With bacterial overgrowth syndrome in the intestines, the number of bacteria that represent normal microflora increases. This rarely leads to gastroenterological diseases and does not directly affect the patient's life expectancy.
In some cases, pathogenic microorganisms may appear. But, as a rule, it is not this that negatively affects the quality of life, but bloating, gas formation, heartburn, nausea and other constant manifestations of SIBO. A set of symptoms may appear after various surgical interventions, with impaired peristalsis or changes in acidity levels.
Description of SIBO
Normally, the mass of bacteria in the intestines of an adult is about 2.5 kg. Moreover, the total genome includes 400 thousand genes, which is 12 times more than the human genome. The small intestine contains about 100 microorganisms per ml. In the intestinal flora of the large intestine, their number is much higher - 1010-1012 per 1 ml. Most microorganisms are destroyed by gastric acid. The microflora is partially represented by opportunistic organisms. Bacteria also have a physiological function: they break down food during the fermentation process. In total, there are from 500 to 1,000 different strains of microorganisms living in the gastrointestinal tract.
With bacterial overgrowth syndrome, microorganisms appear in the small intestine that are qualitatively and quantitatively similar to the microflora of the large intestine. As a result, an inflammatory process develops and the functional functioning of the entire digestive tract is disrupted. Microorganisms metabolize vitamins, leading to malnutrition. Bacteria activate the premature process of divergence of acid salts, contributing to malabsorption and deficiency of nutrients. Also, with excessive bacterial growth in the small intestine, patients experience pathological changes in the mucosa. This can lead to other digestive system diseases.
So what is bacterial overgrowth syndrome? This is a pathological condition characterized by changes in microflora in the small intestine. The syndrome leads to functional disorders in the digestive system, which is manifested by a number of symptoms. Most often, patients experience diarrhea and the process of transport of nutrients is disrupted. Usually (but not necessarily) intestinal bacterial overgrowth syndrome occurs against the background of another disease.
Risk factors
At risk for developing intestinal bacterial overgrowth syndrome are young children (including newborns, whose gastrointestinal tract is just beginning to be colonized by bacteria) and the elderly. According to statistics, SIBO develops in approximately 20-43% of patients with diabetes.
A complex of symptoms is also typical for people with eating disorders and eating disorders. Bulimia, anorexia, periodic episodes of overeating, irregular and irrational nutrition with a deficiency of vitamins and nutrients can also lead to bacterial overgrowth syndrome (SIBO).
In half of cases, the cause of neonatal chronic diarrhea is SIBO. Microflora can also change after taking a course of antibiotics, with nutritional disorders (for example, eating foods that are not appropriate for age), intestinal infections and lactase deficiency.
The following phenomena also contribute to the occurrence of bacterial overgrowth syndrome in the intestines (symptoms will be described below):
- anatomical changes that contribute to a delay in the passage of contents through the gastrointestinal tract;
- absence of ileocecal valve;
- various peristalsis disorders;
- increased secretion of hydrochloric acid;
- immune system disorders;
- the use of certain pharmaceutical drugs (for example, proton pump inhibitors, which inhibit the secretion of hydrochloric acid).
Main symptoms
The clinical picture of the disease is varied. Among the symptoms of bacterial overgrowth in the intestines, doctors distinguish abdominal (associated with the abdominal cavity) and general. Abdominal manifestations include:
- flatulence (rumbling in the stomach, bloating) that occurs a short time after eating;
- irregular bowel movements with frequent bouts of diarrhea;
- the presence of undigested food particles in the stool.
Rarely, patients experience nausea.
Common symptoms include:
- various neurotic disorders (frequent mood swings, hysteria, anxiety, insomnia);
- weight loss;
- signs of deficiency of iron, folic acid, vitamins D, K, A, E.
The latter also has its symptoms, expressed as:
- general weakness and drowsiness throughout the day;
- rapid fatigue;
- visual impairment;
- frequent headaches and dizziness;
- decreased visual acuity;
- dry skin.
Possible signs of hematopoietic disorders. Children may experience growth retardation.
Why is bacterial overgrowth dangerous? All characteristic symptoms of SIRD do not threaten the patient’s life, but negatively affect its quality. Over time, psychological and other health problems may increase, because all processes in the human body are interconnected.
Forms of the disease
Depending on the amount and nature of the microflora, doctors distinguish three forms of the disease. The first degree of SIBO is characterized by an increase in aerobic microflora (bacteria that require air to function predominate). At the second stage, anaerobic microorganisms appear. These are those who do not need access to oxygen for normal existence. The third stage is characterized by the predominance of anaerobic microflora in the gastrointestinal tract.
Diagnostic methods
Diagnosis and treatment of gut bacteria overgrowth begins with an assessment of the patient's overall health because SIBO is typically caused by underlying medical conditions or as a result of eating disorders. Often the cause of SIBO, for example, can be irritable bowel syndrome - a functional disorder accompanied by bloating, abdominal pain, discomfort in the absence of structural lesions of the gastrointestinal tract. In half of the cases, this diagnosis leads to increased bacterial growth.
The doctor needs to rule out:
- valve malfunction;
- diseases associated with intestinal motility disorders;
- long-term nutritional imbalance;
- inflammatory diseases of the gastrointestinal tract (especially chronic);
- short bowel syndrome;
- immune disorders (local and systemic, including chemical or radiation exposure, AIDS);
- entry of bacteria from the extraintestinal reservoir;
- patient taking antibiotics;
- intestinal tumors.
Cleansing with enemas and various diets have a negative impact. Intestinal bacterial overgrowth syndrome can also be caused by stress of various origins.
SIBO should be suspected in patients who complain of uncontrolled weight loss, flatulence, bloating, discomfort, and frequent diarrhea. The diagnosis is made based on the results of microflora culture. For this purpose, intestinal contents are aspirated and inoculated onto a nutrient medium.
Stool culture, which is widely used in domestic medicine, is already considered uninformative in international practice, since it can only give an idea of 12-15 types of bacteria. This method, however, can be used to identify specific infectious agents.
The diagnosis is made after a hydrogen breath test with glucose and lactose. Both studies are usually easily tolerated by patients. It is necessary to drink a sugar solution, after which the hydrogen content in the exhaled air is determined. The milk sugar test additionally evaluates blood glucose. Increased levels indicate excessive gas formation. A breath test may also be used to examine jejunal secretions.
Additionally, a general blood test is indicated. The following may indicate SIBO and anemia:
- decreased hemoglobin (with excessive bacterial growth it decreases due to impaired absorption of B12 and iron);
- low protein;
- decreased albumin level.
Due to impaired glucose absorption, blood sugar levels may decrease.
For dermatological problems combined with gastrointestinal symptoms, a selenium test is especially important. SIBO confirms a deficiency of this element. The exact scope of the examination is determined by the attending physician based on the medical history and anamnesis.
SIBO Treatment
After determining the exact diagnosis, the doctor is faced with the question of choosing treatment tactics. Intestinal bacterial overgrowth syndrome involves:
- antibacterial therapy;
- if necessary, taking probiotics and prebiotics to restore normal gastrointestinal microflora;
- antidiarrheal and painkillers as indicated.
The treatment regimen must include measures to relieve the underlying disease. How to treat bacterial overgrowth syndrome? A therapeutic diet can lead to an improvement in the patient's condition. Sometimes surgical treatment is necessary: if SIBO has developed against the background of anatomical pathologies in the structure of the digestive system.
After a course of antibiotics that lasts at least two weeks, it is recommended to monitor the patient for several months. At the same time, the best results can be achieved if the main attention is paid not to eliminating symptoms, but to treating the underlying disease.
