Managing Small Intestinal Bacterial Overgrowth in Pediatric Short Bowel Syndrome

@article{zong2026managing,
  title = {{Managing Small Intestinal Bacterial Overgrowth in Pediatric Short Bowel Syndrome}},
  author = {Wenjing Zong and Vahe Badalyan and David Galloway and Nathan Zev Minkoff and Clarivet Torres and Valeria Cohran and Rebecca Same and Astrela Moore and Reena Alame and Nikhil Pai},
  journal = {JAMA Network Open},
  year = {2026},
  month = nov,
  doi = {10.1001/jamanetworkopen.2026.41939},
  url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2856237},
  note = {CC BY 4.0},
}

TY  - JOUR
TI  - Managing Small Intestinal Bacterial Overgrowth in Pediatric Short Bowel Syndrome
AU  - Wenjing Zong
AU  - Vahe Badalyan
AU  - David Galloway
AU  - Nathan Zev Minkoff
AU  - Clarivet Torres
AU  - Valeria Cohran
AU  - Rebecca Same
AU  - Astrela Moore
AU  - Reena Alame
AU  - Nikhil Pai
PY  - 2026
DA  - 2026/11/03
JO  - JAMA Network Open
DO  - 10.1001/jamanetworkopen.2026.41939
UR  - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2856237
AB  - Importance: Small intestinal bacterial overgrowth (SIBO) is a common and clinically important complication of short bowel syndrome (SBS) in children, contributing to feeding intolerance, malabsorption, bloodstream infections, and frequent antibiotic exposure. Diagnostic and management practices vary widely across centers, and no rigorously developed, evidence-informed pediatric-specific guidance currently exists.  Objective: To develop international, pediatric-specific, expert consensus recommendations for the diagnosis and management of SIBO in children with SBS, with emphasis on diagnostic approach, antibiotic therapy, treatment response, and prevention.  Evidence Review: A modified Delphi process was conducted between April 4, 2024, and February 18, 2025. A 7-member steering committee reviewed pediatric and adult SIBO literature using the terms small-intestinal bacterial overgrowth , short bowel syndrome , intestinal failure , and pediatric . Because pediatric-specific data were limited and study designs were heterogeneous, systematic reviews and meta-analyses were not feasible. Fifty-five international experts from multidisciplinary intestinal rehabilitation programs in North America and Europe were invited to participate in 3 rounds of anonymous online surveys and 2 in-person moderated consensus meetings. Draft statements were iteratively refined. Consensus was defined a priori as agreement of 75% or greater among respondents.  Findings: Completed surveys were received from 33 participants in round 1, 38 in round 2, and 28 in round 3. Consensus was achieved on 21 statements involving diagnostic approaches, therapeutic strategies, and monitoring practices. Recommendations addressed the use of breath testing and clinical criteria, indications for empiric antibiotic therapy and cycling, antibiotic selection and duration, and dietary considerations. Symptomatic improvement was considered an acceptable indicator of treatment response. Metronidazole was identified as the preferred first-line antibiotic, and long-term antibiotic cycling was supported for selected patients with recurrent, treatment-responsive SIBO. Collectively, the statements provide a practical framework to support consistent clinical decision-making in pediatric SBS-associated SIBO.  Conclusions and Relevance: This Delphi-based consensus provides the first international pediatric-specific guidance for diagnosing and managing SIBO in children with SBS. Implementation of these recommendations may reduce practice variability, support more judicious antibiotic use, and improve patient outcomes while establishing a foundation for future research in this high-risk population.
SN  - 2574-3805
ER  -