Bacterial overgrowth syndrome in the gut

Small intestinal bacterial overgrowth (SIBO) is a pathological condition caused by colonization of the small intestine with fecal microflora. SIBO is accompanied by diarrhea and malabsorption of fats and vitamins.

It is a consequence of pathological disorders in the intestine and is caused by the introduction of undigested food residues into the large intestine, contributing to the formation of additional colonies of putrefactive and yeast bacteria that disrupt the functioning of the digestive tract. Toxic substances of E. coli, getting into the blood, cause intoxication, leading to inflammatory changes in the digestive tract.

Epidemiology

The risk group is: newborns, children of the younger age category, elderly people. Cases of chronic diarrhea are mostly caused by the symptom complex of excessive growth of bacterial culture.

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Causes CIBR

At birth, the baby's intestines are sterile. Over the following weeks, the digestive tract becomes populated with streptococci, lactobacilli, and enterococci. Then the number of coliforms in the small intestine decreases sharply, and by multiplying in the large intestine, they become the norm.

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

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Risk factors

The causes leading to the development of intestinal bacterial overgrowth syndrome are: morphological or destructive features in the small intestine, contributing to partial inhibition of food movement through the digestive system. This is caused by pathological conditions in: prolonged stress, enteropathies of various etiologies, constant inflammatory bowel diseases, cholangitis, etc.

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

• dysfunction 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 intestinal motility disorders (chronic constipation, gastrostasis, duodenostasis);
• conditions caused by pathological changes in cavity digestion and absorption (maldigestion and malabsorption);
• pathological changes in the pancreas associated with secretory insufficiency;
• pathological conditions of the biliary tract;
• persistent nutritional imbalance, intestinal inflammation, diverticula, short bowel syndrome;
• immunosuppressive pathologies in AIDS and chemotherapy, antibiotics;
• tumors of the intestine and surrounding lymph nodes
• Crohn's disease.
• celiac disease.
• hypogammaglobulinemia

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Pathogenesis

The pathogenesis of SIBO consists of the following elements:

• Poor absorption of lipids, proteins, polysaccharides, and vitamins leads to the suppression of enterocyte functions and bacterial changes in the nutrient medium to a toxic and non-absorbable state.
• Anaerobic flora leads to pathological changes in bile acids and excludes them from the digestion process. Altered acids and carbohydrate fragments provoke loose stools.
• Anaerobic microorganisms absorb vitamin B12, which leads to the formation of macrocytic anemia.

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Symptoms CIBR

Symptoms of SIBO are as follows: nausea attacks, increased gas formation, diarrhea, malabsorption syndrome, persistent weight loss. SIBO can be diagnosed by specific tests such as: aspiration of small intestinal contents for culture and breath tests.

Symptoms are divided into two groups:

1. Abdominal, caused by pathological processes in the abdominal cavity, quite frequent bloating and rumbling in the stomach, sometimes nausea, occurring some time after eating. Unstable stool.
2. General, which are based on the deficiency of fat-soluble vitamins, cyanocobalamin and folic acid, iron, leading to decreased performance, rapid fatigue, weakness, lethargy, dizziness, weight loss. Vitamin deficiency states are characterized by dry skin, deterioration of vision in the twilight; increased anxiety, mood swings, nervousness.

Stages

The division into stages in SIBO is more than arbitrary. There are four main stages:

• The number of beneficial flora bacteria is slightly reduced. It is asymptomatic.
• The level of beneficial microflora is reduced to a critical limit. Abdominal pain, flatulence, and diarrhea appear.
• Active growth of pathogenic microorganisms. Chronic diarrhea and inflammation of the intestinal walls
• Pathogenic bacteria and fungi dominate in the small intestine. The body becomes exhausted and anemia occurs.

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Forms

The types of SIBO are classified depending on the prevailing microflora of the small intestine.

• There are three main types of pathogenic microorganisms that provoke SIBO: aerobic;
• anaerobic;
• opportunistic bacteria.

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Complications and consequences

If the cause of SIBO is not eliminated, it progresses and leads to persistent weight loss, hypovitaminosis and hematopoietic dysfunction (folate-iron deficiency anemia).

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Diagnostics CIBR

A thorough anamnesis ensures the accuracy of the diagnosis. The patient is questioned in detail about the presence of functional gastrointestinal diseases, accompanied by pain of varying intensity in the abdomen, flatulence, diarrhea.

Diagnosis of SIBO requires the use of laboratory tests and various examination methods (non-invasive, invasive).

It is necessary to sow aspiration masses of the small intestine to determine the type of pathological microflora. A typical diagnostic study is the performance of respiratory tests.

In the coprogram for SIBO, undigested food residues and the formation of excessive amounts of fat are determined. Intestinoscopy and biopsy of the small intestine walls are performed.

Breath test for bacterial overgrowth syndrome

Glucose test. Based on the identification of hydrogen in the patient's exhaled air using 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 laboratory technician records the device readings. The patient then drinks a solution with added glucose. At 30-minute intervals, the specialist takes measurements on exhalation three times. A noticeable increase in hydrogen readings indicates problems in the small intestine.

Xylose test (xylose is a carbohydrate that is absorbed only in the small intestine). This test detects altered CO2, the formation of which is associated with impaired metabolic reactions in the patient's body caused by SIBO.

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Tests

When diagnosing bacterial overgrowth syndrome, laboratory tests are recommended: complete blood count - determination of anemia (low hemoglobin, abnormally altered red blood cells, low color index), presence of inflammation (leukocytosis, increased ESR);

Biochemical blood test (increased ALT, AST, positive C-reactive protein).

