Bacterial overgrowth in the intestines symptoms. Sibr in the intestine - what is it, symptoms, causes, treatment

Small intestine bacterial overgrowth syndrome (SIBO) can cause constipation, diarrhea, hunger, unexplained weight loss, and fatigue. In the article we will consider SIBO in the intestine - what it is, the causes of this condition, diagnosis and treatment. Getting rid of bacterial overgrowth can significantly improve your health.

What is SIBR

The small intestine is designed to have a lot less bacteria than the large intestine (colon). The upper two-thirds of the small intestine typically contains less than 10,000 bacteria / ml.

In healthy people, bacteria in the small intestine have 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 is the result of an increase in bacteria already found in the small intestine ().

Bacteria can wreak havoc by feeding on nutrients the human body needs to maintain health 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, resulting in protein deficiency.

SIBO in the intestine - what is it, causes, treatment

Symptoms of SIBO

SIBO in the intestines 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

Since these are common, nonspecific symptoms, it is difficult to determine whether it is SIBO in the gut or another condition such as irritable bowel syndrome, lactose or fructose intolerance.

Scientists are still studying the statistics of the incidence of SIBO. On average, the figures are 6-8% among the healthy population ().

Does SIBO cause other diseases

SIBO has been 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 number 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 IBS patients, treatment with the antibiotic neomycin improved their symptoms ().

The prevalence of SIBO in celiac patients varies from 50 to 75% ().

2. Inflammatory bowel disease

SIBO is present in 25 - 33% of patients with Crohn's disease ().

A 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 disease outside the intestines. One study found SIBO in 46% of patients with rosacea. Ten days of antibiotic treatment completely reduced skin damage in 20 of 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 patients with fibromyalgia tested positive for SIBO. The severity of overgrowth was associated with 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 have analyzed SIBO in the intestine - what it is and how it manifests itself. Next, consider the causes of SIBO.

Bacterial growth is usually caused by many factors and conditions. They can be broken down into three distinct groups:

  • Disorders of the intestinal antibacterial mechanism
  • Structural abnormalities
  • 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 cells of the immune system. The absence of any of these allows bacteria to multiply exponentially, resulting in SIBO ().

Low production of stomach acid and enzymes

Stomach acid kills bacteria before they reach the small intestine. The lack of acid production allows bacteria to pass through the stomach into the small intestine, where they can multiply. Enzymes secreted 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 gut

Immunoglobulin A (IgA) is a type of antibody that helps fight harmful bacteria in the intestines. SIBO is common in people with a genetic condition who lack IgA (selective IgA deficiency) (). Bacterial growth is also common in AIDS patients due to an insufficient immune system ().

2. Structural violations

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 sacs 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 intestine. Bacteria can enter these compounds.

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 travel from the large intestine to the small intestine. Bacterial overgrowth occurs shortly after patients have their ileocecal valve removed.

Surgery on the stomach and intestines

Surgery to the stomach and intestines, such as gastric bypass surgery, can cause SIBO (). Surgery to the stomach and intestines that bypass parts of the intestine can create areas that collect bacteria, called blind loops. Because SIBO often develops in people with such blind loops, it is often referred to as blind loop syndrome.

3. Disorders causing slow digestion (intestinal blood flow disorders)

Usually, the muscles lining the stomach and small intestine contract and relax in waves. This process is known as the migratory motor complex (MMC). MMK prevents bacteria from entering the small intestine from the colon.

Peristalsis is the movement of food through the intestines caused by the undulating 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 in the intestines from diabetes. When nerves become damaged due to too high blood sugar levels, bowel movement slows down and bacteria can build up.

Scleroderma

Scleroderma is a chronic connective tissue disorder. It partially blocks the intestines, slowing down the movement of food. It also allows bacteria to build up.

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 gut in a variety of ways, including:

  • Reduces enzymes
  • Damages the villi
  • Thicken the walls of the intestine with connective tissue (fibrosis)
  • Slows down bowel movement
  • Disrupts the work of intestinal immune cells

Some harmful bacteria can even feed on alcohol (). All of these factors lead to bacterial overgrowth.

Excessive intake of refined carbohydrates

Eating refined sugar tends to increase the growth of bacteria, both good and bad (). The body can only absorb small amounts of sugar, and the excess is stored in 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.

Common risk factors

The following conditions increase the risk of developing SIBO in the intestines:

  • Use of proton pump inhibitors (PPIs) and other antacids ()
  • Pain relievers
  • Lack of breastfeeding ()
  • Antibiotic use ()
  • Celiac disease ()
  • Crohn's disease
  • Irritable bowel syndrome
  • Liver disease
  • Renal failure
  • Inflammation of the pancreas
  • Leaky gut syndrome ()
  • Immunodeficiency ()
  • Diabetes mellitus (type I and type II)

Contraceptive drugs

Contraceptive use has been associated with IBD and IBS (,). Given the close relationship between these conditions and SIBO in the gut, it is likely that birth control pills also trigger SIBO.

SIBO diagnostics

We studied SIBO in the intestines - what it is, what are its symptoms and causes. Next, let's look at how to determine if you have SIBR.

