What causes flatulence or bacterial overgrowth syndrome (sibr)? Diagnosis and Treatment of Small Intestine Bacterial Overgrowth Syndrome Small intestine bacterial overgrowth symptoms.

Due to the bactericidal action of hydrochloric acid in the stomach and the movement of contents through the small intestine as a result of peristalsis, the proximal parts of the small intestine in normal conditions contain a relatively small amount of bacteria, mainly gram-positive microorganisms and anaerobes from the oral cavity. In the ileum, the amount of microflora increases to 109 colony-forming units (CFU) / ml due to gram-negative microorganisms and anaerobes. And, finally, a huge number of bacterial bodies, mainly anaerobes, appear in the large intestine at a concentration of 10 "2 CFU / ml.

Excessive proliferation of bacteria in the small intestine (IPBTC) is characterized by the appearance a large number bacteria in the small intestine from among those that normally inhabit mainly the large intestine. Traditionally, IPBTC is spoken of if more than 105 CFU / ml is found in the culture of aspirate taken at the level of the proximal small intestine. Recently, it was proposed to revise the definition and lower the threshold level to 103-104 CFU / ml of colonic bacteria, when this indicator is combined with characteristic symptoms... IPBTC is now increasingly recognized as a cause of malabsorption. It is believed that bacterial overgrowth is at the root of many of the unexplained causes of various nonspecific gastrointestinal disorders.

Epidemiology

The prevalence of IPBTC and its relation to a number of clinical conditions have not yet been clarified, since there are discrepancies that relate to both the concept of IPBTC and the methods of detection. Moreover, the set of clinical symptoms in IPBTC largely overlaps with the manifestations of many other gastrointestinal disorders.

A high degree of vigilance should be maintained in relation to patients with underlying diseases that destroy the protective barriers that exist normally and prevent IPBTC. The prevalence of IPBTC varies depending on the characteristics of the study population and the diagnostic method used. So, when conducting a breath test with glucose in adult subjects, IPBTK is detected in 0-12% of cases, and with a similar test with lactulose - in 22%. As it turned out, IPBTC is more common among older people. In neonates and the elderly, IPBTC can lead to serious illness and even death, but no precise mortality rates directly related to IPBTC are provided.

Pathogenesis

The most important factors in the pathogenesis of IPBTK include disturbances in the motor function of the intestine, changes in the anatomy of the gastrointestinal tract that contribute to stagnation of the contents (large duodenal diverticula, superimposed surgical anastomoses, resection of the ileocecal valve zone), weakening of the production of hydrochloric acid by the stomach, elderly age... Although to a lesser extent, bile, proteolytic pancreatic enzymes, and the internal immune system also protect against IPBTC. However, identifying a predisposing factor is not always easy. IPBTK can develop as in the presence of a specific pathogenetic mechanism (for example, with diabetes mellitus, blind loop syndrome, gastrectomy, immunodeficiency states), and due to a combination of the above factors. For example, chronic pancreatitis is accompanied by a weakening of intestinal motility and a decrease in the production of pancreatic enzymes; obesity is characterized by a combination with changes in the intestinal microflora and impaired motor function of the small intestine; cirrhosis of the liver and non-alcoholic steatohepatitis cause hypomotoricity of the intestines and increased permeability of the intestinal wall.

Symptoms and Signs

Initially, IPBTC was considered a condition that invariably provokes diarrhea, low nutrition, vitamin deficiency and weight loss, and all this against the background of conditions that contribute to stagnation of intestinal contents, but the "classic picture" of the disease is now rare. It is characteristic that patients with IPBTK almost always present completely nonspecific complaints, such as abdominal pain and discomfort, increased gas discharge, abdominal distension, changes in stool frequency in the absence of obvious factors predisposing to this. Children with IPBTC may have diarrhea and abdominal pain, while malnutrition and vitamin deficiencies usually do not develop. On the contrary, in elderly patients, IPBTK may not manifest itself in anything or be expressed in unexplained weight loss and malabsorption. The clinical picture of IPBTC can develop according to various scenarios, including excessive gas production, induction of diarrhea, malabsorption, etc.

Pathogenesis of clinical manifestations in patients with excessive proliferation of bacteria in the small intestine

  1. Fermentation of carbohydrates by gut bacteria leads to the production of carbon dioxide, hydrogen and methane, which cause bloating and distension of the abdomen, abdominal pain and excess gas
  2. Short-chain fatty acids produced during fermentation stimulate the secretion of water and electrolytes, leading to diarrhea
  3. Deconjugation of bile salts can lead to fat malabsorption, streatorrhea, weight loss and hypovitaminosis due to fat-soluble vitamins A, D, E, and K
  4. Intake of vitamin B 12 by intestinal microorganisms can lead to macrocytic anemia and neurological disorders
  5. The destruction of the brush border of enterocytes disrupts the absorption of carbohydrates and proteins, although this is very rarely observed with IPBTC

Evidence for the relationship between excess bacterial proliferation in the small intestine and irritable bowel syndrome

  1. Enhanced fermentation and increased gas content in the small intestine in IBS patients compared to controls
  2. Excessive colonic bacteria in the proximal small intestine in patients with IBS
  3. In contrast to the control, the results of breath tests in patients with IBS were not consistent with the norm.
  4. The formation of hydrogen is observed in patients with IBS with diarrhea; "Methane formers" - patients with IBS with a tendency to constipation
  5. Antibiotic treatment relieves the symptoms of IBS, and accordingly, breathing tests return to normal.
  6. One controlled trial showed good results after antibiotic treatment, which lasted for at least 12 weeks.
  7. There is an animal model that combines the theory of the formation of IPBTC with post-infectious IBS. Changes in stool against the background of IPBTC and a decrease in the amount of ISCB in the deep muscular plexus after a significant time after an acute infection caused by C. jejuni were observed in rodents.

