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Treatment of bacterial overgrowth in small intestine. Small Intestinal Bacterial Overgrowth (SIBO): Diagnosis, Treatment, and Management

by alexxlab

What are the symptoms of Small Intestinal Bacterial Overgrowth. How is SIBO diagnosed. What are the treatment options for SIBO. Can SIBO be prevented. What is the prognosis for patients with SIBO. How does SIBO affect nutrient absorption. What dietary changes can help manage SIBO.

Understanding Small Intestinal Bacterial Overgrowth (SIBO)

Small Intestinal Bacterial Overgrowth (SIBO) is a condition characterized by an abnormal increase in the bacterial population in the small intestine. This overgrowth can lead to various gastrointestinal symptoms and nutritional deficiencies. SIBO occurs when bacteria that normally reside in the large intestine migrate and proliferate in the small intestine, disrupting its normal function.

The small intestine plays a crucial role in nutrient absorption and digestion. When bacterial overgrowth occurs, it can interfere with these processes, leading to malabsorption and various health complications. Understanding the causes, symptoms, and treatment options for SIBO is essential for proper management of this condition.

What causes SIBO?

Several factors can contribute to the development of SIBO:

  • Structural abnormalities of the small intestine
  • Impaired intestinal motility
  • Reduced gastric acid production
  • Immune system dysfunction
  • Certain medications, such as proton pump inhibitors
  • Chronic conditions like celiac disease, Crohn’s disease, and diabetes

These factors can create an environment conducive to bacterial overgrowth, disrupting the delicate balance of the small intestine’s microbiome.

Recognizing the Symptoms of SIBO

SIBO can manifest with a wide range of symptoms, many of which overlap with other gastrointestinal disorders. This overlap can make diagnosis challenging, often leading to misdiagnosis or delayed treatment. Common symptoms of SIBO include:

  • Abdominal bloating and distension
  • Excessive gas and flatulence
  • Abdominal pain or discomfort
  • Diarrhea or constipation
  • Nausea
  • Fatigue
  • Nutritional deficiencies

Is there a connection between SIBO and other gastrointestinal disorders? Research suggests that SIBO may be associated with conditions such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and celiac disease. Some studies have found a higher prevalence of SIBO in patients with these conditions, although the exact relationship is still being investigated.

Diagnostic Approaches for SIBO

Accurate diagnosis of SIBO is crucial for effective treatment. Several diagnostic methods are available, each with its own advantages and limitations:

Breath Testing

Breath testing is a non-invasive method commonly used to diagnose SIBO. It involves ingesting a sugar solution and measuring the levels of hydrogen and methane in the breath over a period of time. Elevated levels of these gases can indicate bacterial overgrowth in the small intestine.

Duodenal Aspirate Culture

Considered the gold standard for SIBO diagnosis, duodenal aspirate culture involves collecting a sample of fluid from the small intestine and culturing it to identify and quantify bacterial growth. While this method is highly accurate, it is invasive and not widely available.

Serum Biomarkers

Certain blood tests can provide indirect evidence of SIBO. Elevated levels of folate or decreased levels of vitamin B12 may suggest bacterial overgrowth, as bacteria can produce folate and compete for vitamin B12 absorption.

Which diagnostic method is most reliable for SIBO? While duodenal aspirate culture is considered the most accurate, breath testing is more commonly used due to its non-invasive nature and accessibility. However, it’s important to note that no single test is perfect, and diagnosis often requires a combination of clinical symptoms, test results, and medical history.

Treatment Strategies for SIBO

The treatment of SIBO typically involves a multi-faceted approach aimed at addressing the underlying cause, eradicating the bacterial overgrowth, and managing symptoms. The main components of SIBO treatment include:

Antibiotic Therapy

Antibiotics are often the first-line treatment for SIBO. Commonly prescribed antibiotics include:

  • Rifaximin
  • Metronidazole
  • Neomycin
  • Ciprofloxacin

The choice of antibiotic depends on the type of bacteria present and individual patient factors. Treatment duration typically ranges from 10 to 14 days.

Dietary Modifications

Dietary changes play a crucial role in managing SIBO. Some effective dietary strategies include:

  1. Low FODMAP diet: Reducing fermentable carbohydrates that can feed bacteria
  2. Elemental diet: Using pre-digested nutrients to reduce bacterial food sources
  3. Specific Carbohydrate Diet (SCD): Limiting complex carbohydrates and sugars

These dietary approaches aim to reduce bacterial fermentation and alleviate symptoms. However, it’s important to work with a healthcare provider or registered dietitian to ensure nutritional needs are met while following these restrictive diets.

