Сибо
Nursing should monitor treatment effectiveness and progress during initial treatment and verify patient compliance. The patient’s calorie intake and weight assessments should be frequently monitored during and after treatment to ensure adequate recovery from their illness. Nursing should follow all these areas and report any concerns to the treating clinician. The pharmacist can assist with agent selection, verifying dosing parameters, and performing medication reconciliation. The pharmacist should also work directly with the clinician and nurse regarding potential drug-condition interactions (eg, opioids, PPIs). SIBO management requires an interprofessional team approach, including physicians, specialists, specialty-trained nurses, and pharmacists collaborating across disciplines to achieve optimal patient results. [Level 5] The overall outcome depends on the underlying condition’s management. If the etiology is not well managed, the overall prognosis is grave.[3] [Level 2]
Pathophysiology
In patients without specific risk factors for SIBO, upper and lower endoscopies are generally performed to rule out other causes like atrophic gastritis and Crohn disease. If endoscopies are normal, imaging studies are done to rule out partial obstruction, diverticula, fistula, or other inflammatory findings. Magnetic enterography increases the sensitivity of diagnosing small intestinal bowel strictures but is costly.
Pimentel M, Chang C, Chua KS, Mirocha J, DiBaise J, Rao S, Amichai M. Antibiotic treatment of constipation-predominant irritable bowel syndrome. Dig Dis Sci. 2014 Jun; 59 (6):1278-85. [PubMed : 24788320 ]
Mackie RI, Sghir A, Gaskins HR. Developmental microbial ecology of the neonatal gastrointestinal tract. Am J Clin Nutr. 1999 May; 69 (5):1035S-1045S. [PubMed : 10232646 ]
Bouhnik Y, Alain S, Attar A, Flourié B, Raskine L, Sanson-Le Pors MJ, Rambaud JC. Bacterial populations contaminating the upper gut in patients with small intestinal bacterial overgrowth syndrome. Am J Gastroenterol. 1999 May; 94 (5):1327-31. [PubMed : 10235214 ]
Във въпросното проучване се споменава разнообразие от билкови лекарства, но не се дават препоръки за дозировка или допълнителни подробности. Масло от риган, екстрактът от берберин, маслото от лимон и екстрактът от корен на червена боровинка са споменати в изследването като полезни средства за облекчаване на SIBO.
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Epidemiology
A bacterial concentration of less than 10 is diagnostic of SIBO, but it is invasive, time-consuming, and expensive, as it is obtained during an upper endoscopy. The results are also poorly reproducible and can lead to false results from patchy bacterial overgrowth or contamination with oropharyngeal flora.[25] Other laboratory findings that support a diagnosis of SIBO may include vitamin levels and markers of malnutrition.[18] Once there is a suspicion of SIBO, additional testing to identify the etiology merits consideration. Anatomic and mucosal abnormalities can be investigated with abdominal imaging and endoscopies. Testing for disorders of abnormal gastrointestinal motility, pancreatic insufficiency, and immunodeficiencies can be considered case-by-case.[3] Rarely, endoscopy with small bowel biopsy is used.