Although IPBTC has traditionally been associated with diarrhea and malabsorption, to date, there is accumulated evidence that allows the imputation of IPBTC also the development of diseases without pathognomonic biochemical, immunological and / or histological characteristics. Indeed, over the past decade, a wealth of data has accumulated to support the role of IPBTC in the development of IBS. The initial controversy of opinions regarding the role of IPBTC in the development of IBS was generated by the low accuracy of breathing tests as a method of diagnosing IPBTC. The latter method, indeed, is considered as a diagnostic "gold standard", however, in one of the latest systematic literature reviews, the authors nevertheless showed that so far none of the tests has acquired a sufficient evidence base for its reliable use in the diagnosis of IPCT.

Diagnostics

The symptom complex in the form of diarrhea, weight loss, bloating and increased gas discharge in a patient with risk factors for IPBTC, regardless of whether there is malabsorption or not, should force the clinician to consider conducting a laboratory test to detect excessive proliferation of bacteria, especially if the patient is not responded to previous empirical therapy. Most likely, in patients without predisposing factors, due to the nonspecificity of symptoms, IPBTC is often missed. In the absence of a gold standard, the most practical method for detecting IPBTC is: a “treat and see the result” approach combined with a breath test to identify those patients who are particularly indicated for antibiotic therapy; the breath test should be normalized after treatment.

Culture of aspirate from the proximal small intestine

Inoculation with counting the number of bacteria in the contents of the proximal small intestine is recognized as the "gold standard" for the diagnosis of IPBTC. The result corresponds to the pathology when more than 105 CFU / ml is detected. Not so long ago, a lower level was proposed - more than 103 CFU / ml of colonic microbes in the presence of an appropriate clinical picture. Culture of aspirate from the proximal small intestine, however, has many limitations that question the sensitivity of the method. Diagnosis in this way is recognized as a rather invasive and expensive procedure requiring endoscopy; the latter, in turn, allows a situation where the aspirate can be contaminated with microflora from the oral cavity. When performing EGDS, in addition, it is possible to reach only the duodenum, but sowing material from this level can lead to an underestimation of excessive bacterial proliferation in the more distal parts of the intestine. In addition, IPBTK can be uneven along the entire length of the small intestine, developing only in certain areas ("patchy" distribution), which further reduces the value of aspirate cultures. An additional nuance is that it is difficult to work with an aspirate sample for inoculation of anaerobes: false negative results are very real, when the aspirate, before entering the nutrient medium for growth, has time to contact with oxygen. And, finally, using molecular techniques, it was found that only 40% of the total intestinal microflora can be identified by conventional culture methods.

Breathing tests

Breath tests / assays are based on the principle of fermentation of the carbohydrate substrate by luminal bacteria, which leads to additional gas (hydrogen or methane) production, absorption and ultimately excretion with exhaled air. Breath tests are safe, non-invasive, and easy to perform. Among them, the hydrogen test is especially popular. It is carried out after a test breakfast with glucose or lactulose. Other breath tests for the detection of IPBTC (test with bile acids and 14C-labeled xylose) are not widely available, so their value for the diagnosis of IPBTC has not been established.

There are a number of restrictions on breathing tests. In order to be sure of the accuracy of the hydrogen breath test, the carbohydrate-containing solution should be used no later than 12 hours after preparation. Before performing the test, rinse your mouth with an antiseptic solution. Analyze immediately and determine the expiratory methane concentration. This is required to avoid false negative results due to the possible presence of methane-producing bacteria in the mouth that can convert hydrogen to methane.

During testing, which is prescribed after an overnight fasting period, an initial sample of exhaled air is taken to determine hydrogen and methane in it. After that, the person is given a sugar-containing substrate to drink, and then, for 3 hours, every 10-20 minutes, additional sampling of exhaled air is carried out. Several criteria have been proposed that can signal the presence of IPBTC when performing a lactulose breath test, but it turned out that an early (before the 90th minute) increase in the concentration of hydrogen or methane in the exhaled air after lactulose is taken is not reliable. Unfortunately, the criterion under consideration does not allow distinguishing between IPBTC and fast transit. Normalization of breath test scores after antibiotic treatment clearly indicate IPBTC. The sensitivity and specificity of the breath test varies from 17 to 90% and from 44 to 100%, respectively.

When glucose is used as a substrate for the hydrogen test, an increase in gas concentration of more than 20 ppm is usually considered a sign of IPBTC. This test reveals only IPBTC in the proximal small intestine, since glucose is rapidly and completely absorbed already at this level. Glucose does not reach the distal sections, unless there is a rapid passage or shortening of the small intestine. Thus, a glucose breath test can give a false negative result if IPBTC is limited to the distal small intestine only. The answer to the question whether the test is acceptable for the clinical separation between proximal and distal distribution of IPBTC has not yet been obtained and requires further study. According to literature data, the sensitivity and specificity of the test are from 27 to 93% and from 36 to 86%, respectively.

Trial therapy

If there is no “gold standard” in the diagnostic arsenal, additional diagnostic information can be counted on by prescribing a trial antibiotic treatment, especially in patients with typical symptoms and the presence of a condition predisposing to IPBTK. The disappearance of symptoms after the therapy gives reason to think about the IPBTK. Of course, the same can be done in relation to a patient in the absence of a clear tendency to IPBTK, however, the interpretation of the response to treatment measures and the further plan of patient management in this case are complicated. In addition to abnormal breath test results, other symptomatic patients with no predisposing factors can also be tried with some other trial therapy option. Improvement of well-being and simultaneous return of breath test results to the norm is also evidenced by IPBTC.

