Risk factors for the development of bacterial overgrowth include the use of medications including proton pump inhibitors, anatomical disturbances in the bowel, including fistulae, diverticula and blind loops created after surgery, and resection of the ileo-cecal valve. The diagnosis of bacterial overgrowth is made by a number of techniques, with the gold standard diagnosis being an aspirate from the jejunum that grows in excess of 105 bacteria per millilitre. Patients with bacterial overgrowth typically develop symptoms including nausea, bloating, vomiting and diarrhea, which is caused by a number of mechanisms. Unlike the colon (or large bowel), which is rich with bacteria, the small bowel usually has less than 104 organisms per millilitre. Small bowel bacterial overgrowth syndrome (SBBOS), or small intestinal bacterial overgrowth (SIBO), also termed bacterial overgrowth is a disorder of excessive bacterial growth in the small intestine.
Small Bowel Bacterial Overgrowth Syndrome Small Intestinal Bacterial Overgrowth (SIBO) Signs and Symptoms. "Small Intestinal Bacterial Overgrowth (SIBO) Signs and Symptoms".
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For one thing, a response could be due to a reduction in pathogenic colonic flora as well as overgrown small intestinal bacteria. Many physicians resort to prescribing antibiotics on an empirical basis in these patients, but this may often be counterproductive. The nonspecific nature of most signs and symptoms means that many alternative diagnoses have to be kept in mind, and testing is typically required to make a diagnosis with confidence. Protein malabsorption also occurs due to consumption by bacteria, but in some cases, flattening of the brush border leads to protein-losing enteropathy.Ītrophic gastritis may be a risk factor in precipitating cobalamin deficiency, which can lead to severe polyneuropathies, because of competitive absorption of cobalamin by bacteria in the upper intestine. Malabsorption of carbohydrates can result from sugars being digested in the gut lumen by bacteria, along with secondary disaccharidase deficiency, because of damage to the brush border. This may account for pallor and fatigability in patients with SIBO. Iron deficiency can also occur, which may result in macrocytic or microcytic anemia. In prolonged multi-nutrient deficiency, neuropathies, retinopathies, and T-cell defects are observed. However, this is very rare as the vitamin K level is rarely reduced, because it is synthesized by luminal bacteria. Vitamin K reduction may prolong bleeding times. The former presents with a softening of the bones, while the latter has muscle spasms that occur intermittently. In a few very severe cases the vitamin A deficiency may cause night blindness, while that of vitamin D may result in osteomalacia or tetany. The severity and frequency of these symptoms are likely to be related to the intensity of bacterial overgrowth and resulting mucosal inflammation. However, this is rarely the case, and therefore most diagnoses are based on the overall clinical findings. The classical picture of SIBO comprises steatorrhea, abdominal bloating, and weight loss.
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