Small Intestine Bacterial Overgrowth and Environmental Enteropathy in Bangladeshi Children

ABSTRACT Recent studies suggest small intestine bacterial overgrowth (SIBO) is common among developing world children. SIBO’s pathogenesis and effect in the developing world are unclear. Our objective was to determine the prevalence of SIBO in Bangladeshi children and its association with malnutriti...

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Autores principales:	Jeffrey R. Donowitz, Rashidul Haque, Beth D. Kirkpatrick, Masud Alam, Miao Lu, Mamun Kabir, Shahria Hafiz Kakon, Bushra Zarin Islam, Sajia Afreen, Abu Musa, Shaila Sharmeen Khan, E. Ross Colgate, Marya P. Carmolli, Jennie Z. Ma, William A. Petri
Formato:	article
Lenguaje:	EN
Publicado:	American Society for Microbiology 2016
Materias:	Microbiology QR1-502
Acceso en línea:	https://doaj.org/article/2bbf91478a3b4d02807fe8154d556225
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spelling	oai:doaj.org-article:2bbf91478a3b4d02807fe8154d5562252021-11-15T15:49:39ZSmall Intestine Bacterial Overgrowth and Environmental Enteropathy in Bangladeshi Children10.1128/mBio.02102-152150-7511https://doaj.org/article/2bbf91478a3b4d02807fe8154d5562252016-03-01T00:00:00Zhttps://journals.asm.org/doi/10.1128/mBio.02102-15https://doaj.org/toc/2150-7511ABSTRACT Recent studies suggest small intestine bacterial overgrowth (SIBO) is common among developing world children. SIBO’s pathogenesis and effect in the developing world are unclear. Our objective was to determine the prevalence of SIBO in Bangladeshi children and its association with malnutrition. Secondary objectives included determination of SIBO’s association with sanitation, diarrheal disease, and environmental enteropathy. We performed a cross-sectional analysis of 90 Bangladeshi 2-year-olds monitored since birth from an impoverished neighborhood. SIBO was diagnosed via glucose hydrogen breath testing, with a cutoff of a 12-ppm increase over baseline used for SIBO positivity. Multivariable logistic regression was performed to investigate SIBO predictors. Differences in concomitant inflammation and permeability between SIBO-positive and -negative children were compared with multiple comparison adjustment. A total of 16.7% (15/90) of the children had SIBO. The strongest predictors of SIBO were decreased length-for-age Z score since birth (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.03 to 0.60) and an open sewer outside the home (OR, 4.78; 95% CI, 1.06 to 21.62). Recent or frequent diarrheal disease did not predict SIBO. The markers of intestinal inflammation fecal Reg 1β (116.8 versus 65.6 µg/ml; P = 0.02) and fecal calprotectin (1,834.6 versus 766.7 µg/g; P = 0.004) were elevated in SIBO-positive children. Measures of intestinal permeability and systemic inflammation did not differ between the groups. These findings suggest linear growth faltering and poor sanitation are associated with SIBO independently of recent or frequent diarrheal disease. SIBO is associated with intestinal inflammation but not increased permeability or systemic inflammation. IMPORTANCE A total of 165 million children worldwide are considered stunted, which is associated with increased risk of death prior to age 5 years and cognitive disability. Stunting has, in part, been attributed to the presence of environmental enteropathy. Environmental enteropathy is a poorly understood condition leading to chronic intestinal inflammation. It has been postulated that small intestine bacterial overgrowth contributes to the pathogenesis of environmental enteropathy as overgrowth has been associated with intestinal inflammation and micronutrient malabsorption when it develops in other clinical contexts. This study confirms the finding that overgrowth occurs at high rates in the developing world. This is the first study to show that overgrowth is associated with intestinal inflammation and linear growth delay in this setting and is the first to examine why children with no known gastrointestinal dysfunction develop overgrowth from the developing world environment.Jeffrey R. DonowitzRashidul HaqueBeth D. KirkpatrickMasud AlamMiao LuMamun KabirShahria Hafiz KakonBushra Zarin IslamSajia AfreenAbu MusaShaila Sharmeen KhanE. Ross ColgateMarya P. CarmolliJennie Z. MaWilliam A. PetriAmerican Society for MicrobiologyarticleMicrobiologyQR1-502ENmBio, Vol 7, Iss 1 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	Microbiology QR1-502