Prokinetics

Prokinetic agents can help improve intestinal motility, which may be impaired in SIBO. These medications can help prevent bacterial stasis and recurrence of overgrowth. Examples include:

  • Prucalopride
  • Tegaserod
  • Low-dose erythromycin

Addressing Underlying Conditions

Treating any underlying conditions that may be contributing to SIBO is essential for long-term management. This may involve managing conditions such as diabetes, hypothyroidism, or structural abnormalities of the gastrointestinal tract.

Nutritional Support and SIBO

SIBO can lead to significant nutritional deficiencies due to malabsorption. Addressing these deficiencies is crucial for overall health and recovery. Common nutritional concerns in SIBO include:

  • Vitamin B12 deficiency
  • Iron deficiency anemia
  • Fat-soluble vitamin deficiencies (A, D, E, K)
  • Mineral deficiencies (calcium, magnesium)

How can nutritional deficiencies be addressed in SIBO patients? Supplementation may be necessary to correct these deficiencies. However, it’s important to use forms of supplements that are easily absorbed and do not exacerbate SIBO symptoms. For example, sublingual or intramuscular vitamin B12 may be preferred over oral supplements.

Prevention and Long-Term Management of SIBO

Preventing recurrence is a key aspect of SIBO management. Strategies for prevention and long-term management include:

  1. Maintaining a balanced diet that supports gut health
  2. Regular physical activity to promote intestinal motility
  3. Stress management techniques, as stress can impact gut function
  4. Avoiding unnecessary use of medications that can disrupt gut flora
  5. Regular follow-up with healthcare providers to monitor for recurrence

Can probiotics help prevent SIBO recurrence? The role of probiotics in SIBO prevention is controversial. While some studies suggest probiotics may be beneficial, others indicate they could potentially worsen symptoms. The decision to use probiotics should be made on an individual basis in consultation with a healthcare provider.

Emerging Research and Future Directions in SIBO Management

The field of SIBO research is rapidly evolving, with new insights into diagnosis, treatment, and prevention emerging regularly. Some areas of ongoing research include:

  • Development of more accurate and accessible diagnostic tests
  • Investigation of novel antimicrobial agents for SIBO treatment
  • Exploration of the gut-brain axis and its role in SIBO
  • Study of the long-term effects of SIBO on overall health
  • Identification of genetic factors that may predispose individuals to SIBO

What potential breakthroughs are on the horizon for SIBO management? Researchers are exploring targeted therapies that can selectively reduce harmful bacteria while preserving beneficial gut flora. Additionally, advancements in microbiome analysis may lead to more personalized treatment approaches based on an individual’s unique gut bacterial composition.

Living with SIBO: Patient Perspectives and Quality of Life

SIBO can significantly impact a person’s quality of life, affecting not only physical health but also emotional well-being and social interactions. Patients with SIBO often report:

  • Frustration with chronic symptoms
  • Anxiety about eating and social situations involving food
  • Difficulty maintaining work or social commitments due to symptoms
  • Feelings of isolation or misunderstanding from others

How can patients cope with the challenges of living with SIBO? Support groups, both online and in-person, can provide valuable emotional support and practical advice. Working with a mental health professional can also be beneficial in developing coping strategies and managing the psychological impact of chronic illness.

Educating family members and friends about SIBO can help create a supportive environment. Additionally, developing a strong partnership with healthcare providers and actively participating in treatment decisions can empower patients and improve overall outcomes.

In conclusion, Small Intestinal Bacterial Overgrowth is a complex condition that requires a comprehensive approach to diagnosis, treatment, and management. While it can be challenging to live with SIBO, advances in understanding and treating this condition offer hope for improved outcomes. By working closely with healthcare providers, adopting appropriate lifestyle changes, and staying informed about new developments, individuals with SIBO can effectively manage their symptoms and maintain a good quality of life.

How to Recognize and Treat Small Intestinal Bacterial Overgrowth?

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Bacterial overgrowth syndrome. What is Bacterial Overgrowth Syndrome?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Bacterial overgrowth syndrome (SIBO) is an increase in the number of normal microbial flora or the appearance of pathological microorganisms in the small intestine, accompanied by symptoms of digestive disorders. The disease is manifested by abdominal pain, flatulence, diarrhea. Later, weight loss, hematological and neurological signs of beriberi are added. To diagnose bacterial overgrowth syndrome, a microbiological analysis of feces and intestinal contents, breath tests, ultrasound and other instrumental imaging methods are performed. Treatment includes diet, prescription of probiotics and prebiotics, antibiotics, sorbents.

