Nemtsov L.M.
Bacterial overgrowth syndrome: urgent problems of diagnosis and management
Education establishment "Vitebsk State Order of Peoples’ Friendship Medical University", Republic of Belarus
Abstract.
The article presents literature review on the problems of diagnosis and management of small intestinal bacterial overgrowth (SIBO). Bacterial overgrowth can be diagnosed by detecting ≥105 colony-forming units/ml in the aspirate from the small intestine. There are significant differences in the prevalence of SIBO in both healthy individuals and in different clinical conditions, depending on the examined population or the used test. In case of SIBO, microflorа both qualitatively and quantitatively similar to the colonic microflora appears in the small intestine, which causes carbohydrates fermentation producing gases and leads to symptoms including meteorism, abdominal discomfort, changes in the character of stool.
Clinical picture of SIBO is nonspecific. SIBO should be supposed in any patient with diarrhea, steatorrhea, weight loss, macrocytic anemia in combination with symptoms of intestinal dysfunction, long-term therapy with proton pump inhibitors and immunosuppressants, prolonged stay in the intensive care unit.
Modern diagnostic tests have a number of important limitations regarding their performance and interpretation. These tests are overly invasive and technically complicated (aspiration of jejunum contents) or not validated (aspiration of duodenal contents), or unreliable and associated with high levels of false positives (breathing tests). Trial antibiotic therapy is regarded as an alternative diagnostic strategy. However, there is no standardized approach to the type, dose and duration of antibiotic regimens, and in the definition of clinical response to antibiotics. Modern genomic and metabolomics methods offer new opportunities in determining the true normality and complete identification of microflora changes in SIBO.
Key words: diagnosis, management, bacterial overgrowth syndrome.
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