Bacterial Overgrowth

A bacterial overgrowth of the small intestine can be caused by changes in the intestinal anatomy or in gastrointestinal motility or a lack of gastric acid secretion. A bacterial overgrowth can lead to vitamin deficiencies, to a fat malabsorption and malnutrition. Diagnosis is made by a breath test, or by quantitative culture of aspirates the intestinal fluid. The treatment consists of the administration of oral antibiotics.

The syndrome of bacterial overgrowth is a Malabsorptionsstörung.

A bacterial overgrowth of the small intestine can be caused by changes in the intestinal anatomy or in gastrointestinal motility or a lack of gastric acid secretion. A bacterial overgrowth can lead to vitamin deficiencies, to a fat malabsorption and malnutrition. Diagnosis is made by a breath test, or by quantitative culture of aspirates the intestinal fluid. The treatment consists of the administration of oral antibiotics. The syndrome of bacterial overgrowth is a Malabsorptionsstörung. Normally, the proximal small intestine contains <105 bacteria / ml, v. a. Gram-positive aerobes. This low number of bacteria is maintained by normal peristalsis, the normal gastric acid secretion by mucus secretory IgA and a functional ileocecal valve. Etiology Anatomical changes in the stomach and / or small intestine promoting stasis of intestinal contents, resulting in bacterial overgrowth. Among the conditions that cause such anatomical changes or presuppose include diverticulosis of the small intestine, surgically created blind loops, conditions after gastrectomy (v. A. In the afferent loop of Billroth II engagement), strictures or a partial closure. In addition, disorders of intestinal motility in diabetic neuropathy, in scleroderma, in amyloidosis, hypothyroidism and idiopathic intestinal pseudo-obstruction may reduce the elimination of bacteria. A achlorhydria and idiopathic changes in intestinal motility can lead to bacterial overgrowth in the elderly. Pathophysiology present in excess bacteria consume nutrients incl. Carbohydrates and vitamin B12 and lead to calorie deprivation and vitamin B12 deficiency. Since the bacteria produce folic acid, folic acid deficiency, however, is rare. The bacteria deconjugate bile salts, leading to disruption of the micelle and subsequently to fat malabsorption. A severe bacterial overgrowth also damages the intestinal mucosa. Fat malabsorption and mucosal injury can cause diarrhea. Symptoms and complaints, many patients are asymptomatic and show only weight loss or a lack of nutrients. The most common symptoms are abdominal pain, diarrhea, bloating and excessive flatulence. Some patients suffer from severe diarrhea or steatorrhea. Diagnosis 14C-xylose breath test or quantitative culture of Dünndarmaspiraten Occasionally contrast study of the upper GIT with small bowel barium enema Some clinicians see the success of an empirical antibiotic therapy as a diagnostic test. However, since bacterial overgrowth can mimic other malabsorption syndromes (eg. as Crohn's CrOH) and side effects of antibiotics can worsen the symptoms, one should determine the definitive etiology of the disease. As a standard diagnosis of bacterial overgrowth syndrome quantitative culture of the aspirate from the small intestine fluid showing a bacterial count of> 105 / ml is considered. However, this method requires an endoscopy. Breath tests using substrates such as glucose, lactulose and xylose are non-invasive and easy to perform. The 14C-xylose breath test (diagnosis of the causes of malabsorption) appears to provide better results than the other breath tests. If the anatomical changes are not due to an earlier previous history of operation, a small bowel to diagnose a possible predisposing anatomic lesion should be done. Oral antibiotics therapy (different) diet The treatment of a bacterial overgrowth syndrome is for 10-14 days in the use of oral antibiotics that cover both aerobic and anaerobic intestinal bacteria. Among the measures that have been proven empirically, include the following: tetracycline 250 mg 4 times daily, amoxicillin / clavulanic acid 250-500 mg 3 times daily, cephalexin 250 mg 4 times daily, trimethoprim / sulfamethoxazole 160/800 mg 2 times daily, metronidazole 250-500 mg 3 times or 4 times daily or 400-550 mg Rifaximn 2 times daily. The antibiotic treatment may be cyclic if symptoms recur, and will be changed due to culture and sensitivity. However, a change in antibiotic treatment can be difficult due to the coexistence of several bacteria. Because bacteria in the intestinal lumen mainly metabolize carbohydrates rather than fats, is a diet high in fat and low carbohydrates and fiber beneficial. Underlying disturbances or a deficiency of certain nutrients (such. As vitamin B12) must be corrected. Summary Anatomical changes in the stomach or intestines cause gastrointestinal stasis and thus bacterial overgrowth. Bacteria deconjugate bile salts, leading to fat malabsorption. The diagnosis is made on the 14C-xylose breath test and other breath tests or by quantitative culture of intestinal pirates. The treatment consists of the administration of oral antibiotics, followed by a high-fat and low-carb diet.

Health Life Media Team

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