Two popular tests are used to diagnose SIBO:

  • Breathing (hydrogen) test for SIBO
  • Small intestine aspiration

Breathing (hydrogen) test

Problems with aspiration of the small intestine led to the invention of another type of test called the hydrogen or SIBO breath test. It 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 consuming sugar, which is fermented by bacteria in the small intestine. The gases released by the bacteria are then trapped in the person's breath and used to detect overgrowth.

The SIBO breath test has its drawbacks. In about 15 to 30% of people with SIBO, the bacteria will produce methane instead of hydrogen ().

In addition, the hydrogen test has a high false negative rate. This means that the test is negative when the person actually has SIBO.

Finally, there is no consensus on what constitutes a positive outcome. The only way to be sure of results is to treat SIBO and see if the symptoms go away.

Despite these drawbacks, most doctors still choose to use the SIBO breath test.

Some practitioners even prefer to use stool or urine (organic acids) analysis, but there is no scientific support for these tests.

Hydrogen breath tests may be ordered by a gastroenterologist. They can also be purchased online and performed in the comfort of your own home. The results are sent to a laboratory to be checked for SIBO.

Small intestine aspiration

The gold standard of diagnosis to find out if it is SIBO in the intestine or not is aspiration of the small intestine. 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 a tube to be inserted into the small intestine. Another concern is the risk of contamination of the tube as it passes through the stomach.

How to treat SIBO

For the treatment of SIBO, antibacterial drugs, diet and supplementation are used. Most conventional doctors will treat this condition with antibiotics. However, SIBR often returns. We will look at both the traditional approach to treating SIBO and the naturopathic and less risky one.

1. Pharmaceuticals (antibiotics)

The standard therapy for SIBO is antibiotics such as tetracycline, vancomycin, metronidazole, neomycin, and rifaximin. This is counterintuitive, as 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, therefore it remains in the intestine and does not lead to bacterial resistance ().

This table is a summary of studies on rifaximin and other antibiotics for treating SIBO in the gut.

Patient categories Number of patients Medicine Duration Efficiency A 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 a day) Rifaximin Daily for 14 days Improvement of digestive symptoms in all patients and elimination 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 2 times a day, neomycin and / or

400 mg 3 times daily for rifaximin

 10 days Elimination rate

33% neomycin alone

Only 28% of rifaximin

87% both drugs

2. Probiotics

S. thermophilus

50 liver disease patients with SIBO 5 billion CFU capsules per day for 4 weeks Eliminated in 6 out of 25 probiotic patients compared to 0/25 in the control group. Digestive symptoms improved with probiotics alone. 59

Why patients with SIBO or IBS respond poorly to probiotics

Many patients with SIBO have slow bowel movements. Usually, a bowel movement sweeps away bacteria and food, preventing them from accumulating in the small intestine. Decreased bowel movement allows bacteria to grow in the small intestine.

Plus, giving more bacteria to someone who already has too much can make the problem worse.

Many probiotic foods also contain prebiotics, which can be fermented by bacteria in the small intestine. This can worsen the symptoms of SIBO.

3. Herbal antimicrobials

Herbal antibiotics can 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% versus 34% eradication rate after 4 weeks) than 1200 mg daily rifaximin (). The formulas contained extracts of well-studied antibacterial herbs such as thyme, wormwood, olive leaf, ginger and oregano (,,, - prevents bacteria from transferring from the colon to the small intestine ().

A combination of nine different herbs called Iberogast has been studied to treat bowel conditions like 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

An elemental diet is a liquid diet that consists of pre-split, separate, nutritious portions of foods such as:

  • amino acids
  • Sahara
  • vitamins
  • minerals

Such diets are prescribed for patients with inflammatory bowel disease because the nutrients do not have to be digested and are easily absorbed.

An elemental diet depletes bacteria because it is low in carbohydrates that bacteria in the small intestine feed on.

In IBS patients with SIBO, 15 days of elemental diet resulted in normal breathing tests in 80% of patients (). While these results are great, it is important to recognize that there are imperfections in the diet. Elementary formulas do not taste good and can be tricky to last long enough. Indeed, 25% of subjects refuse to follow such a diet for more than 2-3 weeks ().

If you've tried other treatments without success, it may be worth trying the elemental diet.

5. Low FODMAP, Specific Carbohydrate Diet and GAPS Diet

A diet called low-FODMAP is about eliminating FODMAP foods from your diet. They stand for Fermentable Oligosaccharides Disaccharides Monosaccharides And Polyols - that is, fermented oligosaccharides, disaccharides, monosaccharides and polyols. This diet is specially formulated to treat the symptoms of irritable bowel syndrome. The diet restricts carbohydrates, which are poorly absorbed by humans but easily eaten by bacteria.

Given the link between SIBO and IBS, it is likely that the FODMAP diet's effectiveness is due to its ability to limit bacterial nutrition.

Another diet, called the Specific Carbohydrate Diet (SPD), restricts 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 therefore can only tolerate simple sugars.

The effectiveness of the described diets in the treatment of SIBO is questionable. One study found that a diet with a low FODMAP, but not a specific carbohydrate diet, improved IBS symptoms after three months. A potentially alarming result was that vitamin D levels decreased by 42% in OVD patients and 67% in folate levels.

Another diet that can be considered as a treatment for SIBO in the gut is the GAPS diet. It resembles a low FODMAP and VUD diet. It restricts complex carbohydrates like those found in grains, starchy vegetables, and potatoes. The GAPS diet includes many 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 degrading SIBO. If so, it is recommended to eat broth instead, which is lower in these carbohydrates but still helps heal the gut with gelatin and minerals.

