Microbial overgrowth syndrome. What is, causes, diagnosis and treatment of SIBO

It is well known that microorganisms live in the large intestine. But the small intestine cannot boast of microbial diversity: the proximal section should be almost sterile (this is where aggressive digestive enzymes work), and in the distal section the number of bacteria is 104 -105 CFU (colony forming units - i.e. living microorganisms) per ml of contents . Bacterial overgrowth syndrome is a disease in which the concentration of bacteria increases and leads to functional impairment. With this disease, microflora develops in sterile departments, and in populated areas its quantity greatly exceeds the norm.

Unpleasant symptoms occur, stools are disrupted, and nutrient absorption is disrupted. SIBO often develops against the background of another gastrointestinal disease, but it can also be a separate pathology. Gastroenterologists treat SIBO.

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Symptoms

Symptoms of the disease vary and depend on how severe the bacterial growth is and which groups of microorganisms predominate. Clinical manifestations are divided into two types: abdominal (associated with the abdominal organs) and general.

Abdominal symptoms:

• Flatulence and bloating, which are usually associated with food intake.
• Abnormal stool (diarrhea predominates).
• The appearance of atypical inclusions in the stool: fat fragments, undigested food.
• Abdominal discomfort, nausea, loss of appetite (do not always occur).

General symptoms:

• Deficiency of vitamins, especially fat-soluble ones, as well as folic acid.
• Deficiency of microelements, especially iron (due to impaired absorption).
• Weakness, fatigue.
• Dizziness and headache.
• Dry skin and flaking.
• Visual impairment.
• Weight loss.
• Emotional lability, anxiety.

Dysbacteriosis: what is it?

Let's start with the fact that dysbiosis is unfavorable changes in the microbial communities of the human body. There are two main types of such imbalance: bacterial and fungal. However, it is important to understand that dysbiosis itself is not a disease. This is a fairly common problem: dysbiosis occurs in adults and children, even infants. But researchers are still not sure what comes first: dysbiosis itself or the diseases that are associated with it.

Microorganisms live everywhere in our body: on the skin and on the mucous membranes inside. Most often these are harmless bacteria, some fungi, viruses and archaea. Normally, this entire community is in harmony, but changes in the host’s body can cause an imbalance - this is called dysbiosis.

Dysbiosis is a general term because there is no “ideal” microbiome. Each person is unique, and so is each microbiome. In general, researchers define dysbiosis by the ratio of some microorganisms to others. Here are the main general signs:

• excessive growth of certain bacteria or fungi,
• absence or deficiency of beneficial bacteria,
• low diversity of individual types of microorganisms in the microbiota.

Fungal dysbiosis is considered separately. It occurs when harmless fungi in the human body begin to grow more intensely than normal. This fungal overgrowth is a common cause of ear infections, athlete's foot, thrush and vaginal infections, many of which are caused by Candida and Aspergillus fungi.

Interesting fact☝The meaning of the word “dysbiosis” comes from the ancient Greek: dys (bad or unhealthy) and biosis (way of life).

Causes

The most common causes of SIBO are gastrointestinal diseases, systemic diseases, autoimmune disorders, as well as pathologies of other internal organs.

Intestinal diseases that cause the development of SIBO:

• Irritable bowel syndrome. This is an extremely common intestinal pathology, accompanied by many unpleasant symptoms. A distinctive feature of the disease is functional impairment in the absence of organic pathology. According to statistics, more than half of IBS cases are accompanied by excessive growth of pathogenic flora.
• Diverticulosis. This is a disease manifested by the formation of depressions in the intestinal wall. Normally, the bacterial biofilm is located on the mucous membrane. When the intestinal wall changes, the structure of the microbiome also changes.
• Anastomoses connecting the large and small intestines. After resection of part of the intestine, the two parts of the intestine are sutured and an anastomosis is performed. As a result, microorganisms migrate from the large intestine to the small intestine.
• Crohn's disease. With the development of complications of this disease, structures develop, intestinal permeability decreases, and the inflammatory process progresses.

Other medical conditions that can lead to the development of SIBO:

• Diseases of the pancreas, liver and kidneys.
• Diabetes.
• Autoimmune processes and long-term use of drugs that suppress the immune system.
• Resection of part of the stomach.
• Diseases associated with impaired secretion of hydrochloric acid in the stomach.
• Alcoholism.

4. Treatment for bacterial overgrowth syndrome

If during the diagnosis it was possible to identify negative factors that served as the background for the development of the pathology, then therapy combines antibacterial and symptomatic care, as well as measures to eliminate this background.

An individual diet must be developed. If necessary, vitamin preparations, enzymes and other means are prescribed to compensate for the lack of substances that are normally produced in the intestines and the entire digestive system.

However, antibiotics have priority in the treatment of SIBO. Medicines that are active against gram-negative aerobic and anaerobic bacteria are prescribed. The course of treatment is usually 10 days. Unsystematic and non-course medication is strictly prohibited, since in this case the microflora develops resistance to this group of antibiotics, and further treatment becomes even more difficult.

