Syndrome of excessive bacterial growth in the intestine

Syndrome of excessive bacterial growth in the intestine (SIBR) is a pathological condition caused by the colonization of the small intestine by a fecal microflora. SIBR accompanies diarrhea and malabsorption of fats and vitamins.

It is a consequence of pathological disorders in the intestine and is due to the introduction of intestinal remains of undigested food, contributing to the formation of additional colonies of putrefactive and yeast bacteria that disrupt the work of the food tract. Toxic substances of Escherichia coli, getting into the blood, cause intoxication, which leads to inflammatory changes in the food tract.

Epidemiology

The risk group is: newborns, children of younger age group, elderly people. The occurrence of chronic diarrhea in its majority is due to the simpotomocomplex of excessive growth of bacterial culture.

[1], [2]

Causes of the sIBR

When the baby is born, his intestines are sterile. Over the next weeks, the digestive tract is populated with streptococci, lactobacilli and enterococci. Further, the number of colibacilli in the small intestine decreases sharply, and multiplying in the large intestine becomes the norm.

In the pathological state of SIBR, cecoileal reflux occurs, leading to increased gas formation and additional stimulation of the peristalsis of the small and large intestines.

[3]

Risk factors

The causes leading to the appearance of a syndrome of excessive bacterial growth in the intestine are: morphological or destructive features in the small intestine, which contribute to partial inhibition of food movement through the digestive system. This leads to pathological conditions with: prolonged stress, enteropathy of various etiologies, persistent inflammatory bowel diseases, cholangitis, and the like.

Among the factors that cause pathological changes in the balance of the microflora of the small intestine include:

• disturbed functioning of the ileocecal valve;
• surgical interventions - formation of a blind loop, cholecystectomy, resection of the small intestine, etc .;
• diseases of the digestive system, which are based on a disorder of intestinal motility (chronic constipation, gastrostasis, duodenosis);
• conditions caused by a pathological change in cavitary digestion and absorption (maldigestia and malabsorption);
• pathological changes in the pancreas associated with secretory insufficiency;
• pathological conditions of the biliary tract;
• permanent food imbalance, inflammation of the intestine, diverticula, short bowel syndrome;
• immunodepressant pathologies in AIDS and chemotherapy, antibiotics;
• tumors of the intestine and surrounding lymph nodes
• Crohn's disease.
• celiac disease.
• hypogammaglobulinemia

[4], [5],

Pathogenesis

The pathogenesis of SIBR consists of the following elements:

• Poor absorption of lipids, proteins, polysaccharides, vitamins leads to inhibition of the functions of enterocytes and bacterial changes in the nutrient medium to the state of toxic and non-adsorbed.
• Anaerobic flora leads to a pathological change in bile acids and excludes them from the digestive process. Changed acids and fragments of carbohydrates provoke a loose stool.
• Anaerobic microorganisms absorb vitamin B12, which leads to the formation of macrocytic anemia.

[6], [7], [8]

Symptoms of the sIBR

Symptoms of SIBR are as follows: attacks of nausea, phenomena of increased gas formation, diarrhea, malabsorption syndrome, persistent decrease in body weight. SIBR helps diagnose such specific studies as: aspiration of the contents of the small intestine for inoculation and respiratory tests.

Symptoms are divided into two groups:

1. Abdominal, caused by pathological processes in the abdominal cavity, quite frequent swelling and rumbling in the abdomen, sometimes nausea arising after a while after eating. Instability of the chair.
2. Common, based on a lack of fat-soluble vitamins, cyanocobalamin and folic acid, iron, leading to a decrease in efficiency, rapid fatigue, impotence, lethargy, dizziness, weight loss. Vitamin-deficient conditions are characterized by dry skin, deterioration of vision at twilight; increased anxiety, mood swings, nervousness.

Stages

The division at the stage with SIBR is more than arbitrary. There are four main stages:

• The number of bacteria in the useful flora has been reduced insignificantly. It is asymptomatic.
• The level of useful microflora is reduced to a critical limit. There are pains in the abdomen, flatulence, diarrhea.
• Active growth of pathogenic microorganisms. Chronic diarrhea and inflammation of the intestinal wall
• In the small intestine, pathogenic bacteria and fungi predominate. There is depletion of the body, anemia.