6. Limiting lectins

Avoiding foods that contain lectins can help treat SIBO. The diet excludes grains, legumes, nuts, seeds, most potatoes, and all dairy products. These foods can harbor bacteria in the small intestine and damage the intestinal lining, making SIBO symptoms worse.

Small intestinal bacterial overgrowth (SIBO) occurs when bacteria normally found in the large intestine enter the small intestine.

The small intestine is the longest section of the gastrointestinal tract. It mixes food with digestive juices, releasing nutrients into the bloodstream.

With the development of SIBO, the absorption of nutrient compounds is sharply deteriorated. Fat-soluble vitamins and iron are especially poorly absorbed.

The microflora of the large intestine is essential for the normal functioning of the body. It not only helps the assimilation of food, but also.

However, bacteria invading the small intestine can cause symptoms similar to those of irritable bowel syndrome (IBS).

Signs of the presence of a syndrome of increased bacterial growth in the small intestine are often similar to the symptoms of other gastrointestinal diseases, primarily IBS [,].

Common symptoms of bacteria invading the small intestine include:

  • nausea and vomiting;
  • diarrhea;
  • poor absorption of nutrients and, as a result, weight loss;
  • joint pain;
  • chronic fatigue;
  • rash, acne and eczema;
  • asthmatic phenomena;
  • depression;

Causes of occurrence

The exact reasons for the development of bacterial overgrowth in the small intestine have not been established. However, it is known that most often SIBO occurs against the background:

  • chronic pancreatitis;
  • diabetes;
  • diverticulosis;
  • congenital structural defects in the small intestine;
  • trauma, fistula, abdominal surgery;
  • intestinal lymphoma;
  • scleroderma [,].

The use of certain drugs, including immunosuppressants and inhibitors of H + -K + -ATPase, is important.

Very often the disease occurs in those people who suffer from celiac disease (true gluten intolerance).

Natural aging of the body can also trigger the onset of the disease.

Diagnostics

Making a diagnosis is a challenging task. If only simply because the disease was described not so long ago, and many doctors, especially in ordinary district polyclinics, simply do not know about its existence.

In addition, this pathology is not so easy to distinguish from celiac disease, exocrine pancreatic insufficiency, irritable bowel syndrome.

The reason for suspicion of the presence of a syndrome of enhanced bacterial growth should be the clinical picture of the disease, which manifests itself against the background of other pathologies listed above. The age of the patient is also important: the larger it is, the higher the likelihood of developing the syndrome.

An unambiguous diagnosis can be made after examining aspiration samples obtained from the small intestine. However, research is costly and traumatic for the patient. Therefore, it is rarely used.

Indirect hydrogen breath tests with glucose and lactulose are commonly used. The sensitivity of these methods can be as high as 93%. However, unlike direct research, they are cheap and minimally invasive.

Should SIBO be treated?

Some people mistakenly believe that since bacteria must live in the large intestine, then there is nothing wrong with them staying in the small intestine. Therefore, SIBO can be safely left without treatment. Unfortunately, this is not so.

The syndrome of bacterial overgrowth threatens severe health consequences, which are primarily associated with the fact that microorganisms in the small intestine do not allow the normal absorption of nutrient compounds.

Usually, the absorption of substances such as calcium, iron, zinc, vitamins A, E, K, D worsens.

But the most dangerous is the disadvantage.

Symptoms of B12 deficiency sometimes develop gradually and sometimes occur almost overnight. They include:

  • numbness or tingling in the extremities;
  • anemia;
  • jaundice;
  • decreased cognitive abilities and memory loss;
  • constant fatigue and weakness.

In severe cases, paranoia and hallucinations.

Therefore, if you have SIBO or vitamin B12 deficiency, you must treat this ailment immediately. Otherwise, irreversible changes may occur.

How is SIBO treated?

The first thing to do if excess bacterial growth is detected is to identify the pathology that led to SIBO. And if such a pathology exists, and this is not just a natural aging of the body, then first of all it is necessary to treat the underlying disease, and then - the increased growth of bacteria.

Medications

The main drug treatment is broad-spectrum antibiotics.

In addition, it is mandatory to take vitamins and minerals, the absorption of which is hampered by the excessive growth of bacteria. These are vitamins A, E, K, D and B12, trace elements - iron and zinc.

The use of preparations with digestive enzymes is shown.

Of the antibiotics, Rifaximin and Metronidazole are most often prescribed.

However, antibiotic treatment itself, if it gives results, is not very good.

First, together with the pathogenic microflora in the small intestine, antibiotics also kill beneficial microorganisms in the large intestine.

Second, after stopping the drug, relapse is very common. The symptoms of the disease, especially those that relate directly to the gastrointestinal tract, become more pronounced.

Therefore, the correct treatment for SIBO should include not only antibiotic therapy, but also other measures [,,].

