In addition, an intact ileocecal valve serves as a physiological barrier between the small bowel and colon. įactors promoting the development of SIBO include changes in the acid secretion of the stomach, fistulae, strictures and motility disturbances. SIBO also results in a constellation of symptoms including watery diarrhea, weight loss, meteorism, flatulence and abdominal pain. Malabsorption affects the intake of important nutrients, like fat-soluble vitamins, and certain minerals, such as calcium. Īs a consequence of maldigestion and inflammatory changes of the bowel mucosal membrane secondary to SIBO, patients experience a reduction in intestinal absorption. An increase in the H 2 concentration in exhaled air (>10 ppm) over baseline (H 2 level prior to substrate intake) after oral application of 50 mg of glucose is considered evidence of SIBO. Physiologically absorbed carbohydrates such as glucose undergo fermentation mediated by bacteria prior to their absorption in the small bowel. A simple and sensitive test for detecting bacterial overgrowth is the H 2 glucose breath test (HGBT). This production of H 2 by intestinal bacteria following oral application of carbohydrates can be used diagnostically to demonstrate, among other entities, bacterial overgrowth of the upper gastrointestinal tract with H 2-forming microorganisms. Because of its low solubility in blood, it is completely eliminated through the lungs in exhaled air. H 2 gas formed in the bowel passes by diffusion into the capillary circulation of the intestinal mucosa. H 2 is produced exclusively by bacteria in healthy individuals, significant numbers of such bacteria are found only in the colon. Hydrogen Breath Tests (HBT) determine the concentration of hydrogen gas (H 2) in exhaled air following the oral administration of carbohydrates. Because of the difficulty of integrating this method into clinical routine, it has become standard procedure to utilize indirect non-invasive methods for detecting SIBO based on changes caused by the metabolic activity of bacteria colonizing these bowel segments. ĭirect confirmation of SIBO is possible only by microbiological examination of aspirate from the proximal small bowel. SIBO is characterized by a population corresponding to >10 5 CFU/ml of aspirate. Under physiological conditions, the proximal jejunum is characterized by a bacterial population corresponding to 10 3-10 4 colony forming units (CFU) per milliliter of aspirate. Small intestinal bacterial overgrowth (SIBO) represents an increased colonization by bacterial species derived from the colonic flora that may spread beyond the small bowel segments and sometimes affect the stomach. The small bowel represents a transition zone between the stomach, which harbors low numbers of microorganisms, and the colon, with its high level of bacterial colonization. Because symptoms of SIBO are often difficult to differentiate from those caused by the underlying disease, targeted work-up is recommended in patients with corresponding clinical signs and predisposing factors. SIBO represents a frequently ignored yet clinically relevant complication in CD, often mimicking acute flare. SIBO rate was also higher in patients with affection of both the colon and small bowel, while inflammation of the (neo)terminal ileum again showed only tendential association with the development of SIBO. SIBO was significantly more frequent in patients with partial resection of the colon or multiple intestinal surgeries there was also a clear trend in patients with ileocecal resection that did not reach statistical significance. There was no correlation with the Crohn's Disease Activity Index. SIBO patients reported a higher rate of abdominal complaints and exhibited increased stool frequency (5.9 vs. Thirty-eight patients (25.3%) were diagnosed with SIBO based on positive findings at HGBT. One-hundred-fifty patients with CD reporting increased stool frequency, meteorism and/or abdominal pain were prospectively evaluated for SIBO with the Hydrogen Glucose Breath Test (HGBT). As result, CD patients may experience malabsorption and report symptoms such as weight loss, watery diarrhea, meteorism, flatulence and abdominal pain, mimicking acute flare in these patients. Hence, patients with Crohn's Disease (CD) are especially predisposed to develop SIBO. Potential causes of SIBO include fistulae, strictures or motility disturbances. Small intestinal bacterial overgrowth (SIBO) is characterized by excessive proliferation of colonic bacterial species in the small bowel.
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