spellingShingle	Microbiology QR1-502 Jeffrey R. Donowitz Rashidul Haque Beth D. Kirkpatrick Masud Alam Miao Lu Mamun Kabir Shahria Hafiz Kakon Bushra Zarin Islam Sajia Afreen Abu Musa Shaila Sharmeen Khan E. Ross Colgate Marya P. Carmolli Jennie Z. Ma William A. Petri Small Intestine Bacterial Overgrowth and Environmental Enteropathy in Bangladeshi Children
description	ABSTRACT Recent studies suggest small intestine bacterial overgrowth (SIBO) is common among developing world children. SIBO’s pathogenesis and effect in the developing world are unclear. Our objective was to determine the prevalence of SIBO in Bangladeshi children and its association with malnutrition. Secondary objectives included determination of SIBO’s association with sanitation, diarrheal disease, and environmental enteropathy. We performed a cross-sectional analysis of 90 Bangladeshi 2-year-olds monitored since birth from an impoverished neighborhood. SIBO was diagnosed via glucose hydrogen breath testing, with a cutoff of a 12-ppm increase over baseline used for SIBO positivity. Multivariable logistic regression was performed to investigate SIBO predictors. Differences in concomitant inflammation and permeability between SIBO-positive and -negative children were compared with multiple comparison adjustment. A total of 16.7% (15/90) of the children had SIBO. The strongest predictors of SIBO were decreased length-for-age Z score since birth (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.03 to 0.60) and an open sewer outside the home (OR, 4.78; 95% CI, 1.06 to 21.62). Recent or frequent diarrheal disease did not predict SIBO. The markers of intestinal inflammation fecal Reg 1β (116.8 versus 65.6 µg/ml; P = 0.02) and fecal calprotectin (1,834.6 versus 766.7 µg/g; P = 0.004) were elevated in SIBO-positive children. Measures of intestinal permeability and systemic inflammation did not differ between the groups. These findings suggest linear growth faltering and poor sanitation are associated with SIBO independently of recent or frequent diarrheal disease. SIBO is associated with intestinal inflammation but not increased permeability or systemic inflammation. IMPORTANCE A total of 165 million children worldwide are considered stunted, which is associated with increased risk of death prior to age 5 years and cognitive disability. Stunting has, in part, been attributed to the presence of environmental enteropathy. Environmental enteropathy is a poorly understood condition leading to chronic intestinal inflammation. It has been postulated that small intestine bacterial overgrowth contributes to the pathogenesis of environmental enteropathy as overgrowth has been associated with intestinal inflammation and micronutrient malabsorption when it develops in other clinical contexts. This study confirms the finding that overgrowth occurs at high rates in the developing world. This is the first study to show that overgrowth is associated with intestinal inflammation and linear growth delay in this setting and is the first to examine why children with no known gastrointestinal dysfunction develop overgrowth from the developing world environment.
format	article
author	Jeffrey R. Donowitz Rashidul Haque Beth D. Kirkpatrick Masud Alam Miao Lu Mamun Kabir Shahria Hafiz Kakon Bushra Zarin Islam Sajia Afreen Abu Musa Shaila Sharmeen Khan E. Ross Colgate Marya P. Carmolli Jennie Z. Ma William A. Petri
author_facet	Jeffrey R. Donowitz Rashidul Haque Beth D. Kirkpatrick Masud Alam Miao Lu Mamun Kabir Shahria Hafiz Kakon Bushra Zarin Islam Sajia Afreen Abu Musa Shaila Sharmeen Khan E. Ross Colgate Marya P. Carmolli Jennie Z. Ma William A. Petri
author_sort	Jeffrey R. Donowitz
title	Small Intestine Bacterial Overgrowth and Environmental Enteropathy in Bangladeshi Children
title_short	Small Intestine Bacterial Overgrowth and Environmental Enteropathy in Bangladeshi Children
title_full	Small Intestine Bacterial Overgrowth and Environmental Enteropathy in Bangladeshi Children
title_fullStr	Small Intestine Bacterial Overgrowth and Environmental Enteropathy in Bangladeshi Children
title_full_unstemmed	Small Intestine Bacterial Overgrowth and Environmental Enteropathy in Bangladeshi Children
title_sort	small intestine bacterial overgrowth and environmental enteropathy in bangladeshi children
publisher	American Society for Microbiology
publishDate	2016
url	https://doaj.org/article/2bbf91478a3b4d02807fe8154d556225
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Small Intestine Bacterial Overgrowth and Environmental Enteropathy in Bangladeshi Children

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