Other tests

Other laboratory criteria for IPCT are nonspecific. So, for example, in a typical case reveal macrocytic anemia with a low concentration of vitamin B] 2. Folate and vitamin K levels increase as microbes synthesize them. There may be steatorrhea, which is confirmed by quantification of fat in the stool or microscopic examination of fresh stool that is stained for fat. If pathology that alters anatomy is assumed as the cause of IPBTC, appropriate imaging studies are resorted to, including studying the passage of barium through the intestine, enteroclysis and / or CT / MRI enterography. With IPBTC, endoscopic findings and biopsies with small bowel histology are usually normal, but these studies may make sense to rule out celiac disease and Crohn's disease. Both can act as a cause of malabsorption syndrome. The analysis of feces allows to exclude the infectious nature of the disease, while the determination of motor function / transit time is designed to identify disorders of gastrointestinal motility.

Differential diagnosis

The fact that many diseases predisposing to IPBTC are accompanied by symptoms that do not differ in any way from the manifestations of IPBTC greatly expands the range of differential diagnosis. For example, gastric paresis, chronic pancreatitis, IBD, celiac disease, chronic mesenteric ischemia contribute to IPBTC and at the same time make themselves felt with the same clinical picture as IPBTC, even when there is no IPBTC.

Treatment

IPBTC treatment differs depending on the nature of the pathology against which it develops. Treatment includes nutritional support, antibiotic therapy, and prevention of recurrence of IPBTC. The main goal is to correct the underlying pathology of the small intestine as much as possible. In rare cases, when anatomical changes occur or complications develop after surgery, this can be achieved with surgery. Correction of impaired motility is also a difficult problem, since there are few effective prokinetics with good tolerance. Low doses of octreotide in the form of subcutaneous injections have been reported to be successful for the treatment of IPBTC associated with scleroderma.

When IPBTC leads to deficiency conditions, special nutritional mixtures are additionally connected to antibacterial treatment. Common measures include eliminating lactose and reducing indigestible carbohydrates. A diet high in fat, low in carbohydrates, and low in fiber is believed to provide adequate calories for people in need of complementary nutrition, and such a diet provides fewer fermentable substrates for microorganisms, although there is no direct publication on this topic. If a micronutrient deficiency is formed, it is recommended to introduce an appropriate supplement into the diet.

Antibiotic therapy is a stumbling block in the management of the patient with IPBTC. It is designed to reduce microbial load and symptomatic improvement. The choice of antibiotic should be guided by a wide range of microflora in IPBTC. The drug should act on both aerobic and anaerobic intestinal bacteria. There is no particular need to determine the sensitivity of bacteria from the small intestine to antibiotics, since microbes in the aspirate with IPBTC are always numerous and their strains have different sensitivity. In this regard, it is recommended to immediately prescribe empirical treatment in the form of a 7-10-day course with one of the antibiotics. If therapy is successful, antibiotic use usually relieves symptoms, often for a long time (several months). Nevertheless, a certain proportion of patients, before signs of response to therapy appear, require a longer antibiotic intake, sometimes, depending on the predisposing conditions, a course of therapy is required for several months (for example, the patient takes the drug for 7-10 days each month). In such cases, it is recommended to adhere to the principle of rotation of three or four different antibiotics to prevent the development of resistance, although there are practically no randomized controlled trials that would support this generally accepted policy.

Key aspects of patient management

  • IPBTC is a condition that is increasingly recognized as a cause of malabsorption syndrome, but, apparently, is underestimated as a factor in the pathogenesis of a wide range of nonspecific gastrointestinal disorders.
  • The prevalence of IPBTC and its relationship with severe clinical conditions is not fully understood. The reason, among other things, is in the discrepancies both regarding the diagnosis and the interpretation of the concept itself. Along with this, there is a significant overlap of the clinical manifestations of IPBTK on the symptomatology of many other gastrointestinal diseases.
  • The most important factors in the pathogenesis of IPBTC are impaired intestinal motility and gastrointestinal tract pathology, which alters the anatomy of organs. All this predisposes to the retention of intestinal contents. Insufficient acidification is also important.
  • The classic symptomatology of IPBTC in the form of malabsorption is currently rare. Most patients present with nonspecific complaints. They are worried about abdominal pain or discomfort, profuse discharge of gas and bloating, changes in stool in the absence of obvious pathology. The most acceptable diagnostic approach for IPBTC has not been developed. Everything is still under discussion, while there are neither completely reliable tests, nor a true "gold standard" today.
  • In the treatment of IPBTC, it is extremely important to take into account predisposing conditions, to ensure the most adequate intake nutrients into the body, antibiotic therapy and prevention of recurrence of IPBTK.

What Small Intestine Bacterial Overgrowth Syndrome or SIBO, symptoms, what is dangerous and how to get rid of with the help of nutrition and taking natural drugs.

Many people suffer from some kind of problems with the digestive system. These are heartburn, cramps, pain, heaviness, belching, gas, constipation, diarrhea, and so on. And sometimes it is very difficult to find the real reason for this or that condition.

Increasingly, as I read scientific articles on digestive problems, I come across an interesting term. Namely, "Small Intestine Bacterial Overgrowth Syndrome." It turns out that more and more scientists and even conservative doctors are talking about the fact that this pathological syndrome leads to improper absorption of food, a deficiency of vitamins and minerals and, consequently, great health problems.

Now they are just beginning to talk about the real causes of many diseases and conditions, and I decided that I should definitely write a separate post dedicated to another syndrome that is very common among the population and can be the real cause of your disease!

And, as always, I want to remind you that all diseases do not begin anywhere, but in our intestines! And therefore, it is very important to always pay attention to his condition.