Drug-free therapy scheme

  1. Reducing the size of consumed portions. You need to eat not three times a day, but at least 5-6 times, but little by little. This allows food to be digested faster, which is extremely important with SIBO. A large amount of food in the stomach makes it difficult to produce gastric juice and reduces its acidity. This can worsen the symptoms of SIBO, as stomach acid is designed to kill bacteria in the upper GI tract.
  2. Since digestion begins in the mouth and not in the stomach, food must be chewed very thoroughly. This makes it possible to accelerate its further absorption, which is extremely important with SIBO.
  3. You should start taking probiotics and include foods that are rich in them in your menu. In a recent clinical study, it was demonstrated that the use of probiotic preparations containing Lactobacilluscasei, Lactobacillusplantarum, Streptococcusfaecalis and Bifidobacterium brevis, more effectively eliminates the symptoms of bacterial overgrowth than the use of Metronidazole.
  4. Switching to a special diet.

Diet for the treatment of SIBO

If you want to get rid of SIBO without the use of antibiotics or with their minimal involvement, you must definitely switch to a special diet consisting of two phases - Elimination and Maintenance.

Phase One - Elimination

The first phase of the diet implies a complete rejection of FODMAP products, that is, those food that cannot be independently assimilated by the human body and requires the participation of bacteria for its fermentation.

In the first phase, the following are prohibited:

  • fructose - most fruits and juices from them, honey, cereals (first of all, instant food), baked goods, all products, the content of a lot of sugars (especially industrial production);
  • lactose - unfermented dairy products;
  • fructans - wheat, onions and garlic, leeks, broccoli and cabbage, asparagus;
  • galactans - legumes (including any soy products), Brussels sprouts and cabbage;
  • polyopes - products with artificial sweeteners - erythritol, xylitol, sorbitol, etc.

Products allowed in the first phase:

  • a fish;
  • bird;
  • meat - beef and lamb;
  • eggs;
  • hard cheeses;
  • walnuts;
  • greens, including spinach;
  • zucchini, zucchini and pumpkins;
  • cucumbers and tomatoes;
  • carrot;
  • potato;
  • bananas;
  • strawberries, blueberries, grapes;
  • melons;
  • pineapples.

The duration of the first phase is two weeks. If you broke off and ate foods from the prohibited list, you will have to re-count the days.

Phase 1 goals:

  • healing of the intestinal wall damaged by microorganisms;
  • reducing inflammation;
  • elimination of excessive bacterial growth;
  • saturation of the body with all those nutrient compounds that it lacks due to the deterioration in the absorption of food in the small intestine.

Phase Two - Maintenance

The goals of the second phase of the diet are:

  • final healing of the intestinal wall;
  • restoration of microflora balance;
  • preventing the entry of toxins from the gastrointestinal tract into the bloodstream.

Pleasant side effects include:

  • elimination of food allergies;
  • strengthening of immunity;
  • reduction of chronic anxiety and depression.

The second phase is less severe than Elimination, however, there is a ban on some products for it.

Prohibited:

  • cereals;
  • all sweet foods, especially industrially produced;
  • foods high in starch;
  • unfermented dairy products.

Basic rules for the Maintain phase include:

  • Eating a small cup of bone broth with every or nearly every meal
  • cooking only with coconut or ghee;
  • eating fruit exclusively between meals;
  • the inclusion in the diet of a large number of fermented foods (so sauerkraut should be eaten at least a little with all meals);
  • independent preparation of fermented milk products, and not the purchase of ready-made ones;
  • the use of vegetables mainly boiled in a boiled form.

How long is the second phase?

It is advisable to eat like this always.

However, what has been said does not mean that one should never give oneself relief. Can. On holidays. But then it is still better to return to the described dietary food.

When you start treating SIBO, remember that your body needs time to overcome the problems caused by the overgrowth of bacteria in the intestines. So don't expect instant results.

However, you will find that after two weeks of abstaining from FODMAPS foods and then switching to a gentle Maintenance diet, your gut begins to heal and you feel better and better.

SIMILAR MATERIALS

Similar materials

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

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

Bacterial Overgrowth Syndrome: Symptoms and Treatment

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

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

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


What is SIBR?

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

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

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

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

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

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

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

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

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

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

SIBO and small intestine

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

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

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

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

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

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

What causes SIBR?

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

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

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

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

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

Should you be afraid?

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

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

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

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

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

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

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

Are there other health problems?

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

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

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

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

Do not underestimate this condition as people rarely seek medical attention for these symptoms.

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

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

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

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

Signs of the presence of SIBR

The main symptoms include:

    Chronic gas contamination;

    Bloating (especially a few hours after eating);

    Signs of a vitamin or mineral deficiency;

    Constipation or diarrhea;

  • Frequent abdominal pain

    Fatigue;

    Seizures;

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

    Leaky gut;

  • Chronic diseases (diabetes, autoimmune diseases);

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

    Depression;

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

Major risk factors

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

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

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

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

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

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

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

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

How is SIBO diagnosed?

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

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

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

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

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

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

How to deal with SIBO?

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

1) stick to a diet

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

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

Foods to avoid:

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

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

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

    Galactans - legumes, cabbage, Brussels sprouts, soybeans.

    Polyols (carbohydrates with very large molecules) - sorbitol, isomalt, lactitol, maltitol. They are found in chewing gum, hard candy, and some medications.

    Foods you can eat:

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

  • Fresh fruits;

    Tuna and salmon;

    Beef and lamb;

  • Raw hard cheeses;

    Almond or coconut milk;

    Fresh berries (blueberries, strawberries, currants);

    Nut oils.