    ICD-10

    K63.8 Other specified diseases of intestine

    • Causes

      • Risk factors
    • Pathogenesis
    • Symptoms
    • Complications
    • Diagnostics
    • Treatment of bacterial overgrowth syndrome
    • Prognosis and prevention
    • Prices for treatment

    General

    In the domestic literature, SIBO is usually referred to under the names “dysbacteriosis” or “intestinal dysbiosis”. A separate nosological form of the syndrome is pseudomembranous colitis. Bacterial overgrowth is an extremely common phenomenon in the population, which is determined in 20% of healthy people. The condition is recorded equally often in both sexes, develops at any age, including children. Among gastroenterological patients, pathology occurs in 26-88% of cases; in abdominal surgery, the prevalence of the syndrome is up to 95%.

    bacterial overgrowth syndrome

    Causes

    The main cause of bacterial overgrowth syndrome is the colonization of the small intestine with microflora, which is normally located in the large intestine. SIBO is characterized by the appearance of Escherichia coli, Enterococcus, Klebsiella and Proteus. Less commonly, the small intestine is filled with anaerobic bacteria (bacteroids, clostridia), aerobes (staphylococci and streptococci). A number of etiological factors are involved in the formation of the syndrome:

    • Gastrointestinal motility disorder. Prolonged stagnation of the contents of the small intestine creates favorable conditions for excessive bacterial reproduction. Motor dysfunction is observed in gastrostasis, duodenostasis, chronic constipation in diabetic patients. A common cause is irritable bowel syndrome.
    • Disorders of abdominal digestion. Violation of the digestion and absorption of food leads to the accumulation of partially cleaved molecules, which serve as a breeding ground for bacteria. Problems are caused by achlorhydria (atrophic gastritis, disease of the operated stomach), pathology of the biliary tract, chronic pancreatitis.
    • Surgical operations. Often, bacterial overgrowth syndrome results from the formation of a small-colonic anastomosis, in which microorganisms freely pass from the lower intestine into the small intestine. An increased growth of bacteria is observed after vagotomy, cholecystectomy, and the formation of a blind loop.
    • Ileocecal valve insufficiency. The inflammatory process (bauginitis) is accompanied by incomplete closure of the valve, as a result of which a reverse movement of intestinal contents is possible. A similar situation occurs with primary functional insufficiency of the Bauhinian valve, tumors of the ileocecal angle.
    • Taking medicines. Most often, SIBO is caused by systemic antibiotic therapy, as a result of which beneficial intestinal lactobacteria and bifidobacteria die. Pathology occurs when using drugs that depress peristalsis, which include antidepressants, ganglionic blockers, opioid analgesics.

    Risk factors

    Various forms of disaccharidase deficiency, food allergies are considered predisposing factors. The risk of developing the syndrome is increased in patients with Crohn’s disease, ulcerative colitis, diverticulitis. Strict diets and various nutritional supplements for weight loss have a negative impact on the composition of the intestinal microflora.

    The likelihood of the syndrome increases significantly after hydrocolonotherapy, which is due to the intensive leaching of beneficial microflora from the intestines. The connection of excessive bacterial growth with stress and neurosis has been proven.

    Pathogenesis

    The intestine of a healthy person contains more than 500 types of microorganisms, the total weight of which is about 2-2.5 kg. The leading role in the manifestation of excessive bacterial growth belongs to a violation of the level and ratio of bifidobacteria and lactobacilli, a decrease in the mechanisms of local immunological control. At the same time, the small intestine is populated by pathogenic microflora, which is associated with increased secretion of adhesion factors.

    Bacteria begin to secrete endotoxins, which penetrate into the capillary network of the small intestine through the damaged epithelial layer of the mucous membrane. Further, the activation of the inflammatory process occurs, the production of cytokines and the migration of immunocompetent cells increase. As a result, the processes of parietal and abdominal digestion are disturbed in the intestine, the absorption of split products into the bloodstream slows down.

    Symptoms

    Clinical signs of the syndrome are nonspecific, similar to the manifestation of organic and functional pathologies of the gastrointestinal tract. Typical symptoms include moderate diffuse pain in the abdominal cavity, which is combined with rumbling and flatulence. Symptoms are aggravated by eating a large amount of food, drinking alcohol. Characterized by nausea, belching. Occasionally there is vomiting, which does not bring relief to the patient.