What is Small Intestine Bacterial Overgrowth Syndrome or SIBO?

In simple and understandable language, this is an overgrowth of bacteria in the small intestine. You may ask, what is the actual problem? The fact that a healthy person has practically no bacteria in the small intestine.

The small intestine is the longest section of our digestive system. This is the place where incoming food mixes with digestive juices and nutrients are absorbed by our body.

If you have Small Intestinal Bacterial Overgrowth (SIBO), when food passes through the small intestine, bacteria in it interfere with normal digestion and absorption of nutrients. This is especially true for fat-soluble vitamins and Iron.

This syndrome eventually leads to damage to the intestinal wall and another syndrome, no less serious for our health - "Leaky gut" or.

Symptoms

It is very often intertwined with other gastrointestinal problems and therefore the symptoms are very difficult to distinguish from other conditions and diseases.

The most common symptoms are:

  • Nausea
  • Gases
  • Bloating
  • Diarrhea or constipation
  • Haemorrhoids
  • Deficiency of vitamins and / or minerals
  • Unexplained weight loss
  • Joint pain
  • Chronic fatigue
  • Skin irritation
  • Acne
  • Eczema
  • Asthma
  • Depression
  • Anxiety

Causes of Small Intestine Bacterial Overgrowth Syndrome

The most common causes may be related to:

  • Age (the older we are, the more likely we are to develop this syndrome)
  • Chronic pancreatitis
  • Taking medications
  • Celiac disease (intolerance)
  • Chronic stress
  • Taking antibiotics
  • The presence of infection
  • Weakened immunity

How can SIBO be diagnosed?

At the moment, there are several ways to diagnose this syndrome.

The breath test is the most informative and accurate. There are as many as 3 of them: hydrogen, with xylose and with bile acid. The xylose test is the most accurate.

What can Small Intestine Bacterial Overgrowth Syndrome cause?

I believe that it is very important for good health to diagnose and get rid of this pathological condition of the intestine in time. Let me explain why.

First, it leads to a deficiency of important substances. Deficiencies of vitamins B12, A, D, E, K, calcium and iron minerals develop especially often. Deficiencies of these substances can lead to very serious health problems, even anemia or osteoporosis.

Secondly, it turns out that bacterial overgrowth in the intestines, where it should not be, leads not only to gas and diarrhea, but to more global, seemingly completely unrelated conditions - take again the same anemia!

Third, over time, SIBO leads to increased permeability of the intestinal wall. And this means the ingress of microscopic particles of food and toxins into the bloodstream, the immune response, and here you are, allergic reactions, autoimmune diseases, skin problems, hormones and much more.

Therefore, you should always keep your gut a priority!

How to treat SIBO with natural methods and techniques?

The usual conservative treatment for this syndrome is with antibiotics. But there are several problems.

  1. they kill not only harmful bacteria, but also beneficial ones. So you can immediately say goodbye to all your intestinal microflora.
  2. SIBO includes different strains of bacteria and in order for antibiotics to be at least a little effective, they must be combined, and this must be done very skillfully!
  3. Well, do not forget that bacteria develop addiction or tolerance to antibiotics and they simply stop working and require stronger "options".

Therefore, I am for natural and natural treatment!

So, the treatment plan for Enhanced Bacterial Growth Syndrome in the Small Intestine:

1. Starve the bad bacteria

We will do this with the help of food. Special food!

The food is called ... It aims to eliminate foods that cause fermentation in the intestines, making it difficult to kill harmful bacteria.

This diet must be strictly adhered to for 14 days! This phase is aimed at healing the intestinal wall, reducing inflammation and getting rid of bacterial proliferation.

The following products should be discarded:

  • Containing Fructose (honey, maple syrup, fruits, dried fruits, fruit juices, cereals and anything else that may contain)
  • Containing Lactose (all dairy products)
  • Containing Fruits (wheat, onion, garlic, artichoke, cabbage, broccoli)
  • Containing Galactans (legumes, soy)
  • Containing Polyols (sorbitol, maltitol, xylitol, erythritol)

2. Restore bacterial balance

To do this, we will need to follow the GAPS power protocol. It is aimed at restoring the Leaky Gut, balancing microflora, preventing toxins from entering the bloodstream, reducing sensitivity to foods, improving neurological function, strengthening immunity, reducing anxiety and depression, and healing Irritable Bowel Syndrome.

I have already written about this protocol in detail. It should be followed for at least 3 months.

3. Natural supplements

a) Natural antibiotics:

Garlic or Allicin

Can be taken as simple cloves of Garlic, or as an Allicin supplement. The second option is more concentrated and easier for the stomach, not to mention the smell :)

  • - 1 finely chopped clove each (do not forget to leave it to rest for 10 minutes - this will enhance its antibacterial properties).
  • Allicin - 450 mg 3 times a day.

Take for 14 days.

Berberine

Vitamin D3 + Vitamin K2

It is also a prohormone responsible for numerous functions in our body.

Always choose Vitamin D3 over D2 and best paired with Vitamin K2 for better absorption.

Iron

What do you know about Small Intestine Bacterial Overgrowth Syndrome?

* Important: Dear readers! All iherb links contain my personal referral code code. This means that if you go to this link and order from the iherb website or enter HPM730 when ordering in a special field (referral code), you get 5% discount on your entire order, I get a small commission for this (it has absolutely no effect on the price of your order).

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The syndrome occurs when the number of bacterial cells in the small intestine exceeds 10 5 in 1 ml content. Most often, newborns and the elderly are affected. Up to 50% of severe diarrhea in infants is caused by this particular syndrome. Diabetics suffer from this syndrome - up to 45% of patients. In adults, this syndrome is one of the causes of malabsorption or malabsorption of nutrients.

