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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

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.


1. Eckburg PB, Bik EM, Bernstein CN, Purdom E, Dethlefsen L, Sargent M, Gill SR, Nelson KE, Relman DA. Diversity of the human intestinal microbial flora. Science. 2005 Jun;308(5728):1635-8.
2. Compare D, Coccoli P, Rocco A, Nardone OM, De Maria S, Cartenì M, Nardone G. Gut-liver axis: the impact of gut microbiota on non alcoholic fatty liver disease. Nutr Metab Cardiovasc Dis. 2012 Jun;22(6):471-6.
3. Gasbarrini A, Corazza GR, Gasbarrini G, Montalto M, Di Stefano M, Basilisco G, Parodi A, Usai-Satta P, Vernia P, Anania C, Astegiano M, Barbara G, Benini L, Bonazzi P, Capurso G, Certo M, Colecchia A, Cuoco L, Di Sario A, Festi D, Lauritano C, Miceli E, Nardone G, Perri F, Portincasa P, Risicato R, Sorge M, Tursi A. Methodology and indications of H2-breath testing in gastrointestinal diseases: the Rome Consensus Conference. Aliment Pharmacol Ther. 2009 Mar;29 Suppl 1:1-49.
4. Bondarenko VM, Matsulevich TV. Disbakterioz kishechnika kak kliniko-laboratornyi sindrom: sovremennoe sostoianie problemy [Intestinal dysbiosis as kliniko-laboratory syndrome: current state of a problem]: ruk. dlia vrachei. Moscow, RF: GEOTAR-Media; 2007. 304 р.
5. Grace E, Shaw C, Whelan K, Andreyev HJN. Small Intestinal Bacterial Overgrowth. Aliment Pharmacol Ther. 2013;38(7):674-688.
6. 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.
7. Sachdev AH, Pimentel M. Gastrointestinal Bacterial Overgrowth Pathogenesis and Clinical Significance. Ther Adv Chronic Dis. 2013 Sep;4(5):223-31.
8. Quigley EM. Small Intestinal Bacterial Overgrowth: What It Is and What It Is Not. Curr Opin Gastroenterol. 2014 Mar;30(2):141-6.
9. Arumugam M, Raes J, Pelletier E, Le Paslier D, Yamada T, Mende DR, Fernandes GR, Tap J, Bruls T, Batto JM, Bertalan M, Borruel N, Casellas F, Fernandez L, Gautier L, Hansen T, Hattori M, Hayashi T, Kleerebezem M, Kurokawa K, Leclerc M, Levenez F, Manichanh C, Nielsen HB, Nielsen T, Pons N, Poulain J, Qin J, Sicheritz-Ponten T, Tims S, Torrents D, Ugarte E, Zoetendal EG, Wang J, Guarner F, Pedersen O, de Vos WM, Brunak S, Doré J, Antolín M, Artiguenave F, Blottiere HM, Almeida M, Brechot C, Cara C, Chervaux C, Cultrone A, Delorme C, Denariaz G,Dervyn R, Foerstner KU, Friss C, van de Guchte M, Guedon E, Haimet F, Huber W, van Hylckama-Vlieg J, Jamet A, Juste C, Kaci G, Knol J, Lakhdari O, Layec S, Le Roux K, Maguin E, Mérieux A, Melo Minardi R, M'rini C, Muller J, Oozeer R, Parkhill J, Renault P, Rescigno M, Sanchez N, Sunagawa S, Torrejon A, Turner K, Vandemeulebrouck G, Varela E, Winogradsky Y, Zeller G, Weissenbach J, Ehrlich SD, Bork P. Enterotypes of the human gut microbiome. Nature. 2011 May;473(7346):174-80.
10. Claesson MJ, Jeffery IB, Conde S, Power SE, Connor EM, Cusack S, Harris HMB, Coakley M, Lakshminarayanan B, O’Sullivan O, Fitzgerald GF, Deane J, O’Connor M, Harnedy N, O’Connor K, O’Mahony D, van Sinderen D, Wallace M, Brennan L, Stanton C, Marchesi JR, Fitzgerald AP, Shanahan F, Hill C, Ross RP [et al.] Gut microbiota composition correlates with diet and health in the elderly. Nature. 2012 Aug;488:178–84.
11. Pimentel M, Lezcano S. Irritable bowel syndrome: bacterial overgrowth - what's known and what to do. Curr Treat Options Gastroenterol. 2007 Aug;10(4):328–37.
12. McCollum DL, Rodriguez MJ. Diagnostika, lechenie i profilaktika in-fektsii, vyzvannoi Clostridium difficile [Diagnostics, treatment and prophylaxis of the infection caused by Clostridium difficile]. Klinicheskaia Gastroenterologiia i Gepatologiia. Russkoe izdanie. 2012;5(4):169-82.
13. Quigley EM, Stanton C, Murphy EF. The gut microbiota and the liver. Pathophysiological and clinical implications. J Hepatol. 2013 May;58(5):1020-7.
14. 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.
15. Bures J, Cyrany J, Kohoutova D, Förstl M, Rejchrt S, Kvetina J, Vorisek V, Kopacova M. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010 Jun;16(24):2978-90.