Lauritano EC, Gabrielli M, Scarpellini E, Lupascu A, Novi M, Sottili S, Vitale G, Cesario V, Serricchio M, Cammarota G, Gasbarrini G, Gasbarrini A. Small intestinal bacterial overgrowth recurrence after antibiotic therapy. Am J Gastroenterol. 2008 Aug; 103 (8):2031-5. [PubMed : 18802998 ]
Jones RM, Neish AS. Recognition of bacterial pathogens and mucosal immunity. Cell Microbiol. 2011 May; 13 (5):670-6. [PubMed : 21352463 ]
Hoog CM, Lindberg G, Sjoqvist U. Findings in patients with chronic intestinal dysmotility investigated by capsule endoscopy. BMC Gastroenterol. 2007 Jul 18; 7 :29. [PMC free article : PMC1940016 ] [PubMed : 17640373 ]
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Histopathology
There is no validated gold standard diagnostic test for SIBO.[2] When a patient presents with signs and symptoms concerning SIBO, the diagnosis garners further support with a positive carbohydrate breath test or a bacterial concentration of more than 1000 colony-forming units/mL in a jejunal aspirate culture.[21] A carbohydrate breath test is a noninvasive, fast, and inexpensive test.[22] The test uses the principle that the metabolism of either lactulose or glucose as its carbohydrate substrate by bacteria will produce either hydrogen or methane. This product will then be absorbed and excreted in the patient’s breath.[21] A rise of more than 20 parts per million from baseline in hydrogen within 90 minutes or a methane level of more than ten parts per million are positive results.[21] Results may be falsely positive in patients with short bowel syndrome. Low anaerobic organism counts may result in false negative results. In a review by Romagnuolo J et al., the sensitivity of the glucose breath test is 20-93%, and specificity is 45-86%.[23] The lactose breath test has 17-68% sensitivity and 44-86 % specificity.[24] In an appropriate clinical setting with no risk factors, breath tests can be used for SIBO diagnosis.
Pimentel M, Constantino T, Kong Y, Bajwa M, Rezaei A, Park S. A 14-day elemental diet is highly effective in normalizing the lactulose breath test. Dig Dis Sci. 2004 Jan; 49 (1):73-7. [PubMed : 14992438 ]
Riordan SM, McIver CJ, Wakefield D, Duncombe VM, Thomas MC, Bolin TD. Small intestinal mucosal immunity and morphometry in luminal overgrowth of indigenous gut flora. Am J Gastroenterol. 2001 Feb; 96 (2):494-500. [PubMed : 11232696 ]
Choung RS, Ruff KC, Malhotra A, Herrick L, Locke GR, Harmsen WS, Zinsmeister AR, Talley NJ, Saito YA. Clinical predictors of small intestinal bacterial overgrowth by duodenal aspirate culture. Aliment Pharmacol Ther. 2011 May; 33 (9):1059-67. [PubMed : 21395630 ]
Добрата новина е, че според изследователите, билковите лекарства и добавки са също толкова ефективни, колкото и три курса на антибиотична терапия при пациенти, които не реагират добре на рифаксимин.
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Etiology
D-lactic acidosis is a rare neurological syndrome that can present with altered mental status, slurred speech, seizures, and ataxia. This syndrome results from bacterial fermentation of unabsorbed carbohydrates. Patients with SIBO associated with short bowel syndrome or a jejunoileal bypass can develop this syndrome.[19] SIBO has been implicated in developing nonalcoholic fatty liver disease and hepatic encephalopathy.[20] Unless severe malnutrition is evident, physical examination in these patients is generally nonrevealing. Rarely succussion splash from fluid-filled lops can be identified.
Lembo A, Pimentel M, Rao SS, Schoenfeld P, Cash B, Weinstock LB, Paterson C, Bortey E, Forbes WP. Repeat Treatment With Rifaximin Is Safe and Effective in Patients With Diarrhea-Predominant Irritable Bowel Syndrome. Gastroenterology. 2016 Dec; 151 (6):1113-1121. [PubMed : 27528177 ]
Roland BC, Ciarleglio MM, Clarke JO, Semler JR, Tomakin E, Mullin GE, Pasricha PJ. Low ileocecal valve pressure is significantly associated with small intestinal bacterial overgrowth (SIBO). Dig Dis Sci. 2014 Jun; 59 (6):1269-77. [PubMed : 24795035 ]
Greenson JK. The biopsy pathology of non-coeliac enteropathy. Histopathology. 2015 Jan; 66 (1):29-36. [PubMed : 25234408 ]
Антибиотичната терапия със сигурност не е добър избор, защото тя още повече може да влоши състоянието и симптоматиката. Още повече, ако не се приема пробиотик след лечение с антибиотици, рискът за неовладяване на SIBO е голям.