- Tetracycline is usually effective if the syndrome is not idiopathic (of unclear origin);
- patients with diabetes are prescribed Amoxicillin or clavulanic acid;
- for elderly patients, Metronidazole and Clindamycin are recommended;
- “Gentamicin” (judging by reviews from parents) improves the health of children up to one year old.
The listed drugs may be produced under different trade names. “Gentamicin”, for example, is “Gentamin”, and “Amgent”, and “Gentsin”, and “Septopal”, and “Gentamisin”. Indicated for use in bacterial infections. Contraindications include hypersensitivity, neonatal period and prematurity, lactation period and old age. In some cases, it can be used for newborns less than one week old. This is an antibacterial drug for intramuscular or intravenous administration, so self-medication is strictly contraindicated. All of the above medications can only be purchased with a doctor's prescription.
Special diet
During treatment, it is very important for the patient to follow the therapeutic regimen developed by the doctor and take medications in precise dosages. Judging by the reviews, deviation from therapy tactics may not only not give any positive results, but also lead to disastrous consequences. Additionally, you should avoid stress, eat small meals and exclusively according to the treatment menu.
The diet should be based on foods that are easily digestible. Avoid sweeteners, limit sugar, avoid dairy products, drink at least eight glasses of clean water per day, and consume the recommended amount of protein (120-140 grams of beef or poultry per day).
It is imperative to include fresh, boiled or lightly stewed vegetables and fruits in moderate quantities in your diet, which will normalize stool. Rice (except wild rice), pasta, bread and potatoes are acceptable. But each meal should include no more than half a cup of these foods.
Possible complications
Over a long period of time, bacterial overgrowth syndrome leads to a deficiency of vitamins and microelements. Anemia may develop due to a lack of vitamin B12.
Typically, SIBO is not an independent disease, so complications and prognosis largely depend on the underlying pathology that led to its formation. If it is not eliminated, then unpleasant symptoms from the gastrointestinal tract will regularly recur.
Prevention
Successful treatment of intestinal bacterial overgrowth syndrome usually begins with differential diagnosis and identification of concomitant diseases, because SIBO is rarely an independent pathology. For this reason, the main preventive measure is timely detection and diagnosis-appropriate treatment of any infectious and non-infectious gastrointestinal diseases, regular medical supervision in case of digestive problems and following all doctor’s recommendations.
Patients (especially those at risk) are advised to follow the rules of a balanced diet in everyday life, not to overeat or starve, and to abandon strict diets for weight loss and home colon cleanses, which usually do not lead to anything good. It is advisable to avoid stress, ensure the normal functioning of the immune system and ensure sufficient physical activity. These are general rules for a healthy lifestyle.
Finally
The description, diagnosis and treatment of intestinal bacterial overgrowth syndrome have been discussed in detail above. The clinical symptoms of the syndrome are nonspecific, but can cause significant disruption of the entire digestive system. Diagnostic methods are predominantly non-invasive. Treatment of bacterial overgrowth syndrome in the small intestine is carried out with the use of antibiotics, probiotics, adherence to a therapeutic diet, correction of eating habits and treatment of the underlying disease. Judging by patient reviews, the prognosis is usually entirely determined by the course of the pathology that caused SIRB.
SIBO is defined as bacterial overgrowth in the small intestine. This syndrome still remains a little studied disease. In English it sounds like SIBO.
SIBO (bacterial overgrowth syndrome) was initially thought to only occur in a small number of patients, but it is now clear that the disorder is more common. However, patients with bacterial overgrowth syndrome experience a variety of symptoms: chronic diarrhea, weight loss and malabsorption, although minor symptoms also occur.
Bacterial overgrowth syndrome: symptoms and treatment
Patients with SIBO may also suffer from nutritional deficiencies and osteoporosis. A common misconception has been that SIBO only affects a limited number of patients who have anatomical abnormalities of the upper gastrointestinal tract or mobility disorders.
However, new diagnostic tests have revealed that it is a more common condition, as the common symptoms of diarrhea and weight loss can be caused by different disorders.
Therefore, the very first step in solving stomach problems is to determine whether the symptom is caused by bacterial overgrowth in the stomach.
What is SIBO?
This abbreviation stands for bacterial overgrowth in the small intestine.. Those. this condition is caused excessive numbers of microbes in the small intestine.
Everyone knows that bacteria are a normal part of a healthy digestive tract. All bacteria vary 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 beneficial in one place can be very harmful in another.
SIBO occurs when too many colon bacteria enter the small intestine.
SIBO is defined as a bacterial population in the small intestine exceeding 105 - 106 microorganisms per 1 ml.
Typically, there should be less than 103 microorganisms/ml in the upper small intestine, 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 into short-chain fatty acids and gases cause bloating without diarrhea.
Gram-negative bacteria, such as Klebsiella spp., produce toxins that damage the mucosa and interfere with absorption function.
SIBO and the Small Intestine
The bacteria that causes SIBO is usually found in the colon. A rarer situation occurs when they are found in places other than the small intestine in the body, albeit at low concentrations.
The small intestine is the largest part of the digestive tract. This area mixes food with digestive juices and absorbs essential minerals and vitamins into the bloodstream.
The small intestine should normally have fewer bacteria than the large intestine (about 103 - 104 per ml of fluid compared to more than 109 per ml).
These gut bacteria are essential for fighting "bad" bacteria, maintaining healthy immune function, improving nutrient absorption, and promoting vitamin K production.
It is well known that problems like SIBO occur when bacteria in the large and small intestines mix or become out of balance. But why this happens is a more complex question.
SIBO is known to develop when the normal homeostatic mechanisms that control intestinal bacterial populations are disrupted. The two processes that most often predispose to bacterial overgrowth are decreased gastric acid secretion and impaired small intestinal motility.
What Causes SIBO?
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 intestinal defects, diabetes and pancreatitis. Regular use of antibiotics also disrupts the balance of digestive bacteria, which causes this condition.
Certain physical obstructions in the intestines, 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 we be afraid?
When properly balanced, bacteria in the colon help digest foods and the body absorbs essential nutrients. However, when bacteria invade and take over the small intestine, it can lead to poor absorption of nutrients and even damage to the stomach lining.
With SIBO, food passes through the small intestine and excess bacteria interferes with the healthy process of digestion and absorption. Bacteria actually consume certain foods and nutrients, resulting in unpleasant symptoms, including pain.
Is there cause for concern if you suspect SIBO? The longer you go without treatment, the worse its effects will be.
Overgrowth of bacteria can lead to nutrient malabsorption, leading to digestive issues such as gas, bloating, and even leaky gut syndrome.
Iron, calcium and other vitamins are necessary for every body. Malabsorption of vitamins leads to exhaustion, general weakness, mental stress and even long-term nerve damage.
Because SIBO can damage the intestinal lining, sometimes small food particles move into the bloodstream and other parts of the body, triggering an immune response in the body that can lead to food allergies.
Many people, often hearing about bacteria, are immediately afraid of getting infected from other patients. But, fortunately, this is not a contagious disease. And the fact that it is so common is most likely due to the fact that people lead a similar lifestyle and few people eat right.
Are there other health problems possible?
There is evidence that SIBO is linked to various other conditions, including irritable bowel syndrome, inflammatory bowel disease, rosacea, and more.
For unknown reasons, it is a common symptom in people with hypothyroidism, nonalcoholic 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 have been found in more than 80% of patients with leaky gut syndrome, leading some scientists to suggest that it is the underlying cause of the latter disorder.
It is not yet known what percentage of the general population suffers from bacterial overgrowth, but some studies cite the number as high as 20%.
This disease should not be underestimated, as people rarely seek medical help for such symptoms.
If SIBO is not treated promptly, it can lead to other complications over time.
