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- Title
Small Intestine Bacterial Overgrowth is associated with increased Campylobacter and epithelial injury in duodenal biopsies of Bangladeshi children.
- Authors
Fahim, Shah Mohammad; Donowitz, Jeffrey R.; Smirnova, Ekaterina; Jan, Ning-Juin; Das, Subhasish; Mahfuz, Mustafa; Gaffar, S. M. Abdul; Petri Jr, William A.; Marie, Chelsea; Ahmed, Tahmeed
- Abstract
Small intestine bacterial overgrowth (SIBO) has been associated with enteric inflammation, linear growth stunting, and neurodevelopmental delays in children from low-income countries. Little is known about the histologic changes or epithelial adherent microbiota associated with SIBO. We sought to describe these relationships in a cohort of impoverished Bangladeshi children. Undernourished 12-18-month-old children underwent both glucose hydrogen breath testing for SIBO and duodenoscopy with biopsy. Biopsy samples were subject to both histological scoring and 16s rRNA sequencing. 118 children were enrolled with 16s sequencing data available on 53. Of 11 histological features, we found that SIBO was associated with one, enterocyte injury in the second part of the duodenum (R = 0.21, p = 0.02). SIBO was also associated with a significant increase in Campylobacter by 16s rRNA analysis (Log 2-fold change of 4.43; adjusted p = 1.9 x 10−6). These findings support the growing body of literature showing an association between SIBO and enteric inflammation and enterocyte injury and further delineate the subgroup of children with environmental enteric dysfunction who have SIBO. Further, they show a novel association between SIBO and Campylobacter. Mechanistic work is needed to understand the relationship between SIBO, enterocyte injury, and Campylobacter. Author summary: Small intestine bacterial overgrowth (SIBO) is common in low- and middle-income country children with an incidence of up to 30% in some populations. SIBO has been documented as early as 18 weeks of age using the glucose-hydrogen breath test. SIBO is associated with future linear growth shortfalls and decreased language scores on neurodevelopmental testing. Other studies have linked SIBO to enteric inflammation but no work has directly examined histologic associations with the hydrogen breath test. Further, no work linking the duodenal adherent microbiota to breath testing has been published to date. We conducted glucose-hydrogen breath testing and duodenoscopy with biopsy on Bangladeshi toddlers. Biopsy samples were subject to both histological scoring and 16s rRNA sequencing. SIBO was associated with enterocyte injury and with a significant increase in Campylobacter species in biopsy samples. These findings support the growing body of literature showing an association between SIBO and enteric inflammation and enterocyte injury. Further, they show a novel association between SIBO and Campylobacter species.
- Subjects
SMALL intestine; CAMPYLOBACTER; POOR children; LACTOSE intolerance; STUNTED growth; BREATH tests; LOW-income countries
- Publication
PLoS Neglected Tropical Diseases, 2024, Vol 18, Issue 3, p1
- ISSN
1935-2727
- Publication type
Article
- DOI
10.1371/journal.pntd.0012023