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

Coprological examination of feces (detects undigested food residues, increased acidity of feces and high fat content)

Bacteriological culture (detection of rapid growth of colonies of pathological microorganisms).

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Instrumental diagnostics

Intestinoscopy is an endoscopic method. A guide with an optical device is inserted into the patient's small intestine to aspirate its contents, followed by seeding the aspirate onto a nutrient medium.

A small intestinal biopsy is an instrumental capture of small intestinal tissue for microscopic examination. In the symptom complex of excessive bacterial growth, pathologically altered atrophic villi in the small intestine are determined.

X-ray is performed to identify the underlying cause of SIBO (diverticulum, stricula of the small intestine, etc.).

Differential diagnosis

It is necessary to differentiate SIBO from celiac disease and exocrine pancreatic insufficiency. Pathological changes are very similar: partial atrophy of the villi, hyperplasia of the crypts, accumulation of lymphocytes in the proper layer of the epithelium are characteristic of these diseases. Clarification of the differential diagnosis requires specific studies.

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Treatment CIBR

Therapy should be of a complex etiopathogenetic nature. It is necessary to eliminate the pathology that caused the occurrence of SIBO.

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

The decision on the choice of antibiotic is based on the results of bacteriological analysis of small intestinal aspirate and tests for sensitivity of pathological flora to drugs. Therapy of patients with SIBO is carried out with broad-spectrum antibiotics rifaximin in a daily dose of 1200 mg.

Adults actively use tetracycline antibiotics, for example, tetracycline hydrochloride - 0.5 g 4 times a day. Contraindicated for children under 8 years old. Side effects are expressed in the form of increased intracranial pressure, dizziness, weakness, allergic reactions, photosensitivity.

Amoxicillin. Adults - orally 0.25-0.5 g 2 times a day; children - 40 mg/kg/day 2 times a day. Possible side effects - itching, redness of the skin, Quincke's edema, anaphylactic shock.

For successful treatment of intestinal bacterial overgrowth syndrome, it is necessary to create unique conditions that have a beneficial effect on the restoration of normal microflora and colonization of the intestine with bifido- and lactobacilli. Medicines with such properties are called pre- and probiotics.

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

"Bificol". It contains both E.coli M-17 and bifidobacteria grown at the same time. The daily dose is from 6 to 10 doses.

Vitamins

Patients who have problems with weight loss or a deficiency of certain vitamins and minerals are prescribed vitamin preparations that contain vitamin B12, ascorbic acid, fat-soluble vitamins, calcium and magnesium (Undevit, Supradin, Multi-tabs Immuno Plus, Vitrum, Revit).

Physiotherapy treatment

As a physiotherapeutic treatment for SIBO, it is recommended to take warm mineral hydrocarbonate-chloride and sodium-calcium waters orally. They slow down intensive motility and thus reduce the frequency of bowel movements. In the digestive tract, mineral water restores and corrects various types of metabolism. Borjomi, Narzan, Slavyanovskaya, etc. may be recommended.

Folk remedies

Curd whey. It is made from kefir, which is placed in hot water, where it undergoes a process of separation into curd and whey. The whey is carefully drained and used for the effective treatment of dysbacteriosis.

Kefir enema. Kefir (80 g) is heated and given to the baby before bedtime.

Blueberry jelly for the treatment of SIBO is prepared according to the recipe: mix a tablespoon of blueberries with a tablespoon of starch and a small amount of water. Add another glass of water in a thin stream and bring the mixture to a boil while stirring constantly. It is recommended to drink the jelly warm.

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Herbal treatment

For SIBO, herbal infusions are used. To do this, take equal parts of yellow St. John's wort, chamomile, seeds and grass of agrimony plantain, mint, pour 500 ml of boiling water. You can take cinquefoil.

An infusion of mint leaves and chamomile flowers. Take the herbs in equal portions, pour a glass of boiling water over a tablespoon of the mixture. Let it brew for 0.5 hours. Strain and take throughout the day.

Homeopathy

Antimonium crudum – antimony. Indications for use are: stomach pain; diarrhea; abdominal cramps.

Aloe – aloe. The drug is indicated for: sudden urge to defecate; accumulation of gases in the abdomen.

Chamomilla – chamomile. It is used for: pain in the epigastric region; sour belching; bloating; bitterness in the mouth.

Colocynthis is known as wild watermelon. It is used for vomiting, diarrhea, and abdominal cramps.

To choose the right drug that will help eliminate some symptoms of the disease, a consultation with a homeopathic doctor is necessary.

Surgical treatment

When treating SIBO, surgical intervention may be prescribed to radically eliminate the cause of this disease (resections and reconstructive interventions).

Prevention

Prevention of SIBO is reduced to preventing the recurrence of the underlying disease, which has caused the pathological state of the microflora of the small intestine. The set of recommended measures must be carried out under the supervision of specialists. The main preventive measures:

• Normalize body weight;
• Engage in sports and exercise regularly;
• Limit consumption of animal fats and carbohydrates;
• Eat at regular intervals;
• Avoid prolonged fasting;
• Drink enough liquid (at least 1.5 liters per day);
• Treat various intestinal dysfunctions in a timely manner.

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Forecast

Elimination of the cause that led to the formation of the syndrome of excessive bacterial growth in the intestines has a favorable prognosis. This is facilitated by timely and adequate treatment. If the cause is not eliminated, then SIBO recurs.