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

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

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

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

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

2) dietary supplements

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

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

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

3) Antibiotics

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

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

4) Probiotics

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

5) Herbal remedies

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

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

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

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

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


For citation: Shulpekova Yu.O. Excessive bacterial growth in the intestine: pathogenetic features and therapeutic approaches // RMZh. 2003. No. 5. P. 281

MMA named after I.M. Sechenov

V the human gastrointestinal tract is inhabited by many bacteria, which, in fact, are symbionts of their "host". Paradoxical as it may sound, the organism of the “host” just as needs microbial inhabitants as they do in 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 facultatively anaerobic bacteria have been isolated 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 parts 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 content) and includes mainly gram-positive facultative aerobes, a small amount of anaerobes, yeasts and fungi.

As one approaches the ileocecal valve, the composition of the microlore begins to resemble the colon population more and more. In the distal ileum, the microbial content is 10 5 -10 8 / g of intestinal contents.

The largest content of microorganisms is observed in the large intestine. Here their concentration reaches 10 10 -10 11 and more per 1 g of content.

The large intestine is home to the bulk of anaerobic microorganisms. The "main population" (about 70%) are anaerobes - bifidobacteria and bacteroids. Lactobacilli, Escherichia coli, enterococci act as a "concomitant population".

The bacteria that inhabit the lumen of the gastrointestinal tract perform a number of functions that are very important for the "host" organism.

The microbial population plays an important role in intraluminal digestion, in particular, it participates in the digestion of dietary fiber (cellulose), enzymatic breakdown of proteins, high molecular weight carbohydrates, fats, and in the process of metabolism produces a number of substances useful for the body.

The main representative of the anaerobic intestinal microflora is bifidobacteria - synthesize amino acids, proteins, vitamins B 1, B 2, B 6, B 12, vikasol, nicotinic and folic acids. It has been hypothesized 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 microphores have a regulating effect on intestinal peristaltic activity.

Recently, the role of intestinal microflora in the formation of immunological reactivity and immunological tolerance of the organism has been intensively studied.

Representatives of the 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 reproduction 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 bacteroids are lactic, acetic, succinic, formic acids. This ensures the maintenance of the pH of the intestinal contents 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 understanding of the "local" protective role of intestinal microorganisms has expanded significantly in recent years. Microbiologists and immunologists emphasize the importance of continuous "communication" of the "host" organism with its symbionts. Through contact with the microbial population through the mucous membrane and the constant penetration of a small number of bacteria, their antigens and metabolic products into the bloodstream, the necessary immunity is maintained, including, probably, the "tone" of the 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. In the process of intestinal-hepatic circulation, substances coming from the intestinal lumen to the liver are conjugated with glucuronate, sulfate and other molecular residues, and many of them are then re-excreted in 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.

The 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 part of the bacteria is regularly removed to the external environment. The integrity of the brush border of enterocytes also acts as an important link of protection, since it plays the role of a "bacterial filter" that prevents bacteria from contacting 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 seen as secondary to the underlying cause.

Gut bacterial overgrowth (in English literature - bacterial overgrowth) - due to a violation of the qualitative and quantitative composition of the microbial biocenosis of the intestine, the reproduction of conditionally pathogenic bacteria in an amount that is not characteristic of a healthy person. We must not forget that bacterial overgrowth in the intestine and associated clinical manifestations is not an independent nosological form, but a syndrome.

The outdated term "dysbiosis" is not entirely correct to use, since this name does not fully reflect the essence of developing disorders.

From the point of view of microbiology, bacterial overgrowth 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 of conditions for the breeding of candida.

The background for the development of the syndrome of bacterial overgrowth is various conditions accompanied by impaired digestion of food, passage of intraluminal contents; changes in the body's immunological reactivity, iatrogenic effects on the intestinal microflora.

In various conditions, accompanied by impaired digestion and absorption of food (congenital enzyme deficiency, pancreatitis, celiac disease, enteritis), unabsorbed nutrients serve as a breeding ground for excessive bacterial reproduction.

Violation of the passage of the intraluminal contents is observed during 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 the violation of 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, cytostatics, especially in weakened and elderly patients, is accompanied by interference in the relationship of microflora and macroorganism.

Perhaps, the only independent nosological form of bacterial overgrowth in the intestine is pseudomembranous colitis which is due to excess reproduction Clostridium difficile- an obligate-anaerobic gram-positive spore-forming bacterium with natural resistance to most widely used antibiotics. Population C.difficile in the composition 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 strains of intestinal flora, which normally suppress vital activity C.difficile(first of all, clindamycin, ampicillin, cephalosporins).

The syndrome of bacterial overgrowth is characterized by various clinical manifestations, "layering" on the manifestations of the underlying disease.

Excessive multiplication of bacteria in the small intestine is an additional factor supporting inflammation of the mucous membrane, reducing the production of enzymes (to the greatest extent - lactase) and aggravating the impairment of digestion and absorption. These changes cause the development of symptoms such as colicky pain in the umbilical region, flatulence, diarrhea, weight loss.

With the predominant involvement of the colon in the process, patients complain of loose stools, flatulence, aching abdominal pains.