There are several of them, the main ones are:

Why is the number of bacteria increasing?

To maintain a normal number of bacteria in the small intestine (less than 10 5 cells in 1 ml), there are 3 mechanisms:

  • the presence of the Bauhinia valve or ileocecal valve, which passes the contents in one direction - from the small intestine to the large intestine, and never vice versa;
  • normal motor activity of the entire intestine, when peristaltic contractions or waves periodically occur, due to which food consistently moves from the stomach towards the anus;
  • a sufficient level of secretion of hydrochloric acid, which suppresses the overgrowth of bacteria.

If any of these factors are weakened or dropped out, bacteria begin to grow uncontrollably. In terms of the number and composition, the microflora of the small intestine begins to resemble that in the large intestine (the number is up to 10 10 cells in 1 ml).

A twofold excess of the quantitative composition causes inflammation, impaired absorption of nutrients. So, overgrowing bacteria absorb almost the entire amount of vitamin B 12, and a person develops severe multivitamin deficiency. The metabolism of bile acids is impaired, which alters the absorption of fats and fats, as well as iron.

The intestinal mucosa, on which digestion takes place, changes. The villi undergo atrophy, the crypts increase in size and grow, and lymphocytes accumulate in the submucous layer.

Symptoms

Manifestations are nonspecific, typical of many other digestive disorders:

Some people have no manifestations, except for losing weight for an unknown reason. The disease is detected after examination.

Malabsorption causes the second circle of disorders: anemia, vitamin deficiency, the formation of oxalate kidney stones. If nothing is done, then all the functions of the organs are gradually disrupted.

Diagnostics

To suspect the disease allows clinical picture combined with data on human life: old age, alcoholism, gradual weight loss, secondary metabolic disorders. In babies, attention is drawn to the lag in weight, delay in physical development.

"Gold Standard" - growing bacteria from the aspirate of the small intestine. However, this is a traumatic and expensive examination and is rarely used.

In practice, it is used more often. The patient is allowed to drink the dissolved lactulose, then the air is exhaled into the mouthpiece of the analyzer every 15 minutes for an hour and a half.

The gas analyzer detects hydrogen in the exhaled air, which is formed only in the process of metabolism that occurs without access to air (anaerobic). This is how the part of the intestine is found in which the exchange proceeds most intensively, because the number of bacteria there is much higher than normal.

A blood test for D-xylose is also used. This substance does not exist in nature, it is an artificial carbohydrate, it is absorbed exclusively in the small intestine. He is given a drink, and then the blood and urine are examined. A healthy person excretes 80% of the consumed dose. If the substance is not absorbed, then it does not enter the blood and urine, residual amounts are found.

Treatment

The main principles are the reimbursement of those substances that the body lacks, and the suppression of the growth of bacterial flora against the background of a gentle diet.

Nutrition

Basic principles:

Antibiotics

Prescribed in a short course for 1 week, high doses are used. Different groups are used: tetracycline, cephalosporin, containing clavulanic acid, and others.

After the course, a break is made for 2 weeks, and then another antibiotic is used, also for a week.

Additional drugs

Used bactericidal and antiprotozoal drugs - Co-trimoxazole, metronidazole and the like.

According to indications, digestive enzymes are used, especially replacing the secretion of the pancreas - Mezim, Penzital and the like.

Prophylaxis

The best prevention is treatment of the underlying disease that led to the development of bacterial overgrowth syndrome. It is practically impossible to overcome this syndrome in alcoholics; it is a big problem in elderly and operated patients. In this case, the course treatment has to be repeated several times a year.

SIBO is defined as bacterial overgrowth in the small intestine. This syndrome is still a poorly understood disease. In English it sounds like SIBO.

Initially, it was thought that SIBO (bacterial overgrowth syndrome) occurs in only a small number of patients, but it is now clear that the disorder is more common. At the same time, patients with bacterial overgrowth syndrome have different symptoms: chronic diarrhea, weight loss and malabsorption, although there are also minor symptoms.

Bacterial Overgrowth Syndrome: Symptoms and Treatment

Patients with SIBO can also suffer from nutritional deficiencies and osteoporosis. A common misconception was that SIBO only affects a limited number of patients who have upper gastrointestinal anatomical abnormalities or motility disorders.

However, thanks to new diagnostic tests, it has become known that it is a more common condition, as the common symptoms of diarrhea and weight loss can cause different disorders.

Therefore, the very first step in dealing with stomach problems is to determine if the source of the symptom is an overgrowth of bacteria in the stomach.


What is SIBR?

This abbreviation stands for excessive bacterial overgrowth in the small intestine.... Those. this condition is due an excessive amount of microbes in the small intestine.

Everyone knows that bacteria are normal occurrence in a healthy digestive tract. All bacteria differ in type and concentration depending on their location in the digestive system.

Some bacteria, for example probiotics, are very beneficial for our body. However, other types of bacteria that are good in one place can be very harmful in another.

So SIBO appears when too many bacteria in the colon enter the small intestine.

SIBO is defined as the bacterial population in the small intestine in excess of 105 to 106 microorganisms per ml.

Typically, the upper small intestine should have less than 103 microorganisms / ml, and most of them are gram-negative microorganisms.

In addition to the absolute number of microorganisms, the type of microbial flora present also plays an important role in the manifestation of signs and symptoms of overgrowth.

For example, the predominance of bacteria that metabolize bile salts into insoluble compounds leads to malabsorption or diarrhea.

Microorganisms that primarily convert carbohydrates to short-chain fatty acids and gases cause bloating without diarrhea.

Gram-negative bacteria, such as the Klebsiella species, produce toxins that damage the mucous membrane and interfere with absorption.

