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Bacterial Overgrowth
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Written by Dr Sebastian Zeki
MCQs for this page
Bacterial Overgrowth
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H+
Breakdown
amino acid so
protein malab
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sorption
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Written by Dr Sebastian Zeki
Suggested regimes:
Amoxicillin-clavulanate plus metronidazole.
Cephalosporin with metronidazole.
Norfloxacin.
Oral gentamicin and metronidazole.
Rifaximin.
Investigations:
Jejunal intubation (Clinically significant
bacterial overgrowth is diagnosed when
bacterial counts > 10(5) organisms/mL
(normally ≤10(4) organisms/mL).
Radio labelled breath test ().
Fasting breath hydrogen.
Treat Underlying Disease
Surgery is usually for patients with extreme
bowel lengthening associated with bacterial
overgrowth.
Surgery usually involves lengthening or
tapering techniques (eg Bianchi or intestinal
lengthening procedure, which creates a
segment of bowel twice the length but half the
diameter of the originally dilated segment).
Conditions associated with bacterial stasis
should be corrected eg Drugs known to
decrease intestinal motility or reduce gastric
acidity.
Periodic flushing of the small bowel with
balanced polyethylene glycol solutions can give
a transient reduction in bacterial overgrowth
(given orally).
If sluggish motility,
metoclopramide,
domperi
-
done, erythromycin and octreotide can be used.
Nutritional Support
Deficiencies should be corrected.
Lactose-containing foods (get secondary lactase
deficiency) should be avoided.
Supplement fat for carbs as bacteria ferment
carbs with the development of D-lactic acidosis,
the production of small bowel gas, bloating, and
discomfort.
Treatment Of Bacteria
Aerobes and anaerobes should be covered.
There is no point doing MC&S.
Recurrence is common (44% after 9 months).
Recurrence is more likely in older adults, those
with a history of an
appendectomy
and with
chronic PPI use.
Patients may need a rotating course of antibiotics
Can also get:
- Colitis and ileitis resembling
Crohn's disease, although a
more diffuse inflammatory
picture is more common if
severe.
-Inflammatory arthritis.
D-lactic
acidosis
B12 deficiency (without
folate deficiency as bacteria
produce
folic
acid)
Lactase
deficiency
Fat soluble
vitamin
deficiency
Damages
intestinal mucosa
Damages
disaccharidase
activity so
carbohydrate
malabsorption
Toxic lithocholic
acid from
deconjugation
Deconjugates bile so can’t absorb fat
Bile
+
Peptidoglycans (precipitates jaundice)
Ammonia
Urea
Carbs
Mechanisms protecting against bacterial overgrowth:
Antegrade peristalsis.
Gastric acid and bile which destroys many microorganisms before they leave the stomach.
Digestion by proteolytic enzymes which helps to destroy bacteria in the small intestine.
The intestinal mucus layer traps bacteria.
An intact ileocecal valve inhibits
retrograde
translocation of bacteria from the colon to the small bowel.
H+
Complications
Aetiologies:
Short bowel syndrome
as the gut changes
to slow food transit.
Chronic pancreatitis
due to decreased
motility (40% of CP have this).
Intestinal fistula.
Immunodeficiency and hypochloryhydria.
Advancing age.
Liver disease
in 60%
NASH
or cirrhosis.
Antibiotics may improve liver injury.
C
ystic fibrosis.
Jejunal
diverticulosis.
Coeliac disease.
Scleroderma.
Postsurgical blind loop syndrome
.
Bacterial
Overgrowth
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