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Consultations
Corazza GR, Menozzi MG, Strocchi A, Rasciti L, Vaira D, Lecchini R, Avanzini P, Chezzi C, Gasbarrini G. The diagnosis of small bowel bacterial overgrowth. Reliability of jejunal culture and inadequacy of breath hydrogen testing. Gastroenterology. 1990 Feb; 98 (2):302-9. [PubMed : 2295385 ]
Probiotics, low fermentable oligo, di, and monosaccharide (FODMAP) diet, and statins have no proven role in the resolution of SIBO. Some patients show symptomatic improvement but are not effective alone.
Losurdo G, Marra A, Shahini E, Girardi B, Giorgio F, Amoruso A, Pisani A, Piscitelli D, Barone M, Principi M, Di Leo A, Ierardi E. Small intestinal bacterial overgrowth and celiac disease: A systematic review with pooled-data analysis. Neurogastroenterol Motil. 2017 Jun; 29 (6) [PubMed : 28191721 ]
Здравословната и разнообразна чревна микрофлора е изключително важна за здравето и това го доказват все повече съвременни изследвания. Въпреки това, бактериален свръхрастеж в тънките черва – известен под наименованието SIBO, може да причини сериозни здравословни проблеми.
Approximately 45 percent of patients will have recurrent SIBO following antibiotic therapy completion, with higher recurrence rates in older adults, post-appendectomy, and chronic use of proton pump inhibitors.[28] In patients with early recurrence, i.e., within three months, the second course of antibiotics is given. In patients with late recurrence beyond three months, antibiotics are provided only with positive carbohydrate breath testing. Recurrent SIBO is treatable either with the same initial or alternating antibiotic.
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Първо пациентът участва в специална диета два дни преди теста. След това пациентът пие разтвор, съдържащ една от захарите, изброени по-горе, която захранва бактериите. Дихателният тест измерва количеството водород и метан, получени от бактериите в резултат на действието им. Тези резултати позволяват на медицински специалист да определи дали има бактериален свръхрастеж.
Ако трябва да ги разграничим, при бактериален свръхрастеж в тънките черва обикновено се появяват умора, гадене и повръщане, подуване на корема и диария, лошо усвояване на хранителни вещества и загуба на тегло.
Complications
King CE, Toskes PP. Comparison of the 1-gram [14C]xylose, 10-gram lactulose-H2, and 80-gram glucose-H2 breath tests in patients with small intestine bacterial overgrowth. Gastroenterology. 1986 Dec; 91 (6):1447-51. [PubMed : 3770368 ]
Diagnoses that produce chronic diarrhea should be in the differential and investigated while evaluating small intestinal bacterial overgrowth. Irritable bowel syndrome (IBS), celiac disease (CD), and inflammatory bowel disease (IBD) all have considerable overlap with SIBO. Irritable bowel syndrome has recurrent abdominal pain related to bowel movements and is associated with a change in stool frequency or appearance.[31] Celiac disease and SIBO have similar clinical symptoms; however, celiac disease will have positive celiac serologies and a negative carbohydrate breath test.[32] Both Crohn disease and SIBO have patchy mucosal inflammation. However, Crohn disease additionally could demonstrate transmural inflammation and granulomas on biopsy and perianal involvement with anal fissures and fistulas.[33]
Shah A, Morrison M, Burger D, Martin N, Rich J, Jones M, Koloski N, Walker MM, Talley NJ, Holtmann GJ. Systematic review with meta-analysis: the prevalence of small intestinal bacterial overgrowth in inflammatory bowel disease. Aliment Pharmacol Ther. 2019 Mar; 49 (6):624-635. [PubMed : 30735254 ]
В тази статия ще се опитаме да направим подробен преглед на диагнозата SIBO и какво може да помогне за облекчаване на състоянието до пълното му излекуване.
