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Hydrogen breath test to detect small intestinal bacterial overgrowth: a prevalence case–control study in autism

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Abstract

The aim of this study is to assess the prevalence of small intestinal bacterial overgrowth (SIBO) by hydrogen breath test in patients with autism spectrum disorders (ASD) with respect to a consistent control group. From 2011 to 2013, 310 children with ASD and 1240 sex- and age-matched typical children were enrolled in this study to undergo glucose breath test. The study participants were considered to exhibit SIBO when an increase in H2 of ≥20 ppm or CH4 of ≥10 ppm with respect to the fasting value was observed up to 60 min after the ingestion of glucose. Ninety-six children with autism suffered from SIBO, giving a prevalence rate of SIBO was 31.0% (95% CI 25.8–36.1%). In contrast, 9.3% of the typical children acknowledged SIBO. The difference between groups was statistically significant (P < 0.0001). The median Autism Treatment Evaluation Checklist (ATEC) score in the children with autism and with SIBO was significantly high when compared with the children without autism and without SIBO [98 (IQR, 45–120) vs. 63 (32–94), P < 0.001]. For the autism group, the 6-GI Severity Index (6-GSI) score was found to be strongly and significantly correlated with the total ATEC score (r = 0.639, P < 0.0001). SIBO was significantly associated with worse symptoms of autism, demonstrating that children with SIBO may significantly contribute to symptoms of autism.

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Abbreviations

ASD:

Autism spectrum disorder

GI:

Gastrointestinal

IBD:

Inflammatory bowel disease

VTE:

Venous thromboembolism

NBS:

Expanded newborn screening

ADI-R:

Autism Diagnostic Interview-Revised

SIBO:

Small intestine bacterial overgrowth (SIBO)

ATEC:

Autism Treatment Evaluation Checklist

BMI:

Body mass index

NICU:

Neonatal intensive care unit

6-GSI:

6-Gastrointestinal Severity Index

ID:

Intellectual disability

IQ:

Intelligence quotient

H2 :

Hydrogen

CH4 :

Methane

SD:

Standard deviation

IQR:

Interquartile ranges

LPS:

Lipopolysaccharide

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Acknowledgements

This work was supported by the National Natural Science Foundation of China (30950031). The funding organizations had no role in the design and concept of the study; the collection, management, analysis, and interpretation of the data; or the preparation, review, or approval of the manuscript.

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Author notes

  1. Li Wang and Yu-Mei Yu are co-first authors.

Authors and Affiliations

  1. Department of Pediatrics, Cangzhou Central Hospital, No. 16, Xinhua West Road, Cangzhou, 061000, Hebei, China

    Li Wang, Yu-Mei Yu, You-qi Zhang, Jie Zhang & Na Lu

  2. Department of Pediatrics, The Second Hospital of Hebei Medical University, Shijiazhuang, China

    Na Liu

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  1. Li Wang
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Correspondence to Li Wang.

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Wang, L., Yu, YM., Zhang, Yq. et al. Hydrogen breath test to detect small intestinal bacterial overgrowth: a prevalence case–control study in autism. Eur Child Adolesc Psychiatry 27, 233–240 (2018). https://doi.org/10.1007/s00787-017-1039-2

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  • DOI: https://doi.org/10.1007/s00787-017-1039-2

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