SIBO and small intestine

The bacteria that cause SIBO are usually found in the colon. A more rare situation occurs when they are found elsewhere in the body besides the small intestine, albeit at low concentrations.

The small intestine is the largest part of the digestive tract. In this area, food mixes with digestive juices and essential minerals and vitamins are absorbed into the bloodstream.

The small intestine should normally have fewer bacteria than the large intestine (about 103-104 per ml of fluid versus more than 109 per ml).

These gut bacteria are needed to fight off bad bacteria, maintain healthy immune function, improve nutrient absorption, and promote vitamin K production.

It is well known that problems such as SIBO occur when bacteria in the large and small intestines mix or become out of balance. Why this is happening is a more difficult question.

SIBO is known to develop when the normal homeostatic mechanisms that control intestinal bacterial populations are disrupted. Two processes that most commonly predispose to bacterial growth are decreased gastric acid secretion and small bowel motility disorders.

What causes SIBR?

Despite its prevalence, the causes of bacterial overgrowth syndrome are not yet well understood.

Research shows that this syndrome occurs in a large number of people, but symptoms vary greatly from one person to another.

SIBO is known to start for many reasons, from general aging to small bowel defects, diabetes and pancreatitis. Regular use of the antibiotic also disrupts the balance of the digestive bacteria, which causes this condition.

Certain physical obstructions in the gut, such as surgical scars or Crohn's disease, also contribute to it.

However, the most important factor for its development is regular consumption of foods filled with simple sugars, refined carbohydrates, yeast, or alcohol.

Should you be afraid?

When properly balanced, bacteria in the colon help digest foods and the body absorbs essential nutrients. However, when bacteria invade and invade the small intestine, it can lead to poor absorption of nutrients and even damage to the lining of the stomach.

With SIBO, food passes through the small intestine and excess bacteria interfere with healthy digestion and absorption. The bacteria actually consume certain foods and nutrients, resulting in unpleasant symptoms, including pain.

Are there grounds for concern if SIBO is suspected? The longer you live without treatment, the worse the effects will be.

Overgrowth of bacteria can lead to malabsorption of nutrients, leading to digestive ailments such as gas, bloating, and even leaky gut.

Iron, calcium and other vitamins are essential for every body. Impaired absorption of vitamins leads to exhaustion, general weakness, mental stress and even long-term nerve damage.

Since SIBO can damage the intestinal mucosa, sometimes small food particles are transferred into the bloodstream and other parts of the body, thereby triggering an immune response in the body, which also leads to the development of food allergies.

Many people, often hearing about bacteria, are immediately afraid of getting infected from other patients. Fortunately, it is not a contagious disease. And the fact that it is so widespread is most likely due to the fact that people lead a similar lifestyle and few eat right.

Are there other health problems?

There is evidence that SIBO is associated with various other conditions, including irritable bowel syndrome, inflammatory disease intestines, rosacea, etc.

For unknown reasons, it is a common symptom in people with hypothyroidism, non-alcoholic fatty liver disease, and cirrhosis.

It is no coincidence that its main symptoms are the same for leaky gut syndrome. In fact, the same symptoms were found in over 80% of patients with leaky gut syndrome, leading some scientists to speculate that this is the underlying cause of the latter disorder.

It is not yet known what percentage of the total population suffers from bacterial overgrowth, but in some studies, scientists refer to the fact that this number reaches 20%.

Do not underestimate this condition as people rarely seek medical help with such symptoms.

If SIBO is not treated in time, then over time it can lead to other complications.

The growth of bacteria in the small intestine can lead to malnutrition, which prevents many nutrients, proteins, carbohydrates, and fats from being absorbed properly. Later, there is a deficiency of iron, vitamin B12, calcium and even a deficiency of fat-soluble vitamins: A, D, E and vitamin K.

Nutrient deficiencies lead to general weakness, fatigue, confusion and damage to the central nervous system.

Vitamin B12 deficiency is most common. It is more susceptible to vegetarians and vegans, as well as people with insufficient stomach acid production or taking drugs that suppress stomach acid.

Signs of the presence of SIBR

The main symptoms include:

    Chronic gas contamination;

    Bloating (especially a few hours after eating);

    Signs of a vitamin or mineral deficiency;

    Constipation or diarrhea;

  • Frequent abdominal pain

    Fatigue;

    Seizures;

    Sudden food intolerances (gluten, lactose, or fructose);

    Leaky gut;

  • Chronic diseases (diabetes, autoimmune diseases);

    Skin rashes (rosacea, acne, eczema, rash);

    Depression;

  • Malnutrition and unexplained weight loss (in very extreme cases).

Major risk factors

There are many conditions that favor the growth of bacteria in the small intestine. These include general aging of the body, chronic pancreatitis, diabetes, diverticulosis, structural defects in the small intestine, wounds, fistulas, intestinal lymphoma, and scleroderma.

Stomach acid inhibits the growth of ingested bacteria, thereby limiting the number of bacteria in the upper small intestine. Decreased gastric acid production is a significant risk factor for SIBO and may develop after colonization Helicobacter pylori or as a consequence of aging.

Use of certain medications(immunosuppressants, proton pump inhibitors), immune system disorders, recent surgery, and celiac disease, also associated with an increased risk of developing SIBO.

Celiac disease is especially dangerous because it interferes with intestinal motility, leading to malfunctioning of the small intestine.

Another reason for the appearance of SIBO is the blind loop of the intestine.... This happens when the small intestine actually forms a loop, forcing food to bypass part of the digestive tract. Food moves more slowly, making it a breeding ground for bacteria.

Metabolic disorders, including type 2 diabetes, also lead to or contribute to certain gastrointestinal disorders.

