Small bowel bacterial overgrowth. Clinical course, diagnostic procedures, and therapy

Evaluation of three patients, aged between three months and five years because of failure to thrive and persistent diarrhea revealed the diagnosis of small bowel bacterial overgrowth. A combination of a typical history, endoscopy, laboratory, radiological and histological methods as well as the breath hydrogen test were used. All patients had preexisting intestinal disease: two (former premature infants) had been operated several times because of necrotizing enterocolitis including resection of larger parts of small bowel. The third patient was suffering from pancolonic Hirschsprung's disease. All patients gained weight and reported less complaints after antibiotic treatment with metronidazole. Discussion: Small bowel bacterial overgrowth has to be considered in the differential diagnosis of failure to thrive, especially in cases with preexisting intestinal disease. The diagnosis may be substantiated by a combination of indirect methods, Direct bacteriologic analysis is difficult. Usually, antibiotic treatment leads to a good weight gain after a short period of time.