The growth of bacteria in the small intestine can lead to malnutrition, causing many nutrients, proteins, carbohydrates and fats to not be absorbed properly. Later, deficiency of iron, vitamin B12, calcium and even deficiency of fat-soluble vitamins: A, D, E and vitamin K appear.
Nutrient deficiencies lead to general weakness, fatigue, confusion and damage to the central nervous system.
Vitamin B12 deficiency is the most common. Vegetarians and vegans are more susceptible to it, as are people who do not produce enough stomach acid or who take medications that suppress stomach acid.
Signs of SIBO
The main symptoms include:
-
Frequent abdominal pain;
Fatigue;
Convulsions;
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).
Chronic gas pollution;
Bloating (especially a few hours after eating);
Signs of vitamin or mineral deficiency;
constipation or diarrhea;
Main risk factors
There are many conditions that promote 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. SIBO syndrome of the small intestine
Stomach acid inhibits the growth of ingested bacteria, thereby limiting the number of bacteria in the upper small intestine. Decreased stomach acid production is a significant risk factor for SIBO and can develop after colonization with 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 is associated with an increased risk of developing SIBO.
Celiac disease is particularly dangerous because it impairs intestinal motility, leading to improper functioning of the small intestine.
Another cause of SIBO is blind loop syndrome.. This occurs when the small intestine actually forms a loop, forcing food to bypass part of the digestive tract. Food moves more slowly, causing it to become a breeding ground for bacteria to grow.
Metabolic disorders, including type 2 diabetes, can also lead to or contribute to the development of certain gastrointestinal disorders.
Aging of the body– a special risk factor for the development of SIBO. As we age, our digestive tract slows down.
Those who suffer from rosacea, acne and eczema are also at risk. As you can see, bacterial overgrowth in the thin tissue is associated with a wide range of conditions.
How to diagnose SIBO?
Due to the complexity of this condition, no single test is definitively suitable for diagnosing it. The small intestine makes access difficult, so standard stool samples are the best indicator of colon health, but not small intestine health.
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 can be detected in certain concentrations in your breath several hours after drinking a regular sugar solution.
A similar test is performed using lactulose. Bacteria can digest lactulose, and when they do this, a gas is created. If the lactulose breath test detects gas, you most likely have bacterial overgrowth.
Breath tests are far from perfect because they are open to interpretation. All doctors have different experiences and may diagnose the results as positive or negative, since SIBO symptoms often fall on a spectrum of different diseases.
For this reason, it is usually better to take several tests at once to get a clearer picture of the internal bacterial levels.
How to fight SIBO?
If you have an overgrowth of bacteria in your small intestine, don't panic. It is quite possible to restore the balance of bacteria and relieve symptoms.
1) Stick to a diet
One of the main factors that provoke bacterial growth is poor nutrition, filled with easily digestible foods. These include simple sugars, refined carbohydrates and all types of alcohol.
The first point of the diet is to avoid foods that feed these bacteria. The goal of the diet is to feed you but leave the bacteria hungry, usually by limiting carbohydrates and filling your stomach with insoluble fiber.
Foods to avoid:
-
Fresh fruits;
Tuna and salmon;
Beef and lamb;
-
Raw hard cheeses;
Almond or coconut milk;
Fresh berries (blueberries, strawberries, currants);
Nut oils.
Fructose - some fruit juices, honey, processed grains, baked goods, corn and maple syrups, processed sugars.
Lactose - regular dairy products and processed products with milk and lactose additives, such as milk powder.
Fructans – asparagus, onion, artichoke, wheat porridge, garlic, broccoli, kale.
Galactans - legumes, cabbage, Brussels sprouts, soybeans.
Polyols (carbohydrates with very large molecules) - sorbitol, isomalt, lactitol, maltitol. They are found in chewing gum, lozenges and some medications.
Foods you can eat:
Fibrous vegetables (greens, cucumbers, carrots, squash, tomatoes);
Due to the high fiber content, fresh fruits will not ferment in the stomach before their digestion begins.
Don't overeat, because excessive amounts of food limit the production of acid in the stomach, and therefore create a suitable environment for the proliferation of bacteria in the small intestine.
It's also wise to eat smaller meals more often throughout the day rather than three large meals. This will help your digestive system process each meal more efficiently. Small Intestine SIBO Diet. After eating this way for two weeks, the diet changes a little, because it is necessary to rebalance the bacteria throughout the digestive tract and prevent toxins from entering the bloodstream.
All grains, processed sugars, high starches, processed foods and non-organic meat and dairy products should still be avoided.
Products rich in probiotics are gradually introduced, but 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 condition returns 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 restore normal levels of bacteria. Antibiotics kill unwanted bacteria, thereby reducing their number in the small intestine.
However, antibiotics kill bacteria indiscriminately, so the number of beneficial bacteria will also decrease, leading to a high recurrence rate of the disease.
4) Probiotics
Doctors often prescribe probiotics along with antibiotics and in combination with diet. to reduce the frequency of relapse.
5) Herbal remedies
Many plants have natural antibacterial properties, such as mugwort 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 for good.
Peppermint essential oil reduces painful gastrointestinal symptoms such as constipation and diarrhea, as do clove oil, tarragon and frankincense essential oil.
One of the best ways to improve the functioning of your entire digestive system is to adopt a healthy lifestyle that supports your health. Stress management, regular exercise and meditation can reduce the risk of SIBO.published.
P.S. And remember, just by changing your consumption, we are changing the world together! © econet
For quotation: Shulpekova Yu.O. Excessive bacterial growth in the intestine: pathogenetic features and therapeutic approaches // Breast Cancer. 2003. No. 5. P. 281
MMA named after I.M. Sechenov
IN The human gastrointestinal tract is home to many bacteria, which, in fact, are symbionts of their “host”. As paradoxical as it may sound, the “host” organism needs microbial inhabitants just as much as they need its support.
The main part of microorganisms enters the lumen of the gastrointestinal tract from the oropharynx and with food.
More than 400 species of non-pathogenic aerobic and facultative anaerobic bacteria have been identified as part of the normal microflora of the gastrointestinal tract.
The intestinal biocenosis also includes a small number of opportunistic organisms that form the so-called “residual population”: staphylococci, fungi, Proteus, hemolytic strains ( E.coli).
The composition of the microflora is not the same throughout the gastrointestinal tract. In the upper and middle sections of the small intestine, the population of microorganisms is relatively small (at the beginning of the jejunum their content is no more than 100 microorganisms per 1 ml of contents) and includes mainly gram-positive facultative aerobes, a small number of anaerobes, yeasts and fungi.
As you approach the ileocecal valve, the composition of the microflora begins to more and more resemble the population of the large intestine. In the distal ileum, the microbial content is 10 5 -10 8 /g of intestinal contents.
The highest content of microorganisms is observed in the large intestine. Here their concentration reaches 10 10 -10 11 or more per 1 g of content.
The large intestine is home to the bulk of anaerobic microorganisms. The “main population” (about 70%) consists of anaerobes - bifidobacteria and bacteroides. Lactobacilli, Escherichia coli, and enterococci act as “concomitant populations.”
Bacteria inhabiting the lumen of the gastrointestinal tract perform a number of functions that are very important for the “host” organism.
The microbial population plays a critical role in intraluminal digestion, in particular, it participates in the digestion of dietary fiber (cellulose), the enzymatic breakdown of proteins, high-molecular carbohydrates, fats, and in the process of metabolism produces a number of substances beneficial to the body.
The main representative of anaerobic intestinal microflora is bifidobacteria - synthesize amino acids, proteins, vitamins B1, B2, B6, B12, vikasol, nicotinic and folic acids. It has been suggested that some substances produced by bifidobacteria have antioxidant properties and help reduce the risk of colon cancer.