    With excessive bacterial growth, stool disorders are always observed. Often there is diarrhea up to 3-5 times a day. During defecation, liquid feces of light brown or yellow color without pathological impurities are released. Isolation of “fatty” feces, which leave hard-to-wash marks on the walls of the toilet, indicates exocrine pancreatic insufficiency. Diarrhea may alternate with periods of constipation caused by dysmotility of the gastrointestinal tract.

    Due to prolonged maldigestion and malabsorption, weight is reduced. At first, weight loss is not very noticeable due to tissue swelling, which is associated with hypoproteinemia. Characterized by constant weakness, decreased mental and physical performance. Vitamin deficiency is manifested by cracks in the corners of the mouth, peeling of the skin and dermatitis. Women complain of irregular menstrual cycles.

    Complications

    A typical consequence of the disease is a decrease in the level of red blood cells and hemoglobin. Given the prevailing deficiency (vitamin B12 or iron), patients have megaloblastic, hypochromic microcytic or normocytic anemia. In connection with the insufficiency of other B vitamins and electrolytes, neurological symptoms appear: paresthesia, convulsions, muscle weakness. The lack of protein is fraught with severe swelling of the legs, ascites.

    Dysbacteriosis exacerbates the course of all gastroenterological diseases. In 2-4% of patients, systemic inflammatory processes develop due to bacterial translocation. There is a high frequency of mesadenitis, acute and chronic pyelonephritis. Quite rarely, SIBO is complicated by sepsis, bacterial peritonitis. The syndrome is associated with severe liver damage: steatohepatitis, intrahepatic cholestasis.

    Diagnostics

    A gastroenterologist may suspect bacterial overgrowth syndrome based on the history and clinical presentation of the disease. There are no pathognomonic signs on physical examination of the patient. To confirm the diagnosis, laboratory diagnostic methods are prescribed. To identify the root cause of the pathology, instrumental studies are informative. Components of a diagnostic search for SIBO:

    • Fecal analysis. Stool culture is essential to rule out typical infections associated with gastrointestinal symptoms. When conducting a coprogram, they look at the level of neutral fats, bile acids and undigested particles in order to assess the work of the pancreas and the hepatobiliary system.
    • Breath tests. Non-invasive rapid methods can detect atypical bacteria that live in the small intestine cavity. The presence of specific metabolites and methane in the exhaled air indicates the presence of pathogenic bacteria capable of degrading carbohydrate-containing substrates. Sometimes the method gives false negative results.
    • Intestinoscopy. In practical gastroenterology, the technique is recognized as the “gold standard” for verification of bacterial overgrowth syndrome. The material obtained from intestinoscopy is used to determine both aerobic and anaerobic bacteria. After sowing the intestinal contents on a nutrient medium, growth rates of microorganisms of more than 105 CFU / ml are obtained.
    • Instrumental methods. Ultrasound of the abdominal cavity is a screening method for diagnosing an organic lesion of the digestive system. To clarify the diagnosis, radiography of the passage of barium through the intestines, irrigography is performed. Sometimes EFGDS, colonoscopy is prescribed.

    Treatment of bacterial overgrowth syndrome

    SIBO therapy begins with the selection of a diet. In the diet, the content of foods rich in live bacterial cultures (kefirs and natural yoghurts, fermented milk mixtures) is increased. Increase the intake of vegetable fiber, pectin, vegetable and animal proteins. Drug treatment for SIBO includes the following drugs:

    • Probiotics. They belong to the first line of medicines and are shown to saturate the intestinal flora with cultures of beneficial microorganisms. With SIBO, combined probiotics are recommended, which contain lactobacilli, bifidobacteria, saccharomycetes. The action of drugs is enhanced by prebiotics.
    • Antibacterial agents. To suppress the pathogenic flora of the small intestine, non-absorbable antibiotics and intestinal antiseptics are effective. The advantage of therapy is the absence of systemic toxic effects and adverse reactions.
    • Enterosorbents. Drugs are used to bind and eliminate intestinal enterotoxins, which aggravate the clinical symptoms of the syndrome. Preparations normalize the consistency of the stool, eliminate diarrhea.
    • Digestive enzymes. With severe malabsorption syndrome, pancreatic enzymes are prescribed, including lipase, amylase and proteases. Enzyme replacement therapy reduces pain in the abdominal cavity and flatulence, improves absorption of food in the initial sections of the small intestine.

    Prognosis and prevention

    With bacterial overgrowth syndrome, the prognosis is favorable. Carrying out complex drug therapy in combination with diet and influence on the etiological factors of the disease allows you to completely eliminate unpleasant symptoms. Preventive measures involve the timely detection and treatment of gastrointestinal diseases, the rational use of antibiotics and other drugs that violate the intestinal microflora.