Diagnostics

First, the specialist collects an anamnesis. You can suspect SIBO based on the following complaints: bloating and rumbling in the abdomen, frequent loose stools, nausea, loss of appetite. If the patient does not associate these symptoms with objective circumstances, then it is necessary to conduct a series of examinations aimed at confirming the preliminary diagnosis.

In addition, it is necessary to find out whether the patient has chronic diseases of the gastrointestinal tract or internal organs that could provoke a microflora disorder.

Intestinal dysbiosis: causes

Microbiota diversity decreases with dysbiosis.
Source: Arianna K. DeGruttola, et al. Many factors can affect the health of the intestinal microbiota, but the main one is the use of antibiotics. Even one course of antibiotics can cause dysbiosis, which will last for months. Repeated use of antibiotics can permanently disrupt the intestinal microbiome.

Microbiota after antibiotics: how to restore intestinal health

The development of dysbiosis is also influenced by diet and lifestyle. Alcohol, fast food and sugary drinks in large quantities will not benefit your intestines, but eating plenty of fruits and vegetables and regular exercise will.

Intestinal dysbiosis often occurs together with other diseases. For example, obesity, cardiovascular disease, Crohn's disease and ulcerative colitis. Understanding whether dysbiosis causes disease or appears as a symptom is not easy.

Treatment

Treatment includes a whole range of measures. First of all, it is necessary to determine and eliminate the cause of the disease. And then the intestinal microbiocenosis is corrected.

Antibiotics are used to eliminate pathogenic flora. They try to select drugs that have a wide spectrum of action and are not absorbed in the intestines. Adsorbents are used - these are substances that can absorb toxins. They help reduce the severity of unpleasant symptoms. The comprehensive treatment regimen includes probiotics and prebiotics. The former contain normal intestinal microflora. Prebiotics are substances that stimulate the growth of normal microbes.

Bacterial overgrowth syndrome is a disease prone to relapse. Resumption of the disease often occurs due to short-term or insufficient treatment, as well as against the background of exacerbation of the primary pathology. With a long course, complications such as weight loss (due to impaired appetite and absorption in the intestine), hypovitaminosis, anemia (caused by vitamin B12 deficiency) may develop. In this regard, SIBO needs to be treated immediately after diagnosis and until the microflora of the small intestine is normalized.

There are no specific preventive measures. The development of this disease can be avoided by maintaining a healthy lifestyle. This concept includes timely treatment of diseases of the gastrointestinal tract and other organs, weight control, correct (only as prescribed by a doctor!) taking antibiotics, as well as compliance with recommendations on nutrition and diet. The same rules should be followed after successful treatment of the disease.

You can undergo a full diagnosis using the most modern methods, make an appointment with a specialist and begin treatment at the CELT multidisciplinary clinic. Attentive doctors, effective treatment regimens, advanced technologies are the key to successful recovery.

3. Clinical picture and diagnosis of SIBO

Classic symptoms of microbial overgrowth are megaloblastic anemia and steatorrhea. Subjective patient complaints usually include:

• indigestion;
• abdominal pain;
• flatulence;
• malnutrition and weight loss.

Loss of vitamins A, D and B12 over time leads to ataxia, osteoporosis, trophic disorders of the epidermis, and night blindness. Diagnosis of suspected microbial overgrowth syndrome should be aimed not only at confirming the insemination of the small intestine, but also at elucidating the possible causes of this pathology.

Diagnostic data collection relies on:

• examination and identification of patient complaints;
• bacteriological culture of the contents of different parts of the intestine;
• stool analysis for the presence of fat;
• radiography of the gastrointestinal tract;
• hydrogen breath test with glucose.

There is no specific indicator that allows one to accurately establish microbial overgrowth syndrome. As a rule, a combination of signs and laboratory data makes it possible to exclude other diseases, and the response to the therapy confirms the presumed diagnosis of SIBO.

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Intestinal dysbiosis

The best known microbial ecosystem is the gut microbiota. It consists of more than a trillion bacteria, fungi and archaea that support the normal functioning of the organ.

How gut bacteria protect the body

A healthy and balanced microbiota contains a sufficient amount of beneficial bacteria. They produce important nutrients that support the intestinal lining and protect the body from pathogens.

Diversity is a key indicator for diagnosing gut microbiome dysbiosis. A healthy microbiome contains more than 1,000 different species of bacteria. They control the growth and reproduction of foreign bacteria and potentially pathogenic microorganisms.

Symptoms of dysbiosis

Symptoms of gut dysbiosis are very nonspecific and overlap with many common health problems, such as irritable bowel syndrome, inflammatory bowel disease, and celiac disease. Research shows that dysbiosis itself is a risk factor for the development of these conditions.

Common symptoms of intestinal dysbiosis include:

• flatulence,
• bloating,
• abdominal pain,
• diarrhea,
• constipation.

If you have these symptoms, it is best to see a doctor.