Aging of the body- a special risk factor for the development of SIBO. As you age, your digestive tract slows down.

Those with rosacea, acne, and eczema are also at risk. As you can see, bacterial overgrowth in the fine tissue is associated with a wide variety of conditions.

How is SIBO diagnosed?

Due to the complexity of this condition, no test is definitely suitable for diagnosing it. The small intestine makes access difficult, so stool standards are the best indicator of the health of the colon, but not the small intestine.

The standard test for determining SIBO is the hydrogen breath test. It measures the amount of hydrogen and methane gas produced by bacteria in the digestive system.

If you have SIBO, these gases, at certain concentrations, can be found in the exhaled air several hours after drinking a regular sugar solution.

A similar test using lactulose. The bacteria can digest lactulose, and when they do, gas is created. If the lactulose breath test detects gas, then you most likely have an overgrowth of bacteria.

Breath tests are far from perfect because they allow interpretation. All doctors have different experiences, they can diagnose the results as positive or negative, because the symptoms of SIBO often fall into the spectrum of different diseases.

For this reason, it is usually best to take several tests at once to get a clearer picture of the internal bacterial level.

How to deal with SIBO?

If you have an overgrowth of bacteria in your small intestine, then don't panic. It is possible to restore the balance of bacteria and relieve symptoms.

1) stick to a diet

One of the main factors provoking bacterial growth is unhealthy diet, filled with easily digestible foods. These include simple sugars, refined carbohydrates, and all types of alcohol.

The first point in the diet is to avoid foods that harbor these bacteria. The goal of the diet is to feed you but keep the bacteria hungry, usually by limiting carbohydrates and filling your stomach with insoluble fiber.

Foods to avoid:

    Fructose - some fruit juices, honey, processed crops, baked goods, corn and maple syrups, processed sugars.

    Lactose - Common dairy products and processed foods with milk and lactose additives, such as milk powder.

    Fruits - asparagus, onion, artichoke, wheat porridge, garlic, broccoli, collard greens.

    Galactans - legumes, cabbage, Brussels sprouts, soybeans.

    Polyols (carbohydrates with very large molecules) - sorbitol, isomalt, lactitol, maltitol. They meet in chewing gum, lollipops and some medications.

    Foods you can eat:

    Fibrous vegetables (greens, cucumbers, carrots, squash, tomatoes);

  • Fresh fruits;

    Tuna and salmon;

    Beef and lamb;

  • Raw hard cheeses;

    Almond or coconut milk;

    Fresh berries (blueberries, strawberries, currants);

    Nut oils.

Due to its high fiber content, fresh fruit will not ferment in the stomach before their digestion begins.

Don't overeat because an excessive amount of food limits the production of acid in the stomach, and therefore creates a suitable environment for bacteria to multiply in the small intestine.

It is also wise to eat more small meals more often throughout the day rather than three large meals. This will help the digestive system process each meal of the diet more efficiently for SIBO small bowel syndrome. After such a two-week meal, the diet changes slightly, because it is necessary to rebalance bacteria throughout the digestive tract and prevent toxins from entering the bloodstream.

All grains, processed sugars, high starch foods, processed foods, and non-organic dairy meat products should still be avoided.

Probiotic-rich foods are gradually being introduced, not store-bought yogurt, but homemade, cultivated vegetables, natto, kombucha, and fermented foods such as sauerkraut.

2) dietary supplements

SIBO often leads to nutritional deficiencies because gut bacteria digest a large percentage of your food.

Take a daily multivitamin with vitamins B12, D, K, zinc and iron until the state is back under control.

High levels of vitamins also help fight or reduce the chances of developing SIBO.

3) Antibiotics

Antibiotics are often the cause of SIBO, but they also help to restore the normal level of bacteria. Antibiotics kill unwanted bacteria, thereby reducing their numbers in the small intestine.

However, antibiotics will indiscriminately kill bacteria, so the beneficial bacteria will also decrease, leading to a high re-occurrence of the disease.

4) Probiotics

Often, doctors prescribe probiotics along with antibiotics and in combination with diet. to reduce the frequency of recurrence.

5) Herbal remedies

Many plants have natural antibacterial properties such as wormwood extract, argan oil, Indian barberry root extract, and lemon balm oil. They will help reduce small bacterial growth.

Certain essential oils can also improve the symptoms of SIBO and even eradicate the condition permanently.

Peppermint essential oil reduces painful gastrointestinal symptoms such as constipation and diarrhea, as does clove oil, tarragon and frankincense essential oil.

One of the best ways to improve your entire digestive system is to live a healthy lifestyle. Stress control, regular physical exercises and meditation can reduce the risk of SIBO. published.

P.S. And remember, just by changing our consumption - together we are changing the world! © econet

The gastrointestinal tract of the body is seeded with several hundred different types of bacteria. The composition of microorganisms differs in the sections more or less distant from the median plane of the small intestine. Microflora is of great importance for the normalization of the smooth functioning of the intestines. For a person without deviations in health, as a rule, various microorganisms serve to maintain the acid-base balance in the stomach in a normal state, promote the production of gastric juice for processing food, and control the motor activity of the small intestine. In the event of a malfunction of at least one of these devices, there is a high probability of the formation of bacterial overgrowth syndrome in the small intestine.

Definition

Excessive bacterial growth in the small intestine occurs as a result of changes associated with human anatomy, or in violation of the motor activity of the gastrointestinal tract and insufficient gastric secretion. The resulting disturbances can lead to nutritional problems, loss of vitamins and disruptions in the digestion of fats. The syndrome of bacterial redundancy is treated with the use of antibacterial drugs.

Symptoms

Bloating is one of the symptoms of the disease.