Among aerobic microorganisms, the most important role in metabolic processes belongs to Escherichia coli, which has a wide range of functional properties. E.coli produces several vitamins (thiamine, riboflavin, pyridoxine, vitamins B 12, K, nicotinic, folic, pantothenic acids), participates in the metabolism of cholesterol, bilirubin, choline, bile and fatty acids, and indirectly affects the absorption of iron and calcium.
The products of protein metabolism (indole, phenol, skatole) formed under the influence of microphora have a regulating effect on the peristaltic activity of the intestine.
Recently, the role of intestinal microflora in the formation of immunological reactivity and immunological tolerance of the body has been intensively studied.
Representatives of normal intestinal microflora produce substances with antibacterial activity (such as bacteriokines and short-chain fatty acids, lactoferrin, lysozyme), which prevent the introduction of pathogenic microorganisms and suppress the excessive proliferation of opportunistic flora. Escherichia coli, enterococci, bifidobacteria and lactobacilli have the most pronounced antagonistic properties against pathogenic strains.
The metabolic products of lactic acid bacteria (bifidobacteria, lactobacilli) and bacteroides are lactic, acetic, succinic, and formic acids. This ensures that the pH of the intestinal contents is maintained at a level of 4.0-3.8, thereby inhibiting the growth and reproduction of pathogenic and putrefactive microorganisms in the gastrointestinal tract.
Initially limited ideas about the “local” protective role of intestinal microorganisms have expanded significantly in recent years. Microbiologists and immunologists emphasize the importance of continuous “communication” between the “host” organism and its symbionts. Through contact with the microbial population through the mucous membrane and the constant penetration of a small amount of bacteria, their antigens and metabolic products into the bloodstream, the necessary tension of the immune system is maintained, including, probably, the “tone” of antitumor defense is maintained.
The microflora of the gastrointestinal tract is actively involved in the chemical transformations of many substances of endogenous and exogenous origin, in particular drugs. During the enterohepatic circulation, substances passing from the intestinal lumen to the liver undergo conjugation with glucuronate, sulfate and other molecular moieties, and many of them are then re-excreted into the bile. In the intestinal lumen, under the influence of enzymes of the intestinal microflora, they undergo deconjugation and other changes, after which they are reabsorbed and returned to the liver through the portal vein.
Mechanisms for maintaining normal “microbial balance” in the lumen of the gastrointestinal tract and inhibiting microbial growth include protective factors of the mucous membrane (bactericidal properties of gastric hydrochloric acid, production of mucus and antibodies, mainly belonging to the classes of immunoglobulins A and M), as well as normal peristaltic intestinal activity, during which some bacteria are regularly removed into the external environment. The integrity of the brush border of enterocytes also acts as an important element of protection, since it acts as a “bacterial filter” that prevents contact of bacteria with the cells of the mucous membrane.
The quantitative and qualitative composition of the intestinal microflora can change under the influence of various factors of endogenous or exogenous origin. However, this change should be considered secondary to the underlying factor.
Bacterial overgrowth in the intestines (in English literature - overbacterial growth) - is caused by a violation of the qualitative and quantitative composition of the intestinal microbial biocenosis, the proliferation of opportunistic bacteria in quantities not typical for a healthy person. We must not forget that bacterial overgrowth in the intestines and associated clinical manifestations are not an independent nosological form, but a syndrome.
It is not entirely correct to use the outdated term “dysbacteriosis”, since this name does not fully reflect the essence of developing disorders.
From a microbiological point of view, excessive bacterial growth is manifested by a significant decrease in the number of anaerobic representatives (especially bifidobacteria), an increase in the total number of functionally defective E. coli (“lactose”-, “mannitol”-, “indole-negative”), the content of hemolytic forms of E. coli, the creation conditions for candida reproduction.
The background for the development of bacterial overgrowth syndrome is various conditions accompanied by impaired digestion of food and passage of intraluminal contents; changes in the immunological reactivity of the body, iatrogenic effects on the intestinal microflora.
In various conditions accompanied by impaired digestion and absorption of food (congenital enzyme deficiency, pancreatitis, celiac enteropathy, enteritis), unabsorbed nutrients serve as a breeding ground for the excessive proliferation of bacteria.
Violation of the passage of intraluminal contents is observed with the formation of interintestinal fistulas, surgical interventions with the formation of “blind loops” of the intestine, the development of diverticula, impaired motor activity of the intestine (constipation or diarrhea), intestinal obstruction (obstructive or paralytic). These conditions also create favorable conditions for disturbing the “bacterial balance.”
In anacid conditions and immunodeficiencies, the body's regulatory influence on maintaining the composition of the intestinal microflora is lost.
The use of antibiotics, corticosteroids, and cytostatics, especially in weakened and elderly patients, is accompanied by interference in the relationship between the microflora and the macroorganism.
Perhaps the only independent nosological form of excessive bacterial growth in the intestine is pseudomembranous colitis , which is caused by excessive reproduction Clostridium difficile- an obligate anaerobic gram-positive spore-forming bacterium that is naturally resistant to most commonly used antibiotics. Population C. difficile as part of the normal intestinal microflora is approximately 0.01-0.001%; it increases significantly (up to 15-40%) when taking antibiotics that inhibit the growth of intestinal flora strains that normally suppress vital activity C. difficile(primarily clindamycin, ampicillin, cephalosporins).
Bacterial overgrowth syndrome is characterized by various clinical manifestations, “layered” on the manifestations of the underlying disease.
Excessive proliferation of bacteria in the small intestine is an additional factor that maintains inflammation of the mucous membrane, reduces the production of enzymes (mostly lactase) and aggravates the disturbance of digestion and absorption. These changes cause the development of symptoms such as colicky pain in the umbilical region, flatulence, diarrhea, and weight loss.
When the colon is predominantly involved in the process, patients complain of loose stools, flatulence, and aching abdominal pain.
Severe imbalances in the composition of the intestinal microflora may be accompanied by signs of hypovitaminosis B12, B1, B2, B3 (PP). The patient has cracks in the corners of the mouth, glossitis, cheilitis, skin lesions (dermatitis, neurodermatitis), iron and B 12 deficiency anemia. Since the intestinal microflora is an important source of vikasol, blood clotting disorders may occur. In some cases, as a result of a violation of the exchange of bile acids, symptoms of hypocalcemia develop (numbness of the lips, fingers, osteoporosis). A number of authors associate cholesterol metabolism disorders with disturbances in the “microbial balance” of the gastrointestinal tract.
Diagnosis of bacterial overgrowth syndrome involves analyzing the picture of the underlying disease, identifying the possible cause of the disturbance in the intestinal microbial biocenosis. An additional examination is carried out, which may include endoscopic and x-ray examination of the intestines to identify disorders of the anatomical structure and assess the motility of the gastrointestinal tract; biopsy of the small intestine - to establish a diagnosis of enteritis, enteropathy, diagnosis of fermentopathy (unfortunately, the possibilities of conducting this study in our country are limited), etc. Little accessible today, but accurate methods for diagnosing excessive bacterial growth are aspiration of the contents of the small intestine with immediate culture aspirate to culture medium, as well as a non-invasive hydrogen breath test with lactulose. Stool culture, previously used in our country as a method for assessing the microbial biocenosis of the intestine, is considered uninformative, since even with the maximum approximation to the rules for conducting microbiological studies, it can only give an idea of the microbial composition of the distal colon.
Before directly starting to treat bacterial overgrowth syndrome, it is necessary to determine the cause of the development of disturbances in microbial biocenosis and, if possible, eliminate the influence of this factor. For example, prescribe the patient anti-inflammatory, enzyme replacement therapy, and use opportunities to normalize intestinal peristaltic activity.