Expressed imbalances in the composition of the intestinal microflora may be accompanied by signs of hypovitaminosis B 12, B 1, B 2, B 3 (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 vicasol, blood clotting disorders can be observed. In some cases, as a result of impaired metabolism of bile acids, symptoms of hypocalcemia develop (numbness of the lips, fingers, osteoporosis). A number of authors associate disturbances in cholesterol metabolism with disturbances in the "microbial balance" of the gastrointestinal tract.

Diagnosis of bacterial overgrowth syndrome involves the analysis of the picture of the underlying disease, with the identification of the possible cause of the violation of the microbial biocenosis of the intestine. An additional examination is carried out, which may include endoscopic, X-ray examination of the intestine to identify violations of the anatomical structure, assess the motility of the gastrointestinal tract; biopsy of the small intestine - to establish the diagnosis of enteritis, enteropathy, diagnose fermentopathies (unfortunately, the possibilities of conducting this study in our country are limited), etc. Aspiration of the contents of the small intestine with immediate inoculation is currently little available, but accurate methods for diagnosing bacterial overgrowth aspirate on culture medium, as well as a non-invasive breath hydrogen test with lactulose. Sowing feces, which was previously used in our country as a method for assessing the microbial biocenosis of the intestine, is recognized as uninformative, since even with the maximum approach to the rules for conducting microbiological studies, it can only give an idea of ​​the microbial composition of the distal colon.

Before proceeding directly to the treatment of bacterial overgrowth syndrome, it is necessary to determine the cause of the development of microbial biocenosis disorders and, if possible, eliminate the influence of this factor. For example, to prescribe the patient anti-inflammatory, enzyme replacement therapy, to use the possibilities to normalize the peristaltic activity of the intestine.

Changing eating habits allows you to influence the microflora in a physiological way. However, dietary prescriptions must be given with regard to the underlying medical condition. In any case, with excessive bacterial growth in the intestine, it is shown to limit the consumption of easily digestible carbohydrates and the exclusion of the consumption of milk (especially fresh 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, chokeberry, pomegranate juice, cloves, cinnamon, laurel sheet).

The outdated approach to "sanitize - and repopulate the intestines" does not correspond to modern ideas about the pathogenesis of bacterial overgrowth.

However, in severe forms of bacterial overgrowth in the intestine, antibiotic therapy (prescribing metronidazole 400 mg 3 times a day for a week; if metronidazole is ineffective, it is advisable to add tetracycline 250 mg to the treatment 4 times a day for 2 weeks). Reserve antibiotics - 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 considered in this article due to the isolation of this disease.

In some cases, bacteriophages (staphylococcal and coliform) are used to suppress opportunistic microorganisms, 50 ml 2 times a day one hour before meals for 3-4 days, 2-3 courses are carried out with a 3-day break.

An equally important and, often, the main direction of treatment is the recreation of 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 Escherichia coli with beneficial properties, were especially widely used as probiotics. It should be borne in mind that the microbes introduced in the composition of medicinal preparations do not take root in the intestines for a long time and are eliminated after 2-3 weeks. The basis of the therapeutic action of such drugs is their ability to temporarily maintain the enzymatic activity and protective properties (colicinogenicity) of the intestinal microflora. Some of the more well-known drugs are summarized below.

"Colibacterin" contains a suspension of live bacteria of the strain E.coli M-17, which is antagonistic to opportunistic and pathogenic microflora. Assign 6-10 doses in 1-2 doses 40 minutes before meals for 3-4 weeks.

"Bifidumbacterin" contains a strain of bifidobacteria resistant to antibiotics. Assign 5-10 doses per day in 1-2 doses for 2-3 weeks. "Bifidumbacterin" acts most favorably when 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 prepared from lactic acid bacteria. The microbes that make up this drug are highly resistant to antibiotics. Lactobacilli effectively inhibit the growth of Proteus, hemolytic strains of staphylococcus and support the growth of the population E.coli... Apply 3-6 doses per day. Dairy products containing a culture of lactic acid bacteria similar to that included in Lactobacterin - acidophilic yeast cottage cheese and acidophilic milk, as well as the biomass of acidophilic lactobacilli called “Narine” also have therapeutic and prophylactic activity.

Currently, the drug "Enterol" is widely used, which contains lyophilized medicinal yeast Saccharomyces boulardii which are naturally resistant to antibiotics. S. boulardii do not colonize the digestive tract and are eliminated in the feces for several days after the 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 reproduction of bifidobacteria are created by the disaccharide lactulose, which also has laxative and ammonium-binding properties. It serves as a breeding ground for the growth of lactic acid bacteria and the source of their production of lactic acid, which lowers the pH of intestinal contents. The significant disadvantages of lactulose include the often developing bloating and diarrhea with loss of electrolytes (therefore, the appointment 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 contributes to the restoration of the normal population of its "inhabitants". This direction of pharmacological correction of bacterial overgrowth is represented by the drug "Hilak-forte" .

The drug "Hilak-forte" is a sterile concentrate of biologically active substances produced by the normal intestinal microflora (both gram-positive and gram-negative). Among them - lactic acid and short-chain volatile fatty acids (possessing antibacterial properties against opportunistic and pathogenic flora), lactic acid buffer, lactose, amino acids. Just one drop of the concentrate contains the biosynthetic products of 100 billion intestinal bacteria.

