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Abstracts: Annual Meeting of the North American Society for Pediatric Gastroenterology and Nutrition; Denver, October 21-24, 1999


Sondheimer, J; Fidanza, S; Setchell, KDR

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Journal of Pediatric Gastroenterology & Nutrition: October 1999 - Volume 29 - Issue 4 - p 495
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Abstract 25

There are few prospective studies validating the assumption that probiotic bacteria are beneficial in patients with SBS. We therefore prospectively evaluated the impact of Lactobacillus casei GG (LBGG) on growth, GI symptoms and digestive function in 7 patients with neonatally acquired SBS. Seven patients (10-161 mos; median 53 mos) were admitted to the CRC for evaluation. ICV was absent in 5. None had received antibiotics in the preceding month. All were on gastrostomy feedings and 3 also received IV nutrition. Growth rate for the preceding month was calculated (% weight change) from clinic records. For 72 hrs we measured antropometrics, enteral and IV intake, fecal fat, fecal weight, fasting serum and duodenal bile acids (BA), duodenal culture, breath hydrogen after enteral glucose, liver functions and B12. For the next 30 d, patients received LBGG 2 or 3 × 1010 enterally/d. Testing was then repeated. All stools were colonized with LBGG. Results: Mean ht/age Z score was -1.1 and wt/ht Z score was -.02. There was no significant change between pre and post treatment weight gain (1.5 ± .9 vs 1.7 ± 1.5 % per month), fecal weight (16.3 ± 12 vs 13.5 ± 12 g/K/d), fat excretion (14.1 ± 13 vs 11.3 ± 10 %), liver function tests or serum vit B12. Stool frequency decreased in only 2/7 patients. Total fasting duodenal BA (mMol/L) was low before and after LBGG (2.5±2.3 vs 2.8±1.2). Increase in % unconjugated BA (UBA) was found in 1 pt which fell after LBGG (70.9 vs 51.8%). All other patients had <2.5% UBA pre and post LBGG. High serum UBA (81.2 ± 7.8% of total BA) was found in 6 patients but did not predict duodenal bacterial overgrowth. Duodenal culture showed >105 aerobes/ml in the one patient with high duodenal UBA. All other patients had < 104 org/ml. Treatment with LBGG had no impact on post treatment duodenal culture in any patient. Breath H2 after glucose correlated poorly with duodenal UBA and culture. (0% sens, 50% spec). Fat excretion correlated only with fat intake pre and post treatment, not duodenal BA, gut length or duodenal culture. Conclusion: LBGG has no immediate beneficial effect on intestinal function in a small group of patients with neonatal SBS. % UBA in duodenal juice was reduced but not eliminated in one patient with bacterial overgrowth.

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© 1999 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,