Changing your diet allows you to influence microflora physiologically. However, dietary prescriptions must be given taking into account the underlying disease. In any case, with excessive bacterial growth in the intestines, it is recommended to limit the consumption of easily digestible carbohydrates and eliminate the consumption of milk (especially unleavened milk). In the absence of contraindications, it is advisable to consume vegetables, fruits and berries that have a bactericidal effect (radish, radish, onion, garlic, horseradish, carrots, raspberries, strawberries, strawberries, blueberries, apricots, apples, chokeberries, pomegranate juice, cloves, cinnamon, bay sheet).
The outdated approach of “sanitizing and repopulating the intestines” does not correspond to modern ideas about the pathogenesis of bacterial overgrowth.
However, in severe forms of bacterial overgrowth in the intestines, antibacterial therapy (prescription of metronidazole 400 mg 3 times a day for a week; if metronidazole is ineffective, it is advisable to add tetracycline 250 mg 4 times a day to treatment for 2 weeks). Reserve antibiotics are ciprofloxacin (500 mg 2 times a day) and vancomycin (125 mg 4 times a day). Treatment of pseudomembranous colitis is carried out according to certain schemes and is not discussed in this article due to the isolation of this disease.
In some cases, to suppress opportunistic microorganisms, bacteriophages (staphylococcal and coliproteus) are used, 50 ml 2 times a day an hour before meals for 3-4 days, 2-3 courses are carried out with a 3-day break.
No less important and, often, the main direction of treatment is to recreate conditions favorable for the restoration of normal microflora. Medicines with similar properties are called probiotics .
Some time ago, biological preparations for oral administration containing bifidobacteria, lactobacilli, and E. coli with beneficial properties were especially widely used as probiotics. It must be taken into account that microbes introduced as part of medications do not take root in the intestines for a long time and are eliminated after 2-3 weeks. The basis for the therapeutic effect of such drugs is their ability to temporarily maintain the enzymatic activity and protective properties (colicinogenicity) of the intestinal microflora. Some of the most well-known drugs are described below.
"Colibacterin" contains a suspension of live bacteria of the strain E.coli M-17, which has antagonism towards opportunistic and pathogenic microflora. Prescribe 6-10 doses in 1-2 doses 40 minutes before meals for 3-4 weeks.
"Bifidumbacterin" contains a strain of bifidobacteria that are resistant to antibiotics. Prescribe 5-10 doses per day in 1-2 doses for 2-3 weeks. "Bifidumbacterin" acts most favorably if the patient has constipation.
"Bifikol" - a combination of jointly grown crops E.coli M-17 and bifidumbacteria. 6-10 doses are prescribed per day.
Lactobacterin is made from lactic acid bacteria. The microbes that make up this drug are highly resistant to antibiotics. Lactobacilli effectively inhibit the growth of Proteus and hemolytic strains of staphylococcus and support population growth E.coli. Use 3-6 doses per day. Dairy products containing a culture of lactic acid bacteria similar to those included in Lactobacterin - acidophilic yeast curd and acidophilic milk, as well as the biomass of acidophilic lactobacilli called "Narine" - also have therapeutic and preventive activity.
Currently, the drug Enterol, which contains lyophilized medicinal yeast, is widely used. Saccharomyces boulardii that are naturally resistant to antibiotics. S. boulardii do not colonize the digestive tract and are eliminated in feces within a few days after completion of the course of therapy. They produce proteins that prevent the binding of pathogenic microorganisms and their toxins to the intestinal mucosa; stimulate the protective properties of the mucous membrane.
Favorable conditions for the proliferation of bifidobacteria are created by the disaccharide lactulose, which also has laxative and ammonium-binding properties. It serves as a breeding ground for the proliferation of lactic acid bacteria and a source for their production of lactic acid, which reduces the pH of the intestinal contents. Significant disadvantages of lactulose include the frequent development of bloating and diarrhea with loss of electrolytes (therefore, the administration of lactulose is preferable to patients suffering from constipation). Lactulose is contraindicated in galactosemia. The dose of lactulose syrup for adults varies from 15 to 45 ml per day (in 2-3 doses).
There is another, completely original, approach to normalizing the environment in the intestinal lumen, which helps restore the normal population of its “inhabitants.” This direction of pharmacological correction of excessive bacterial growth is represented by the drug "Hilak-forte" .
The drug "Hilak-Forte" is a sterile concentrate of biologically active substances produced by normal intestinal microflora (both gram-positive and gram-negative). Among them are lactic acid and short-chain volatile fatty acids (which have antibacterial properties against opportunistic and pathogenic flora), lactic-saline buffer, lactose, and amino acids. Just one drop of concentrate contains the biosynthesis products of 100 billion intestinal bacteria.
"Hilak-Forte" allows you to create favorable conditions for the proliferation of lactic acid bacteria (by reducing pH, restoring water and electrolyte balance in the intestinal lumen and suppressing competitive flora). It is interesting that the effect of the drug is not limited to the effect on the bacterial composition; it is noted that Hilak-Forte also stimulates the regeneration of the epithelium of the intestinal mucosa.
"Hilak-Forte" is indicated for a wide variety of conditions accompanied by a violation of the "microbial balance": disorders of maldigestion and malabsorption of various origins, disturbances of intestinal peristaltic activity, during the recovery period after acute infectious enterocolitis, etc. Prescribing "Hilak-Forte" is advisable during treatment with antibiotics and for some time after their discontinuation to prevent disturbances in the composition of the intestinal microflora.
"Hilak-Forte" is characterized by high efficiency and good tolerability. No contraindications to the use of the drug or side effects were identified. it can be prescribed not only to adults, but also to infants.
"Hilak-Forte" is taken orally before or during meals, diluted with a small amount of liquid (not an alkaline reaction!).
The initial dose for adults is 40-60 drops 3 times a day; for children - 20-40 drops 3 times a day; for infants - 15-30 drops 3 times a day. As clinical improvement occurs, the dose may be reduced by half.
"Hilak-Forte" cannot be taken at the same time of day with antacid drugs and adsorbents, since antacids neutralize, and adsorbents reduce the bioavailability of the acids that make up the drug.
When diagnosing a patient with bacterial overgrowth syndrome, it is necessary to understand the main thing in correcting this condition - not to aggressively interfere with microbial bicenosis, but to “lend a helping hand” to the microbes that ensure our health and well-being.
Literature:1. Woodley M., Whelan A., eds. Washington University Therapeutic Handbook. Per. from English - M.: Praktika, 1995.
2. Grebenev A.L., Myagkova L.P. Intestinal diseases. - M.: Medicine, 1994.
3. Denisov I.N., Kulakov V.I., Khaitov R.M., Ch. ed. Clinical recommendations for practicing physicians based on evidence-based medicine. - M.: GEOTAR-MED, 2001.
4. Ivashkin V.T., Komarov F.I., Rapoport S.I., eds. A short guide to gastroenterology. - M.: Publishing house "M-Vesti", 2001.
5. Kotelnikov G.P., Yakovlev O.G., eds. Practical geriatrics: A guide for doctors. - Samara: Samara Printing House, 1995.
6. Fauci A.S., Braunwald E., Isselbacher K.J. et al., ed. Harrison's Principles of Internal Medicine. 14th edition - Copyright (c) 1998 by The McGraw-Hill Companies, Inc., USA.
7. Herfindal E.T., Gourley D.R., ed. Textbook for therapeutics: drug and disease management - 6th ed. - Copyright (c) 1996 Williams & Wilkins, Baltimore, USA.
Small intestinal bacterial overgrowth (SIBO) can cause constipation, diarrhea, hunger, unexplained weight loss and fatigue. In this article we will look at SIBO in the intestines - what it is, the causes of this condition, diagnosis and treatment. Getting rid of bacterial overgrowth can significantly improve your health.