An elemental diet can be used in cases where patients cannot tolerate antibiotics or fail to respond to antibiotic treatment (after two times). Limited observational studies suggest remission induction of SIBO symptoms, but poor palatability and high cost limit their use. In an observational study, 80% of patients attained remission (normalization of breath tests and resolution of symptoms) within two weeks.[29]
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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.
Както виждате, бактериалният свръхрастеж в тънките черва е свързан, причинен или обусловен от широк спектър състояния. Дори и тези, за които не се смята, че са свързани със стомашно-чревния тракт очевидно имат значение за симптомите на SIBO.
Evaluation
Vantrappen G, Janssens J, Hellemans J, Ghoos Y. The interdigestive motor complex of normal subjects and patients with bacterial overgrowth of the small intestine. J Clin Invest. 1977 Jun; 59 (6):1158-66. [PMC free article : PMC372329 ] [PubMed : 864008 ]
Disclosure: Venu Chippa declares no relevant financial relationships with ineligible companies.
The etiology of small intestinal bacterial overgrowth is complex. It can be from motility, anatomic, immune, gastric hypochlorhydria, and metabolic and other systemic disorders.
Review the appropriate steps to evaluate a patient with suspected small intestinal bacterial overgrowth (SIBO).
Last Update: April 17, 2023 .
Тънкото черво е най-дългата част от храносмилателния тракт. Това е мястото, където храната се смесва с храносмилателни сокове и хранителните вещества се абсорбират в кръвния поток. Ако се предполага, че има SIBO, малабсорбцията на хранителни вещества, особено на мастноразтворимите витамини и желязо, може лесно да се превърне в проблем.
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Pai RK. A practical approach to small bowel biopsy interpretation: celiac disease and its mimics. Semin Diagn Pathol. 2014 Mar; 31 (2):124-36. [PubMed : 24815938 ]
Treatment / Management
Khoshini R, Dai SC, Lezcano S, Pimentel M. A systematic review of diagnostic tests for small intestinal bacterial overgrowth. Dig Dis Sci. 2008 Jun; 53 (6):1443-54. [PubMed : 17990113 ]
Disclosure: Sufian Sorathia declares no relevant financial relationships with ineligible companies.
Important host defense mechanisms against bacterial overgrowth in the small intestine are gastric acid and bile, peristalsis, proteolytic digestive enzymes, intact ileocecal valve, and secretory IgA. When these protective barriers fail, SIBO occurs. Gastric acids and bile destroy and prevent bacteria from passing through the intestines after ingesting food. So, SIBO is associated with achlorhydria.[3] Also, proteolytic enzymes digest and degrade bacteria in the intestines. So, chronic pancreatic insufficiency is associated with SIBO.[3] Migrating motor complexes are responsible for peristalsis and cleansing of the small intestine and prevent retrograde translocation of bacteria.[4] SIBO is associated with disorders of abnormal gastrointestinal motility, such as irritable bowel syndrome, narcotic use, post-radiation enteropathy, hypothyroidism, diabetes mellitus, and scleroderma.[3]
Small intestinal bacterial overgrowth (SIBO) is the presence of excess colonic bacteria in the small intestine. In contrast to the large intestine, the concentration of the bacteria in the small intestine rarely exceeds 1000 organisms/mL. Gastric acid secretion and intestinal motility limit the overgrowth of bacteria in the small intestine. When these protective mechanisms against excessive bacterial growth fail, small intestinal bacterial overgrowth (SIBO) can manifest. This activity reviews the evaluation and management of SIBO and explains the role of the interprofessional team in improving care for patients with this condition.
Sufian J. Sorathia ; Venu Chippa ; John M. Rivas .
Милиони американци страдат от стомашно-чревни неразположения и проблеми всяка година. Диагнози като синдром на пропускливи черва, болест на Крон или цьолиакия продължават да растат. Изследователите все още не могат да установят защо храносмилателната система е подложена и не може да устои на някои атаки.