[9]

Forms

Classify SIBR species depending on the prevailing microflora of the small intestine.

• There are three main types of pathogenic microorganisms provoking SIBR: aerobic;
• anaerobic;
• opportunistic bacteria.

[10]

Complications and consequences

If you do not eliminate the cause that caused SIBR not to eliminate, then it progresses and leads to persistent weight loss, the emergence of hypovitaminosis and the violation of hematopoiesis (folic-iron deficiency anemia).

[11]

Diagnostics of the sIBR

Careful collection of anamnesis provides accuracy of diagnosis. The patient is asked in detail about the presence of functional GI diseases, accompanied by pain of varying intensity in the abdomen, flatulence, diarrhea.

The diagnosis - SIBR requires the use of laboratory tests and various methods of examination (non-invasive, invasive).

It is necessary to sow aspiration masses of the small intestine in order to determine the type of pathological microflora. A characteristic diagnostic test is the conduct of respiratory tests.

In the coprogram with SIBR, undigested food residues are detected, the formation of excessive amounts of fat. Intestinoscopy and biopsy of the walls of the small intestine are carried out.

Respiratory test in the syndrome of excessive bacterial growth

Test with glucose. Based on the identification of hydrogen exhaled by the patient's air with a special device. It is performed on an empty stomach. The patient takes a deep breath, holds his breath for 10-15 seconds. Then slowly exhales into the testing device. The lab technician records the readings of the device. The patient then drinks the solution with the addition of glucose. With an interval of 30 minutes a specialist performs three measurements on exhalation three times. A noticeable increase in the indices of hydrogen indicates problems in the small intestine.

Test with xylose  (xylose - carbohydrate, which is absorbed only in the small intestine). In this test, an altered CO2 is detected, the formation of which is associated with the disturbed metabolic reactions of the patient's body caused by SIBR.

[12], [13]

Analyzes

When diagnosing the syndrome of excessive bacterial growth, laboratory tests are recommended: a general blood test - the definition of anemia (low hemoglobin, pathologically altered erythrocytes, low color index), the presence of inflammation (leukocytosis, increased ESR);

Biochemical blood test (increase of ALT, ASAT, positive result of C-reactive protein).

General analysis of urine (presence of a large amount of mucus, bacteria).

Koprologicheskoy study of feces (find undigested food, increased acidity of stool and a large amount of fat)

Bacteriological seeding (revealing the rapid growth of colonies of pathological microorganisms).

[14], [15]

Instrumental diagnostics

Intestinoscopy is an endoscopic method. A conductor with an optical device is inserted into the patient's small intestine to aspirate its contents, and then sow aspirate to the nutrient medium.

Biopsy of the small intestine is an instrumental capture of the tissue of the small intestine for the purpose of microscopic examination. In the symptomatic complex of excessive bacterial growth, pathologically altered atrophic villi are detected in the small intestine.

X-rays are used to identify the underlying cause of SIBR (diverticulum, small intestine striae, etc.).

Differential diagnosis

It is necessary to differentiate SIBR from celiac disease and exocrine insufficiency of the pancreas. Pathological changes are very similar: partial villi atrophy, crypt hyperplasia, accumulation of lymphocytes in their own layer of epithelium are characteristic for these diseases. Clarification of the differential diagnosis requires specific studies.

[16], [17]

Treatment of the sIBR

Therapy should have a complex etiopathogenetic character. It is necessary to eliminate the pathology, which was the reason for the occurrence of SIBR.

Patients are treated with antibacterial drugs, vitamins, pro and prebiotics, and absorbents.

The decision to choose an antibiotic is based on the results of a bacteriological analysis of a small intestine aspirate and samples on the sensitivity of pathological flora to drugs. Therapy of patients with SIBR is carried out with broad-spectrum antibiotics   rifaximin  in a daily dose of 1200 mg.

Adults actively use antibiotics tetracycline, for example,  tetracycline hydrochloride  - for 0.5 g 4p. / Day. Contraindicated in children under 8 years old. Side effects are expressed in the form of increased intracranial pressure, dizziness, weakness, allergic manifestations, photosensitization.