What is SIBO
The small intestine is designed to have much less bacteria in it compared to the large intestine (large intestine). The upper two-thirds of the small intestine typically contains less than 10,000 bacteria/ml.
In healthy people, bacteria in the small intestine provide many benefits:
- protect the intestines from harmful bacteria
- boost the immune system
- keep the intestines healthy
- produce nutrients such as vitamins B9 and K
SIBO is defined as an increase in bacteria or the presence of abnormal bacteria in the small intestine. Currently, 100,000 bacteria per ml is considered the threshold for diagnosis.
In most cases, SIBO is caused by multiple strains that live in the colon. Less commonly, SIBO results from an increase in the number of bacteria already found in the small intestine ().
Bacteria can cause harm by feeding on the nutrients the human body needs to stay healthy and releasing toxins. This leads to malabsorption and malnutrition. Patients with SIBO are often deficient in vitamins A, D, E, B12, B9 (folate), calcium and iron (). Bacteria can also steal protein before it is absorbed, leading to protein deficiency.
SIBO in the intestines - what is it, causes, treatment
Symptoms of SIBO
SIBO in the gut can cause a variety of symptoms, including:
- Constipation
- Bloating and bloating
- Diarrhea
- Malabsorption and malnutrition
- Weight loss
- Fatigue
- B12 deficiency
- Leaky gut syndrome
- Abdominal pain
- Depression
Because these are common, non-specific symptoms, it is difficult to determine whether it is SIBO in the gut or another condition such as irritable bowel syndrome, lactose intolerance, or fructose intolerance.
Scientists are still studying the incidence statistics of SIBO. On average, the figures are 6-8% among the healthy population ().
Does SIBO cause other diseases?
SIBO is linked to a number of other conditions, including irritable bowel syndrome (IBS) and autoimmune diseases. In many cases, the severity of these diseases is also related to the amount of bacteria.
Related articles:
1. May Cause Irritable Bowel Syndrome (IBS)
SIBO is present in 30 - 85% of patients with irritable bowel syndrome (). In 111 patients with IBS, treatment with the antibiotic neomycin improved their symptoms ().
The prevalence of SIBO in patients with celiac disease varies from 50 to 75% ().
2. Inflammatory bowel disease
SIBO is present in 25 - 33% of patients with Crohn's disease ().
Bacterial overgrowth in the small intestine is also associated with ulcerative colitis (UC). One study found bacterial overgrowth in ~18% of patients with UC ().
3. Rosacea
SIBO can also cause illness outside the gut. One study found SIBO in 46% of patients with rosacea. Ten days of antibiotics completely reduced the skin lesions in 20 of the 28 patients and significantly improved the condition in six of the remaining eight. Those who did not receive treatment either saw no improvement or their skin condition worsened ().
4. Fibromyalgia
The study found that all 42 fibromyalgia patients tested positive for SIBO. The severity of overgrowth was related to the degree of pain ().
5. Other diseases
SIBO is also common in people with:
- rheumatoid arthritis
- cirrhosis of the liver
The degree of bacterial overgrowth is also related to the severity of these diseases ( , , , , ).
What Causes SIBO – Causes
We looked at SIBO in the intestines - what it is and how it manifests itself. Next, let's look at the causes of SIBO.
Bacterial overgrowth is usually caused by many factors and conditions. They can be divided into three separate groups:
- Disorders of the intestinal antibacterial mechanism
- Structural anomalies
- Disorders that cause slow digestion
1. Violations of antibacterial mechanisms
A healthy digestive system has ways to prevent bacterial overgrowth. These methods include gastric juice, bile, enzymes and immune system cells. The absence of any of these allows bacteria to multiply exponentially, leading to SIBO ().
Low production of stomach acid and enzymes
Stomach acid destroys bacteria before they reach the small intestine. The lack of acid production allows bacteria to pass through the stomach and into the small intestine, where they can multiply. Enzymes released from the pancreas also help destroy harmful bacteria in the small intestine.
Lack of bile
Bile acids inhibit the growth of bacteria in the small intestine. When bile production in the liver or outflow from the gallbladder decreases, pathogenic bacteria in the small intestine increase
Non-destructive immune system in the intestines
Immunoglobulin A (IgA) is a type of antibody that helps fight harmful bacteria in the intestines. SIBO often occurs in people with a genetic condition that lacks IgA (selective IgA deficiency) (). Bacterial overgrowth is also common in AIDS patients due to a deficient immune system ().
2. Structural damage
Structural deficiencies in the small intestine can lead to SIBO. Certain structural abnormalities trap bacteria and allow them to accumulate.
Inflammation of the small intestine
Diverticula are small pouches in the small intestine that can become inflamed. These sacs can collect bacteria and lead to bacterial overgrowth.
One study found that 59% of patients with diverticulitis had SIBO. Antibiotic treatment reduced SIBO and inflammation ().
Poor connections between the intestines and organs
Intestinal fistulas are unnatural connections between an organ and the intestines. Bacteria can get into these connections.
Ileocecal valve dysfunction
The ileocecal valve separates the end of the small intestine from the beginning of the large intestine. When this valve is damaged or removed, bacteria can pass from the large intestine to the small intestine. Bacterial overgrowth occurs soon after patients have their ileocecal valve removed.
Stomach and intestinal surgeries
Stomach and intestinal surgery, such as gastric bypass, can cause SIBO (). Stomach and intestinal surgeries that bypass parts of the intestine can create areas that collect bacteria, called blind loops. Because SIBO often develops in people with these blind loops, it is often called blind loop syndrome.
3. Disorders that cause slow digestion (intestinal blood flow disorders)
Typically, the muscles lining the stomach and small intestine contract and relax in waves. This process is known as the migrating motor complex (MMC). MMC prevents bacteria from entering the small intestine from the colon.
Peristalsis is the movement of food through the intestines caused by wave-like contractions of the muscles lining the intestines. This happens whether food is present or not. Any disease or disorder that stops MMK or slows down peristalsis will allow bacteria from the colon to enter the small intestine.
Diabetic neuropathy
Diabetic neuropathy is damage to the nerves of the intestines from diabetes. When nerves become damaged due to blood sugar levels being too high, bowel movement slows and bacteria can build up.
Scleroderma
Scleroderma is a chronic connective tissue disease. It partially blocks the intestines, slowing down the movement of food. This also allows bacteria to accumulate.
Studies have shown that SIBO is present in 43 – 56% of patients with scleroderma (,).
4. Other reasons
Excessive alcohol consumption
If you have SIBO, you should minimize your alcohol intake. Excessive alcohol consumption has been linked to SIBO. Even moderate alcohol consumption (1 drink per day for women, 2 drinks per day for men) can lead to bacterial overgrowth (). Alcohol damages the intestines in many ways, including:
- Reduces enzymes
- Damages villi
- Thicken the intestinal walls with connective tissue (fibrosis)
- Slows down bowel movements
- Disturbs the functioning of intestinal immune cells
Some harmful bacteria can even feed on alcohol (). All these factors lead to bacterial overgrowth.
Excessive consumption of refined carbohydrates
Eating refined sugar tends to increase the growth of bacteria, both good and bad (). The body can only absorb small portions of sugar, and the excess is stored as fat and used by bacteria (). People with SIBO also have fewer enzymes needed to break down and absorb sugars, allowing them to be absorbed by bacteria.