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Shindo K, Machida M, Koide K, Fukumura M, Yamazaki R. Deconjugation ability of bacteria isolated from the jejunal fluid of patients with progressive systemic sclerosis and its gastric pH. Hepatogastroenterology. 1998 Sep-Oct; 45 (23):1643-50. [PubMed : 9840121 ]
History and Physical
Rao SSC, Bhagatwala J. Small Intestinal Bacterial Overgrowth: Clinical Features and Therapeutic Management. Clin Transl Gastroenterol. 2019 Oct; 10 (10):e00078. [PMC free article : PMC6884350 ] [PubMed : 31584459 ]
Compare D, Pica L, Rocco A, De Giorgi F, Cuomo R, Sarnelli G, Romano M, Nardone G. Effects of long-term PPI treatment on producing bowel symptoms and SIBO. Eur J Clin Invest. 2011 Apr; 41 (4):380-6. [PubMed : 21128930 ]
An intact ileocecal valve and antegrade motility of the ileum prevent retrograde translocation of colonic bacteria.[5] Anatomic abnormalities lead to stasis of the bowels, which may predispose them to SIBO. Such anatomic disorders may include small intestinal diverticulosis, bowel strictures, post-operative adhesions, gastric bypasses with blind intestinal loops, and ileocecal resection.[3] Lastly, the gastrointestinal tract’s secretory immunoglobulin Ig A abundance prevents bacterial proliferation and maintains intestinal immunity. [6] Immunodeficiency disorders, such as acquired immune deficiency syndrome, combined variable immunodeficiency, and IgA deficiency, are associated with an increased risk of SIBO.[7]
Discuss interprofessional team strategies for improving care coordination and communication to improve outcomes in patients who present with small intestinal bacterial overgrowth.
Това е така, защото единственият начин, по който човешкото тяло произвежда тези газове, е чрез продукцията на бактериите.
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Disclosure: John Rivas declares no relevant financial relationships with ineligible companies.
Klaus J, Spaniol U, Adler G, Mason RA, Reinshagen M, von Tirpitz C C. Small intestinal bacterial overgrowth mimicking acute flare as a pitfall in patients with Crohn’s Disease. BMC Gastroenterol. 2009 Jul 30; 9 :61. [PMC free article : PMC2728727 ] [PubMed : 19643023 ]
Источники:
https://www.msdmanuals.com/professional/gastrointestinal-disorders/malabsorption-syndromes/small-intestinal-bacterial-overgrowth-sibo&rut=daa2a71632e51842cc5664e63664d5a0cfcfa65147db7087d1a6586b7083a4cf
https://www.healthline.com/health/sibo-breath-test&rut=42e84dd946e91552977bcf47f89c1874bf0c270bd5b09e14a2505b9a79cad3bd
https://www.healthline.com/health/sibo&rut=040c6f10a8608ee0fa7dc7f08c78584b57f4b15f4030760b3b2a02cd7dbeaa6c
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099351/&rut=dc2ab6c63fce7b596838a320aea83e6429a6763852e5ffe66558aa2ac0500e29
https://medlineplus.gov/ency/article/000222.htm&rut=c9292f158c9b77e6d3758dcfc2bc1cb76a83e69360ce5968bc376f6cff7c43ef
https://herbamedicabg.com/sibo-vsichko-koeto-tryabva-da-znaete-za-bakterialen-svrhrastezh-v-tnkite-cherva&rut=25d5df8c45b8ca037bde423dd566d7ace470eb2babadcf53fa6cd67c2392a8bd
https://www.ncbi.nlm.nih.gov/books/NBK546634/&rut=bef4d75fe7e458f31730c7c78d535340102f1f7fe8de98ff57101e3d17b06992
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6006167/&rut=a458d1cc58ae68d7d783fc7aeb7c04b3cb59907a2b5faed75ed54b9a48ae5262
https://ru.wikipedia.org/wiki/%D0%A1%D0%B8%D0%B1%D0%BE&rut=9ff29e4df2eac1d3e6a2be14df250cdb9c1cdb5c49bb2056c46235ea5e46d9cc