Amoxicillin. Adults - inside by 0,25-0,5 g 2p. / Day; children - 40 mg / kg / day 2r / day. Possible manifestations of adverse reactions - itching, redness of the skin, angioedema, anaphylactic shock.

For successful therapy of the syndrome of excess bacterial growth in the intestine, it is necessary to create unique conditions that favorably restore normal microflora and colonize the intestinal tract with bifido- and lactobacilli. Medicines that have such properties are called pre- and probiotics.

"Colibacterin". It contains live cultures of E. Coli strain M-17 with antagonism to pathogenic and opportunistic microflora. Usually take 6 to 10 doses in one or two doses (take the drug 40 minutes before eating) for a month.

Bifikol. It combines the simultaneously grown E. Coli M-17 bacteria and bifidobacteria. Daily rate of 6 to 10 doses.

Vitamins

Patients who have problems with weight loss or lack of certain vitamins and minerals are prescribed vitamin preparations, which include vitamin B12, ascorbic acid, fat-soluble vitamins, calcium and magnesium (Undevit, Supradin, Multi-tabs immuno plus, Vitrum, Revit) .

Physiotherapeutic treatment

As a physiotherapeutic treatment of SIBR, the reception in a warm form of mineral hydrocarbonate chloride and sodium-calcium waters is shown orally. They inhibit the intensive motor skills and thereby, reducing the frequency of defecation. In the digestive tract, mineral water restores and corrects various types of metabolism. Can be recommended reception - Borjomi, Narzan, Slavyanovskaya and others.

Alternative treatment

Curd whey. It is made from kefir, which is placed in hot water, where it passes the process of separation into cottage cheese and whey. Serum is accurately drained and used for effective treatment of dysbacteriosis.

Kefir enema. Kefir (80 g) is warmed and the baby is administered before bed.

Blueberry jelly  for SIBR treatment is prepared according to the recipe: mix a tablespoon of blueberries with a tablespoon of starch and a small amount of water. A thin stream of water is added to a glass of water and, with constant stirring, bring the mixture to a boil. It is recommended to drink a kissel warm.

[18], [19], [20], [21], [22], [23]

Herbal Treatment

With SIBR using herbal infusions. To do this, take in equal parts: St. John's wort, camomile chamomile, seeds and grass plantain pest, mint, pour 500 ml of steep boiling water. You can take a cobbler.

Infusion of mint leaves and chamomile flowers. Take the grass in equal portions, a tablespoon of the mixture is poured a glass of boiling water. Allow to stand for 0.5 hours. Filter and take during the day.

Homeopathy

Antimonium crudum  is antimony. Indications for the appointment are: pain in the stomach; diarrhea; resi in the abdomen.

Aloe  is an aloe. The drug is indicated for: a sharp urge to defecate; accumulation of gases in the abdomen.

Chamomilla  - chamomile. It is used for: pain in the epigastric region; sour eructations; abdominal swelling; bitterness in the mouth.

Colocynthis  is known as wild watermelon. It is used for vomiting, diarrhea, the presence of spastic abdominal pain.

To choose the right drug, which will help to eliminate some symptoms of the disease, it is necessary to consult a homeopathic doctor.

Operative treatment

In the treatment of SIBR, a surgical intervention can be prescribed to radically eliminate the cause that caused this disease (resections and reconstructive interventions).

Prevention

Prevention SIBR reduces to preventing the recurring course of the underlying disease, which caused the pathological condition of the microflora of the small intestine, a set of recommended activities should be conducted under the supervision of specialists. Main preventive measures:

• Normalize body weight;
• Regularly engage in sports and exercise;
• Limit the use of animal fats and carbohydrates;
• Take food at regular intervals;
• Eliminate prolonged fasting;
• Take sufficient liquid (at least 1.5 liters per day);
• Treat various bowel dysfunctions in a timely manner.

[24]

Forecast

Elimination of the cause that led to the formation of the syndrome of excessive bacterial growth in the intestine is favorable. This is facilitated by timely and adequate treatment. If the cause is not resolved, the SIBR recurs.