General risk factors
The following conditions increase the risk of developing SIBO in the gut:
- Use of proton pump inhibitors (PPIs) and other antacids ()
- Use of painkillers
- Lack of breastfeeding ()
- Use of antibiotics ()
- Celiac disease ()
- Crohn's disease
- Irritable bowel syndrome
- Liver diseases
- Kidney failure
- Inflammation of the pancreas
- Leaky gut syndrome ()
- Immunodeficiency ()
- Diabetes mellitus (type I and type II)
Contraceptive drugs
Birth control use has been associated with IBD and IBS (,). Given the close connection between these conditions and SIBO in the gut, it is likely that birth control pills also trigger SIBO.
Diagnosis of SIBO
We've looked at SIBO in the gut - what it is, its symptoms and causes. Next, let's look at how to determine if you have SIBO.
Two popular tests are used to diagnose SIBO:
- Breath (hydrogen) test for SIBO
- Small bowel aspiration
Breath (hydrogen) test
Problems with small bowel aspiration led to the invention of another type of test called the hydrogen or SIBO breath test. This is the most popular way to diagnose SIBO due to its low risk, simplicity, and non-invasive nature.
The test involves fasting overnight and then eating sugar, which is fermented by bacteria in the small intestine. The gases released by the bacteria are then captured in the person's breath and used to detect overgrowth.
The SIBO breath test has its drawbacks. In approximately 15 - 30% of people with SIBO, the bacteria will produce methane instead of hydrogen ().
Additionally, the hydrogen test has a high false negative rate. This means the test comes back negative when the person actually has SIBO.
Finally, there is no consensus on what is defined as a positive outcome. The only way to be sure of the results is to treat the SIBO and see if the symptoms go away.
Despite these disadvantages, most doctors still prefer to use a breath test for SIBO.
Some practitioners even prefer to use stool or urine tests (organic acids), but scientific support for these tests is lacking.
Hydrogen breath tests may be ordered by a gastroenterologist. They can also be purchased online and completed in the comfort of your home. The results are sent to a laboratory to test for SIBO.
Small bowel aspiration
The gold standard for diagnosis to find out whether it is SIBO in the intestines or not is small intestinal aspiration. This means taking a small sample from the small intestine and counting the number of bacteria per ml.
This is an expensive and invasive procedure that requires inserting a tube into the small intestine. Another concern is the risk of contamination of the tube as it passes through the stomach.
How to Treat SIBO
Antibacterial drugs, diet, and supplements are used to treat SIBO. Most conventional doctors will treat this condition with antibiotics. However, SIBO often returns. We will look at both the traditional approach to treating SIBO, as well as the naturopathic and less risky one.
1. Pharmaceuticals (antibiotics)
The standard treatment for SIBO is antibiotics such as tetracycline, vancomycin, metronidazole, neomycin, and rifaximin. This is counterintuitive since antibiotics themselves can cause SIBO.
However, some antibiotics, such as rifaximin, actually reduce bacterial growth. The effectiveness of rifaximin has been extensively studied. It is poorly absorbed, so it remains in the intestines and does not lead to bacterial resistance ().
This table is a summary of studies of rifaximin and other antibiotics for treating SIBO in the gut.
| Patient categories | Number of patients | Medicine | Duration | Efficiency | Source |
|
Children with IBS |
33 | 600 mg rifaximin | Daily for 1 week | 21 children tested negative for SIBO | |
|
SIBO Patients |
19 | 1200 mg | Daily for 10 days | 8 patients have a normal breath test but no resolution of symptoms | |
|
Patients with IBS and SIBO |
106 | 800 mg (200 mg, 4 times daily) Rifaximin | Every day for 14 days | Improvement in digestive symptoms in all patients and resolution of overgrowth in 55 of 64 patients who were retested. | |
|
SIBO and IBS Patients |
83 | 500 mg neomycin | Daily for 10 days | 35% improvement in symptoms (11% for placebo), 20% of patients tested negative for SIBO | |
| SIBO Patients | 142 | 1200 mg rifaximin or 500 mg metronidazole | 7 days | Eradication rate 63% for rifaximin, 44% for metronidazole | |
| Methane-Positive SIBO Patients | Number of patients receiving: Neomycin = 8 Rifaximin = 39 Both drugs = 27 |
500 mg twice daily, neomycin and/or 400 mg 3 times daily for rifaximin |
10 days | Elimination rate 33% neomycin alone Only 28% rifaximin 87% both drugs |
2. Probiotics
S. thermophilus
Why Patients with SIBO or IBS Respond Poorly to Probiotics
Many patients with SIBO have slow bowel movements. Normally, bowel movements sweep away bacteria and food, preventing them from accumulating in the small intestine. Decreased bowel movements allow bacteria to grow in the small intestine.
Additionally, giving more bacteria to someone who already has too much may make the problem worse.
Many probiotic foods also contain prebiotics, which can be fermented by bacteria in the small intestine. This can make SIBO symptoms worse.
3. Herbal antimicrobials
Herbal antibiotics may be cheaper and have fewer side effects than medications ().
Herbal formulations FC Cidal and Dysbiocide or Candibactin-AR and Candibactin-BR were more effective (46% vs. 34% eradication rate at 4 weeks) than 1200 mg daily rifaximin (). The formulas contained extracts of well-studied antibacterial herbs such as thyme, mugwort, olive leaf, ginger and oregano (, , , - prevents the transfer of bacteria from the colon to the small intestine ().
A combination of nine different herbs called Iberogast has been studied to treat bowel conditions such as IBS. One study found that iberogast improved IBS symptoms compared to placebo (). It is believed to work by improving intestinal motility and killing harmful bacteria.
4. Elemental diets
The elemental diet is a liquid diet that consists of pre-broken down, individual nutritional parts of foods such as:
- amino acids
- Sahara
- vitamins
- minerals
Such diets are prescribed to patients with inflammatory bowel disease because the nutrients do not need to be digested and are easily absorbed.
The elemental diet depletes bacteria because it is low in carbohydrates, which feed the bacteria in the small intestine.
In IBS patients with SIBO, 15 days of an elemental diet resulted in normal breath tests in 80% of patients (). While these results are great, it is important to recognize that there are downsides to the diet. Elemental formulas don't taste good and can be difficult to stay on long enough. Indeed, 25% of subjects refuse to follow such a diet for more than 2–3 weeks ().
If you have tried other treatments without success, it may be worth trying an elemental diet.
5. Low FODMAP, Specific Carbohydrate, and GAPS Diets
The low-FODMAP diet involves eliminating FODMAP foods. They stand for Fermentable Oligosaccharides Disaccharides Monosaccharides And Polyols - that is, fermented oligosaccharides, disaccharides, monosaccharides and polyols. This diet is specifically designed to treat the symptoms of irritable bowel syndrome. The diet limits carbohydrates, which are poorly digestible by humans but are easily eaten by bacteria.
Given the link between SIBO and IBS, it is likely that the effectiveness of the FODMAP diet is due to its ability to limit bacterial feeding.
Another diet, called a specific carbohydrate diet (SCD), limits all carbohydrates except glucose and fructose because they do not need to be broken down to be digested and absorbed. The diet is based on the fact that many people with bowel disorders do not have the enzymes needed to break down carbohydrates and can therefore only tolerate simple sugars.
The effectiveness of the described diets in the treatment of SIBO is questionable. One study found that a low FODMAP diet, but not a specific carbohydrate diet, improved IBS symptoms after three months. A potentially alarming result was that vitamin D levels decreased by 42% and folate levels by 67% in patients on SUD.
Another diet that can be considered as a treatment for SIBO in the gut is the GAPS diet. It resembles a low FODMAP and SUD diet. It limits complex carbohydrates like those found in grains, starchy vegetables and potatoes. The GAPS diet includes lots of fermented foods and bone broth. Bone broth helps heal the gut due to its gelatin content and contains minerals that are often deficient in SIBO patients.
