GI symptoms that are not explained by endoscopy findings.
Core Tip: Small intestinal bacterial overgrowth (SIBO) is defined as an increased number of non-pathogenic bacteria over 105 organisms/mL of small intestinal content. The most common predisposing factors include, among others, gut motility disorders and chronic use of proton pump inhibitors. SIBO is suspected and excluded frequently in functional gastrointestinal (GI) disorders like functional abdominal pain, irritable bowel syndrome, functional dyspepsia, or functional defecation disorder. However, the extent of SIBO in functional GI disorders, which mainly manifest with upper gastrointestinal symptoms such as nausea, vomiting, epigastric pain, belching, dyspepsia, etc, has not been documented earlier. This study uniquely divides the proton pump inhibitor naive children into two groups: One with demonstrable endoscopic lesions (control) and the other without the endoscopic lesions (cases) and compares the prevalence of SIBO between these two groups instead of comparing the cases with healthy children without any symptoms. The result documented a significantly increased number of SIBO in the children with normal endoscopic evaluation. Henceforth, this study documents a need to evaluate the children with functional upper GI symptoms for SIBO.