    You can share your medical history, what helped you in the treatment of bacterial overgrowth syndrome.

    Sources

    1. Small intestinal bacterial overgrowth syndrome: clinical significance, diagnostic criteria and therapeutic tactics / I.V. Maev, Yu.A. Kucheryavy, N.Yu. Ivashkina// Infectious diseases. — 2016.
    2. Bacterial overgrowth syndrome: current issues of diagnosis and management / L.M. Nemtsov // Vestnik VGMU. – 2015.
    3. Diagnosis and treatment of bacterial overgrowth syndrome / E.Yu. Plotnikova, Yu.V. Zakharova // “RMJ”. — 2015.
    4. Bacterial overgrowth syndrome: modern approaches to treatment / T. D. Zvyagintseva, A.I. Chernobay // Family medicine. — 2013.
    5. This article was prepared based on the materials of the site: https://www.krasotaimedicina.ru/

    IMPORTANT
    Information from this section cannot be used for self-diagnosis and self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

    Bacterial overgrowth syndrome (SIBO) treatment consultation at ID-CLINIC expert clinic St. Petersburg

    Bacterial overgrowth syndrome (SIBO) treatment consultation at ID-CLINIC expert clinic St. Petersburg

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    Bacterial overgrowth syndrome (SIBO) is a condition in which there is an increase in the normal microflora and/or pathogenic bacteria in the small intestine. In Russia, the syndrome is often called dysbacteriosis or intestinal dysbiosis. SIBO is one of the most common problems in medicine. It occurs in one in four adults, and among people with gastroenterological symptoms, its frequency is more than 75%.

    How SIBO develops

    Normally, the small intestine contains microorganisms involved in digestion, metabolism, vitamin production, and immune defense. When the balance of beneficial bacteria is disturbed, favorable conditions are created for the growth of pathogenic pathogens. For the syndrome of excessive bacterial growth, the most characteristic is the colonization of the small intestine with microflora, which is normally present in the large intestine – E. coli, enterococci, Klebsiella.

    Predisposing factors

    ● chronic constipation, duodenal congestion and other gastrointestinal motility disorders
    ● abuse of antibiotics and drugs that inhibit the peristalsis of the digestive tract
    ● unbalanced diet, dietary supplements for weight loss and other dietary supplements
    ● the patient has atrophic gastritis, chronic pancreatitis, biliary dyskinesia
    ● stomach and intestinal surgery

    How SIBO manifests itself

    Bacterial overgrowth syndrome resembles other chronic gastrointestinal diseases. Patients complain of stool instability, periodic increase in defecation up to 3-4 times a day. Characterized by moderate pain in the abdomen, rumbling in the intestines, increased gas formation. Occasionally there is nausea and vomiting. With a long course of SIBO, it causes protein-energy insufficiency, beriberi, and microelement deficiency.

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    Why SIBO is dangerous

    All patients with bacterial overgrowth have multiple avitaminosis, which is accompanied by a decrease in immunity, neurological symptoms, constant weakness, disorders of the cellular composition of the blood. Lack of protein in the body causes edema.
    Violation of the intestinal microflora aggravates the course of other gastroenterological diseases. Rare complications include mesadenitis, liver pathology, bacterial peritonitis.

    Doctor’s consultation

    Signs of digestive disorders – a reason to contact a general practitioner who can refer you for additional examination to an infectious disease specialist, hepatologist, gastroenterologist. Given the possible complications, patients are advised to contact specialists as soon as possible, not to ignore the symptoms of the disease and not to try to treat themselves. In our clinic, in addition to face-to-face appointments, you can get an online consultation with a doctor at a convenient time without leaving your home.

    Diagnosis of SIBO

    To make a diagnosis, the doctor will need the results of the following research methods:
    ● Abdominal ultrasound
    ● X-ray of the gastrointestinal tract with contrast
    ● coprogram, stool analysis for dysbacteriosis
    ● clinical and biochemical blood tests
    The “gold standard” for diagnosing bacterial overgrowth is the analysis of the contents of the small intestine, which is obtained with intestinoscopy. In the biomaterial, the number of bacterial colonies and the exact type of bacteria are determined.

    Syndrome treatment principles

    The therapeutic program begins with nutrition correction, increasing the amount of vegetable fiber and fermented milk products, which are rich in beneficial bacterial cultures. Of the drugs prescribed probiotics, digestive enzymes, sorbents. If pathogenic bacteria are detected in the small intestine, antibiotics must be prescribed, with preference given to non-absorbable forms that act strictly in the intestinal lumen.

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