"Hilak-forte" allows you to create favorable conditions for the reproduction of lactic acid bacteria (by lowering the pH, restoring the water-electrolyte balance in the intestinal lumen and suppressing the competitive flora). Interestingly, 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": maldigestion and malabsorption disorders of various origins, impaired intestinal peristaltic activity, during the recovery period after acute infectious enetrocoliths, etc. Appointment of "Hilak-forte" is advisable during antibiotic treatment and some time after their cancellation for the prevention of disorders in the composition of the intestinal microflora.

"Hilak-forte" is characterized by high efficiency and good tolerance. There were no contraindications to the appointment of the drug and no side effects. it can be prescribed not only for adults, but also for 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 progresses, the dose may be halved.

"Hilak-forte" should not be taken at the same time of day with antacids and adsorbents, since antacids neutralize, and adsorbents - reduce the bioavailability of the acids that make up the drug.

When diagnosing the syndrome of bacterial overgrowth in a patient, it is necessary to understand the main thing in correcting this condition - not to aggressively interfere with the microbial bicenosis, but to "lend a helping hand" to the microbes that ensure our health and well-being.

Literature:

1. Woodley M., Whelan A., ed. Therapeutic Directory of the University of Washington. Per. from English - M .: Practice, 1995.

2. Grebenev A.L., Myagkova L.P. Bowel diseases. - M .: Medicine, 1994

3. Denisov IN, Kulakov VI, Khaitov RM, Ch. ed. Clinical practice guidelines for practitioners based on evidence-based medicine. - M .: GEOTAR-MED, 2001.

4. Ivashkin VT, Komarov FI, Rapoport SI, ed. A quick guide to gastroenterology. - M .: Publishing house "M-Vesti", 2001

5. Kotelnikov G.P., Yakovlev O.G., ed. Practical Geriatrics: A Guide for Physicians. - 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 managment - 6th ed. - Copyright (c) 1996 Williams & Wilkins, Baltimore, USA.

Small intestine bacterial overgrowth syndrome (SIBO), or in the English abbreviation SIBO (small intestinal bacterial overgrowth) develops when bacteria normally residing in the large intestine enter the small intestine.

The small intestine is the longest section of the gastrointestinal tract. It mixes food with digestive juices, releasing nutrients into the bloodstream.

With the development of SIBO, the absorption of nutrient compounds is sharply deteriorated. Fat-soluble vitamins and iron are especially poorly absorbed.

The microflora of the large intestine is essential for the normal functioning of the body. It not only helps in the assimilation of food, but also has a host of other useful properties.

However, bacteria invading the small intestine can cause symptoms similar to those of irritable bowel syndrome (IBS).

Signs of increased bacterial growth syndrome in the small intestine are often similar to those of other gastrointestinal diseases, primarily IBS.

Common symptoms of bacteria invading the small intestine include:

  • nausea and vomiting;
  • bloating and gas production;
  • diarrhea;
  • poor absorption of nutrients and, as a result, weight loss;
  • joint pain;
  • chronic fatigue;
  • rash, acne and eczema;
  • asthmatic phenomena;
  • depression;
  • rosacea.

Causes of occurrence

The exact reasons for the development of bacterial overgrowth in the small intestine have not been established. However, it is known that most often SIBO occurs against the background:

  • chronic pancreatitis;
  • diabetes;
  • diverticulosis;
  • congenital structural defects in the small intestine;
  • trauma, fistula, abdominal surgery;
  • intestinal lymphoma;
  • scleroderma.

The use of certain drugs, including immunosuppressants and inhibitors of H ± K ± ATPase, is important.

Very often the disease occurs in those people who suffer from celiac disease (true gluten intolerance).

Natural aging of the body can also trigger the onset of the disease.

Diagnostics

Making a diagnosis is a challenging task. If only simply because the disease was described not so long ago, and many doctors, especially in ordinary district polyclinics, simply do not know about its existence.

In addition, this pathology is not so easy to distinguish from celiac disease, exocrine pancreatic insufficiency, irritable bowel syndrome.

The reason for suspicion of the presence of a syndrome of enhanced bacterial growth should be the clinical picture of the disease, which manifests itself against the background of other pathologies listed above. The age of the patient is also important: the larger it is, the higher the likelihood of developing the syndrome.

An unambiguous diagnosis can be made after examining aspiration samples obtained from the small intestine. However, research is costly and traumatic for the patient. Therefore, it is rarely used.

Indirect hydrogen breath tests with glucose and lactulose are commonly used. The sensitivity of these methods can be as high as 93%. However, unlike direct research, they are cheap and minimally invasive.

Should SIBO be treated?

Some people mistakenly believe that since bacteria must live in the large intestine, then there is nothing wrong with them staying in the small intestine. Therefore, SIBO can be safely left without treatment. Unfortunately, this is not so.

The syndrome of bacterial overgrowth threatens severe health consequences, which are primarily associated with the fact that microorganisms in the small intestine do not allow the normal absorption of nutrient compounds.

Usually, the absorption of substances such as calcium, iron, zinc, vitamins A, E, K, D worsens.

But the most dangerous is the lack of vitamin B12.

Symptoms of B12 deficiency sometimes develop gradually and sometimes occur almost overnight. They include:

  • numbness or tingling in the extremities;
  • anemia;
  • jaundice;
  • decreased cognitive abilities and memory loss;
  • constant fatigue and weakness.

In severe cases, paranoia and hallucinations.