Note: Some people may react negatively to bone broth as it contains certain carbohydrates that can feed bacteria in the small intestine, potentially worsening SIBO. If this is the case, then it is recommended to eat meat broth instead, which contains less of these carbohydrates but still helps to heal the gut with gelatin and minerals.
6. Limit Lectins
Eliminating foods that contain lectins from your diet may help treat SIBO. The diet excludes grains, legumes, nuts, seeds, most potatoes and all dairy products. These foods can feed bacteria in the small intestine and damage the intestinal lining, worsening SIBO symptoms.
Catad_tema Dysbacteriosis - articles
Diagnosis and treatment of small intestinal bacterial overgrowth syndrome
Published in the magazine:"DOCTOR"; No. 12; 2010; pp. 1-3.
V. Avdeev, Candidate of Medical Sciences, Moscow State University. M.V. Lomonosov
The clinical syndrome of bacterial overgrowth in the small intestine, various causes and mechanisms of its development are considered. Algorithms for the diagnosis and treatment of this pathology are presented, with special attention paid to the role of antibiotics.
Keywords: syndrome of bacterial overgrowth in the small intestine, malabsorption, enzyme preparations, antibiotics.
Small Bowel Bacterial Overgrowth Syndrome: Diagnosis And Treatment
V. Avdeyev, Candidate of Medical Sciences M.V. Lomonosov Moscow State University
The paper considers the clinical syndrome of small bowel bacterial overgrowth and various causes and mechanisms of its development. It gives algorithms for the diagnosis and therapy of the above abnormality with particular emphasis on the role of antibiotics.
Key words: small bowel bacterial overgrowth syndrome, malabsorption, enzyme preparations, antibiotics.
Small intestinal bacterial overgrowth syndrome, along with celiac disease and exocrine pancreatic insufficiency, are among the most common causes of malabsorption. The contents of the small intestine of a healthy person contain a small amount of gram-positive aerobic bacteria (no more than 10 5 in 1 ml). When there is an overgrowth of bacteria in the small intestine, the following changes are observed:
Etiology and pathogenesis. The main reasons for the development of bacterial overgrowth syndrome in the small intestine are:
In the area of surgical anastomoses, when bridges, adhesions, or strictures form, the movement of contents through the intestine may be disrupted. Similar conditions occur in a long disconnected segment of the small intestine after ileojejunostomy. Colonic bacteria often colonize small intestinal diverticula and duplications, which also results in their overgrowth. Another cause of bacterial overgrowth is chronic intestinal pseudo-obstruction; this term refers to a set of conditions that simulate attacks of mechanical obstruction in the absence of its source. Intestinal pseudo-obstruction accompanies diseases that cause pathology of the smooth muscles or nervous system of the small intestine: systemic scleroderma, amyloidosis, myotonic dystrophy, Parkinson's, Hirschsprung's, Chagas' diseases, hypothyroidism, diabetes mellitus, hypoparathyroidism, pheochromocytoma, and can also be a consequence of taking medications (phenothiazides, tricyclic antidepressants, ganglion blockers, clonidine). A risk factor for the development of bacterial overgrowth syndrome in the small intestine is old age, which is characterized by a decrease in the secretory function of the stomach, impaired motor-evacuation function of the gastrointestinal tract (GIT), chronic diseases and constant use of medications.
Clinical picture. Manifestations of bacterial overgrowth syndrome in the small intestine vary and are determined by the nature of the damage to the small intestine. Its most important symptoms: weight loss, diarrhea, steatorrhea, formation of oxalate stones in the kidneys, deficiency of vitamins A, D, E, K and B 12. In bacterial overgrowth syndrome, premature conjugation of bile acids occurs in the small intestine. The resulting secondary bile acids cause diarrhea, and their loss occurs, resulting in biliary insufficiency and the possible development of cholelithiasis. A decrease in the amount of conjugated bile acids in the intestinal lumen, which ensure emulsification of fats and activation of pancreatic lipase, leads to steatorrhea, impaired absorption of fat-soluble vitamins. Bacterial overgrowth can directly cause damage to the epithelium of the small intestine, since the metabolites of a number of microorganisms have a cytotoxic effect. Oxalates contained in food normally bind to calcium in the intestinal lumen and are excreted in feces. If a loss of bile acids occurs, a large amount of free fatty acids that bind calcium enters the intestinal lumen. As the concentration of calcium ions in the intestinal lumen decreases, the absorption of free oxalates increases, which leads to the formation of oxalate stones. Bacterial toxins, proteases, and other metabolites bind vitamin B12, which leads to its deficiency and the development of macrocytic B12-deficiency anemia.
Diagnostics. The clinical picture of the disease in combination with advanced age, medical history, results of laboratory and instrumental studies (surgeries on the gastrointestinal tract, the presence of diabetes mellitus, scleroderma, amyloidosis, small intestinal diverticula, achlorhydria, steatorrhea, B 12-deficiency anemia, alcohol abuse (ALD) and etc.) suggest a diagnosis of bacterial overgrowth in the small intestine.
Direct determination of bacterial overgrowth in the small intestine (growing a culture from small intestinal aspiration material) is considered the “gold standard” for diagnosing the syndrome, but is very difficult and is rarely used in clinical practice. Indirect hydrogen breath tests with glucose and lactulose are much simpler and cheaper and, in addition, non-invasive. The specificity and sensitivity of the glucose breath test (78–83 and 62–93%, respectively) are acceptable for both screening and clinical situations.
Differential diagnosis must be carried out with other causes of malabsorption syndrome, primarily celiac disease and exocrine pancreatic insufficiency.
Treatment. Treatment of bacterial overgrowth syndrome in the small intestine involves therapy for the underlying disease, replacement therapy for malabsorption syndrome and antibacterial therapy. First of all, it is necessary to avoid taking drugs that suppress gastric secretion and motor function of the gastrointestinal tract. In many cases, therapy aimed at treating the underlying cause of the disease (eg, diabetic neuropathy, systemic scleroderma, amyloidosis, common small bowel diverticulosis) comes to the fore. Often, surgical correction is impractical or impossible, and prokinetics are prescribed to improve the passage of contents. However, it has been established that conventional motility stimulating drugs are ineffective. Studies have shown that octreotide (a synthetic analogue of somatostatin) in some cases stimulated intestinal motility and suppressed bacterial overgrowth in patients with systemic scleroderma. In atrophic gastritis with a pronounced decrease in the acid-forming function of the stomach, there is no stage of acidification of the duodenum, which leads to a decrease in the synthesis of secretin and cholecystokinin and impaired pancreatic secretion. In this regard, the treatment regimen for atrophic gastritis, in addition to drugs that stimulate gastric secretion, includes enzyme preparations (festal, digestal, panzinorm, etc.).
Festal is a combined enzyme preparation containing the main components of pancreatic juice, hemicellulase and bile components, which allows its use in conditions accompanied by impaired fat solubilization. The presence of hemicellulase in the preparation promotes the formation of gel-like structures, which has a positive effect on gastric emptying, the rate of absorption in the small intestine and the passage time through the gastrointestinal tract. Hemicellulase promotes the uniform distribution of bile acids throughout the gastrointestinal tract, improves the digestion of plant fiber and has a positive effect on the habitat of bacteria in the intestines.
The treatment of small intestinal bacterial overgrowth syndrome is based on the administration of antibacterial drugs. In recent years, many antibiotics have been proposed to eliminate this syndrome. Since bacterial overgrowth can result from the overgrowth of both aerobic and anaerobic flora, the antibiotic must be effective against several types of microorganisms. Satisfactory results were obtained using tetracycline (0.25 g 4 times a day), ampicillin (0.5 g 4 times a day), metronidazole (0.5 g 3 times a day), rifaximin (800-1200 mg/day). In most cases, repeated courses of antibiotic therapy lasting 7-14 days are required.