16. Pande C, Kumar A, Sarin SK. Small-intestinal bacterial overgrowth in cirrhosis is related to the severity of liver disease. Aliment Pharmacol Ther. 2009 Jun;29(12):1273-81.
17. Zharkova MS, Maevskaya MV, Ivashkin VT. Vliianie sindroma izby-tochnogo bakterial'nogo rosta i bakterial'noi translokatsii na techenie za-bolevaniia u bol'nykh tsirrozom pecheni [Influence of a syndrome of excess bacterial body height and bacterial translocation on the course of a disease at patients with cirrhosis]. Rossiiskii zhurnal gastroenterolo-gii, gepatologii, koloproktologii. 2012;22(5):56-63.
18. Zaidel O, Lin HC. Uninvited Guests: The Impact of Small Intestinal Bacterial Overgrowth on Nutritional Status. Practical Gаstroenterology. 2003 Jun;27(7):27-34.
19. Kucheriavyi YuA, Oganesian TS. Sindrom izbytochnogo bakterial'nogo rosta [Syndrome of excess bacterial body height]. Rossiiskii zhurnal gastroenterologii, gepatologii, koloproktologii. 2010;20(5):63-8.
20. Quera RP, Quigley EM, Madrid AM. Sobrecrecimiento bacteriano intestinal. Rev. Med. Chil. 2005;133:1361-70.
21. Quigley EM, Abu-Shanab A. Small intestinal bacterial overgrowth. Infect Dis Clin North Am. 2010 Dec;24(4):943-59.
22. Kocoshis SA, Schletewitz K, Lovelace G, Laine RA. Duodenal bile acids among children: keto derivatives and aerobic small bowel bacterial overgrowth. J Pediatr Gastroenterol Nutr. 1987 Sep-Oct;6(5):686-96.
23. Chalmers RA, Valman HB, Liberman MM. Measurement of 4-hydroxyphenylacetic aciduria as a screening test for small-bowel disease. Clin Chem. 1979 Oct;25(10):1791-4.
24. Ardatskaya MD, Minushkin ON. Sindrom izbytochnogo bakterial'nogo rosta: opredelenie, sovremennye podkhody k diagnostike i lechebnoi korrektsii [Syndrome of excess bacterial body height: definition, modern approaches to diagnostics and medical correction]. Consilium medicum. Gastroenterologiia. 2012;(2):45-9.
25. Bala L, Ghoshal UC, Ghoshal U, Tripathi P, Misra A, Gowda GA, Khetrapal CL. Malabsorption syndrome with and without small intestinal bacterial overgrowth: a study on upper-gut aspirate using 1H NMR spectroscopy. Magn Reson Med. 2006 Oct;56(4):738-44.
26. Monleón D, Morales JM, Barrasa A, López JA, Vázquez C, Celda B. Metabolite profiling of fecal water extracts from human colorectal cancer. NMR Biomed. 2009 Apr;22(3):342-8.
27. Marchesi JR, Holmes E, Khan F, Kochhar S, Scanlan P, Shanahan F, Wilson ID, Wang Y. Rapid and noninvasive metabonomic characterization of inflammatory bowel disease. J Proteome Res. 2007 Feb;6(2):546-51.
28. De-Souza DA, Greene LJ. Intestinal permeability and systemic infections in critically ill patients: effect of glutamine. Crit Care Med. 2005 May;33(5):1125-35.
29. Ley RE, Turnbaugh PJ, Klein S, Gordon JI. Microbial ecology: human gut microbes associated with obesity. Nature. 2006 Dec;444(7122):1022-3.
30. Spencer MD, Hamp TJ, Reid RW, Fischer LM, Zeisel SH, Fodor AA. Association between composition of the human gastrointestinal microbiome and development of fatty liver with choline deficiency. Gastroenterology. 2011 Mar;140(3):976-86.
31. Covington JA, Wedlake L, Andreyev J, Ouaret N, Matthew G, Nwokolo CU, Bardhan KD, Arasaradnam RP. The detection of patients at risk of gastrointestinal toxicity during pelvic radiotherapy by electronic nose and FAIMS: a pilot study. Sensors. 2012;12(10):13002-18.
32. Arasaradnam RP, Ouaret N, Thomas MG, Quraishi N, Heatherington E, Nwokolo CU, Bardhan KD, Covington JA. A novel tool for noninvasive diagnosis and tracking of patients with inflammatory bowel disease. Inflamm Bowel Dis. 2013 Apr;19(5):999-1003.
33. Rana SV, Sharma S, Kaur J, Sinha SK, Singh K. Comparison of lactulose and glucose breath test for diagnosis of small intestinal bacterial overgrowth in patients with irritable bowel syndrome. Digestion. 2012;85(3):243-7.
34. Shah SC, Day LW, Somsouk M, Sewell JL. Meta-analysis: antibiotic therapy for small intestinal bacterial overgrowth. Aliment Pharmacol Ther. 2013 Oct;38(8):925-34.
35. 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.


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