Not so long ago, British hematologists found that megaloblastic anemia (a blood disease that leads to the loss of red blood cells) is a consequence of SIBO and arises from a malabsorption of vitamin B12.

Therefore, if you have SIBO or vitamin B12 deficiency, you must treat this ailment immediately. Otherwise, irreversible changes may occur.

How is SIBO treated?

The first thing to do if excess bacterial growth is detected is to identify the pathology that led to SIBO. And if such a pathology exists, and this is not just a natural aging of the body, then first of all it is necessary to treat the underlying disease, and then - the increased growth of bacteria.

Medications

The main drug treatment is broad-spectrum antibiotics.

In addition, it is mandatory to take vitamins and minerals, the absorption of which is hampered by the excessive growth of bacteria. These are vitamins A, E, K, D and B12, trace elements - iron and zinc.

The use of preparations with digestive enzymes is shown.

Of the antibiotics, Rifaximin and Metronidazole are most often prescribed.

However, antibiotic treatment itself, if it gives results, is not very good.

First, together with the pathogenic microflora in the small intestine, antibiotics also kill beneficial microorganisms in the large intestine.

Second, after stopping the drug, relapse is very common. The symptoms of the disease, especially those that relate directly to the gastrointestinal tract, become more pronounced.

Therefore, the correct treatment for SIBO should include not only antibiotic therapy, but also other measures.

Drug-free therapy scheme

  • Reducing the size of consumed portions. You need to eat not three times a day, but at least 5-6 times, but little by little. This allows food to be digested faster, which is extremely important with SIBO. A large amount of food in the stomach makes it difficult to produce gastric juice and reduces its acidity. This can worsen the symptoms of SIBO, as stomach acid is designed to kill bacteria in the upper GI tract.
  • Since digestion begins in the mouth and not in the stomach, food must be chewed very thoroughly. This makes it possible to accelerate its further absorption, which is extremely important with SIBO.
  • You should start taking probiotics and include foods that are rich in them in your menu. A recent clinical study has shown that the use of probiotic preparations containing Lactobacillus casei, Lactobacillus plantarum, Streptococcus faecalis and Bifidobacterium brevis is more effective in eliminating the symptoms of bacterial overgrowth than using Metronidazole.
  • Switching to a special diet.

Diet for the treatment of SIBO

If you want to get rid of SIBO without the use of antibiotics or with their minimal involvement, you must definitely switch to a special diet consisting of two phases - Elimination and Maintenance.

Phase One - Elimination

The first phase of the diet implies a complete rejection of FODMAP products, that is, those food that cannot be independently assimilated by the human body and requires the participation of bacteria for its fermentation.

In the first phase, the following are prohibited:

  • fructose - most fruits and juices from them, honey, cereals (first of all, instant food), baked goods, all products, the content of a lot of sugars (especially industrial production);
  • lactose - unfermented dairy products;
  • fructans - wheat, onions and garlic, leeks, broccoli and cabbage, asparagus;
  • galactans - legumes (including any soy products), Brussels sprouts and cabbage;
  • polyopes - products with artificial sweeteners - erythritol, xylitol, sorbitol, etc.

Products allowed in the first phase:

  • a fish;
  • bird;
  • meat - beef and lamb;
  • eggs;
  • hard cheeses;
  • walnuts;
  • greens, including spinach;
  • zucchini, zucchini and pumpkins;
  • cucumbers and tomatoes;
  • carrot;
  • potato;
  • bananas;
  • strawberries, blueberries, grapes;
  • melons;
  • pineapples.

The duration of the first phase is two weeks. If you broke off and ate foods from the prohibited list, you will have to re-count the days.

Phase 1 goals:

  • healing of the intestinal wall damaged by microorganisms;
  • reducing inflammation;
  • elimination of excessive bacterial growth;
  • saturation of the body with all those nutrient compounds that it lacks due to the deterioration in the absorption of food in the small intestine.

Phase Two - Maintenance

The goals of the second phase of the diet are:

  • final healing of the intestinal wall;
  • restoration of microflora balance;
  • preventing the entry of toxins from the gastrointestinal tract into the bloodstream.

Pleasant side effects include:

  • elimination of food allergies;
  • strengthening of immunity;
  • reduction of chronic anxiety and depression.

The second phase is less severe than Elimination, however, there is a ban on some products for it.

Prohibited:

  • cereals;
  • all sweet foods, especially industrially produced;
  • foods high in starch;
  • unfermented dairy products.

Basic rules for the Maintain phase include:

  • Eating a small cup of bone broth with every or nearly every meal
  • cooking only with coconut or ghee;
  • eating fruit exclusively between meals;
  • the inclusion in the diet of a large number of fermented foods (so sauerkraut should be eaten at least a little with all meals);
  • independent preparation of fermented milk products, and not the purchase of ready-made ones;
  • the use of vegetables mainly boiled in a boiled form.

How long is the second phase?

It is advisable to eat like this always. However, what has been said does not mean that one should never give oneself relief. Can. On holidays. But then it is still better to return to the described dietary food.

When you start treating SIBO, remember that your body needs time to overcome the problems caused by the overgrowth of bacteria in the intestines. So don't expect instant results. However, you will find that after two weeks of abstaining from FODMAPS foods and then switching to a gentle Maintenance diet, your gut begins to heal and you feel better and better.

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