Patients with excess bacterial growth syndrome observe the following symptoms:

  • painful bloating, rumbling, which occurs a short time after eating;
  • predominantly diarrhea;
  • poorly digested food in the feces;
  • the presence of fat inclusions in the feces;
  • decreased vision;
  • in rare cases, nausea is observed;
  • prostration;
  • headache;
  • drastic weight loss;
  • feeling of anxiety, panic;
  • mostly bad mood;
  • dizziness;
  • depressive state.

Forms of the disease

Bacterial increase in the small intestine depends on the amount and nature of microflora and is of three degrees:

  1. The first degree is aerobic, that is, to perform the vital functions of a group of living organisms invisible to the naked eye, oxygen is needed, with an increased intestinal microflora.
  2. The second degree in the syndrome is an aerobic intestinal enlarged microflora with the formation of bacteria. In this case, oxygen is not required to carry out the vital functions of microorganisms.
  3. The third degree has most of the anaerobic microflora.

The source of the disease

The small intestine with bacterial overgrowth syndrome is a phenomenon that can occur for a number of reasons. Basically, the causes are divided into those that study the origin of the disease, their conditions, as well as those that are based on the study of the development of the disease.

Possible reason bacterial growth.

By etiology, the following reasons for bacterial growth are distinguished:

  • an excessive level of bacteria in the intestine may occur after operations;
  • violations in the functionality of the Bauhinia flap;
  • diseases of the digestive system, which are associated with the motor activity of the intestines;
  • prolonged eating disorder;
  • damage in the intestinal cavity under the influence of digestion and absorption enzymes;
  • the structure of the intestine, namely the narrowing of its lumen;
  • various food intolerances;
  • chronic inflammatory diseases in the intestines;
  • obstruction;
  • symptom complex of chronic disorders;
  • diverticular disease;
  • cirrhosis of the liver;
  • alcoholism;
  • vagatomy;
  • prolonged use of medications that lower the human immune system;
  • excessive antibiotic therapy;
  • bacteria that come from the extraintestinal receptacle;
  • all kinds of stress;
  • local and systemic disorders of the immune system;
  • diabetes.

As a result of exposure to etiological signs, there is a violation of the protective layer of the mucous membrane of the small intestine. As a result, local and systemic pathological processes are caused, the protective purpose of the mucous membrane and the functioning of digestive enzymes are disrupted. In addition, there is a disorder of secretion, oxidation of fatty acids, endogenous intoxication.

In case of serious violations of the human immune system, an exchange of bacteria in the lymph and blood can occur, with the subsequent development of inflammation with pus on all kinds of tissues and organs.

Diagnostics and treatment

Diagnosis allows you to make an accurate diagnosis and ascertain about excessive bacterial growth. Thus, diagnostics can include:

  • Collection of information about the patient's family in order to identify the presence of diseases associated with the digestive system by family relationship.
  • Analysis of patient complaints and past illnesses, as well as the study of the patient's stool (consistency, duration). In addition, flatulence, nausea are taken into account.
  • Visual examination of the patient, which is based on an assessment of the patient's skin color, physique and determination of the presence of excess weight.
  • Collection of information about existing diseases of the gastrointestinal tract and previous operations and other diseases.
The Schilling test detects B12-deficiency anemia.

Diagnosis without fail includes laboratory tests, which are based on donating blood for a general analysis, which will show or refute anemia, an increase in the level of leukocytes, which happens with an inflammatory process in the body. In addition, a biochemical blood test should be carried out, which will reveal the root cause of the disease, a general urine test, which is necessary to determine an increase in possible chemicals indicating the development of bacteria exceeding the norm. To make an accurate diagnosis and determine the root cause, it is important to conduct a canal analysis, which will indicate the presence or absence of undigested food, determine the acidity of the stool and the amount of fat in it.

An important research method is the breath test. Before carrying out which one should adhere to a number of rules: it is forbidden to eat food with the presence of carbohydrates in the evening before testing; do not smoke or overload the body physical activity a few hours before the test; rinse your mouth with an antibacterial effect before testing. Another equally important diagnostic method is a sugar test, which will show hydrogen in bacterial growth, as well as a xylose test, which is necessary to detect labeled carbon dioxide.

Diagnosis of bacterial overgrowth syndrome is based on instrumental research:

  • X-ray, which is needed to detect diverticulosis or narrowing of the small intestine.
  • Schilling's test, which consists in the patient taking vitamin B12 and after which it is excreted in the urine. The doctor evaluates the absorption of the vitamin.
  • Small intestine biopsy. For this, a piece of tissue is taken and sent for examination under a microscope. If the diagnosis of the disease is confirmed, an abnormal change in the intestinal mucosa occurs.

In case of excessive bacterial growth, the following specialists should be consulted:

  • a surgeon who will rule out surgical pathologies;
  • gynecologist - necessary to exclude gynecological pathologies;
  • a urologist, consultation with whom will exclude urinary pathologies;
  • an infectious disease specialist, a consultation with whom is carried out if indicated and is necessary to exclude infectious diarrhea.
Non-drug treatment consists of adhering to the required diet.

Treatment of increased bacterial growth in the small intestine is based on reducing or completely eliminating the symptoms of the primary disease, on eliminating the excessive presence of bacteria in the small intestine, restoring microbiocenosis and normalizing the functioning of the digestive system. Therapy can be carried out with or without medication.

Non-drug treatment consists of adhering to an appropriate diet and eating foods of natural origin. These products include fermented milk products with bifidobacteria. Treatment of the syndrome with drugs is based on therapy with antibacterial drugs, probiotics, prebiotics. If necessary, intravenous vitamin therapy is prescribed.

Surgical intervention is carried out in the case of ineffective drug and non-drug treatment.