Small Bowel Bacterial Overgrowth Syndrome - Symptoms and Treatment

Introduction

Small bowel bacterial overgrowth syndrome is a severe issue with abnormal bacterial growth in the small intestine. Even the bacteria not generally present in the intestines are also seen in this condition. People with this condition have symptoms like loss of appetite, weight loss, belly pain, bloating, and diarrhea. Small bowel bacterial overgrowth syndrome is found by tests like breath testing, small intestine aspiration, and fluid culture. It is treated commonly with an antibiotic and other nutritional supplements.

What Causes Small Bowel Bacterial Overgrowth Syndrome?

Small bowel bacterial overgrowth syndrome occurs after a surgery or a disease condition like Crohn's disease (a type of inflammatory bowel syndrome), scleroderma, and celiac disease that slows down the food passage and the waste material passage in the intestine. It creates a breeding place for the microorganisms to grow and multiply. Thus creating an abnormal accumulation of bacteria in the small intestine. It can also occur as a complication post-surgery like a gastrectomy performed to treat peptic ulcer and abdominal cancer, or a structural defect like diverticulitis, small pouches in the lining of the small intestine.

What Are the Symptoms of Small Bowel Bacterial Overgrowth Syndrome?

• Loss of appetite.

• Unexplained weight loss.

• Stomach pain.

• Nausea.

• Bloating.

• Passing gas frequently.

• Diarrhea or constipation.

• Feeling uncomfortable after having a full meal.

• Malnutrition (poor nutrition absorption).

What Tests Are Performed to Find Small Bowel Bacterial Overgrowth Syndrome?

• Breath Testing: It is a test that measures the amount of gasses like methane and hydrogen produced by the bacteria in the intestines. The gas measured while breathing out will predict bacterial growth in the intestine.

• Complete Blood Count: The parameters in the blood like the red blood cells, white blood cells, platelets, hemoglobin, eosinophils, neutrophils, and basophils are screened. The changes in their normal ranges reveal infection or a disease condition.

• Small Intestine Endoscopy: A thin, flexible tube-like structure with a camera and a light is inserted into the mouth to access the small intestine to view the abnormalities internally.

• Small Intestine Aspirate and Fluid Culture: A small, flexible tube is inserted into the nose and is descended to the small intestine to remove a small amount of the fluid to check for any infections. A small amount of the fluid contents and the tissue in the duodenum (first part of the small intestine) are sucked out, and the tube is removed. The sample is checked in a laboratory for any infection in the duodenum and any changes pathologically in a microscopic view.

• Stool Test: A stool test checks how much fat the body absorbs. It will reveal if there is malabsorption.

• X-ray: It uses a radio wave frequency to capture images of the bony structures and organs.

• Ultrasound Abdomen: Ultrasound abdomen uses a high-frequency sound wave to capture images of the internal organs.

• Computerized Tomography (CT) Scan: Computed tomography scan technique uses high-frequency radio waves to capture images of the internal organs and structures with the help of a computer. It gives a detailed view of the targeted organs.

• Magnetic Resonance Imaging (MRI) Scan: Magnetic resonance imaging captures images of the internal organs, their neighboring structures, and tissues. It gives a very detailed view of the target structures.

How Is Small Bowel Bacterial Overgrowth Syndrome Treated?

• Antibiotics: Antibiotics are medications that kill bacteria that cause infections. Antibiotics like Amoxicillin, Ciprofloxacin, and Metronidazole are recommended. The antibiotics may be consumed from a few weeks to a few months. The doctor will decide on the antibiotic type depending on the breath test results.

• Medications to Speed Intestinal Motility: Medications like Neostigmine, Metoclopramide, and Cisapride elevate motor activity in patients with less bowel motility.

• Fluid Infusions: Normal saline, Lactated Ringer's solutions, and 5 % dextrose dissolved in water are the classical fluid therapy agents used in fluid replacement therapies.

• Nutrient Infusion: A specialized food modified for intravenous route infusion in patients with malabsorption.

• Diet Modifications: Avoid including sugary foods and drinks in your diet. Include probiotics like curd, yogurt, and kimchi. It is recommended to have vegetables and whole grains. An elemental diet replaces the regular diet with a liquid meal that provides a whole nutritional supplement.

What Are the Complications of Small Bowel Bacterial Overgrowth Syndrome?

• Weak bones.

• Kidney stones.

• Electrolyte imbalance.

• Loss of weight.

• Diarrhea.

• Anemia.

• Lack of nutrients and essential vitamins.

What Are the Risk Factors That Cause Small Bowel Bacterial Overgrowth Syndrome?

• Structural deformation in the small intestine.

• Gastric surgery due to peptic ulcer or obesity.

• Damage to the small intestine due to an injury.

• An abnormal passage between the two bowel segments.

• Crohn's disease (a severe inflammatory bowel disease that is life-threatening).

• Scleroderma involves the small bowel (a rare condition that causes the hardening and tightening of the skin).

• Intestinal lymphoma (a rare type of rapidly growing non-Hodgkin's lymphoma that occurs in the small intestine).

• History of radiation therapy due to abdominal cancer in the belly region.

• Diabetes.

• Diverticulosis (pouches in the lining of the intestine).

• Adhesions caused due to previous surgery.

Who Is at Increased Risk of Developing Small Bowel Bacterial Overgrowth Syndrome?

• Old Aged People: Elderly adults as they secrete reduced gastric acids leading to pouch formation in the walls lining the intestine.

• Anatomical Defect: If the shape of the intestine is unusual, which causes sluggish and slow bowel movements.

• Gastrectomy: A surgical procedure where the whole stomach or a part of the stomach is removed

• Bariatric Surgery: Weight loss surgery like gastric bypass surgery also causes small bowel bacterial overgrowth syndrome.

• Medications: Medications like proton-pump inhibitors that decrease gastric acid secretion. Antibiotic drugs kill bacterial flora. Consuming these medications increases the risk of small bowel bacterial overgrowth syndrome.

• Medical Conditions: Medical conditions like diabetes, irritable bowel syndrome, and weakened immune system also increase the risk of acquiring this condition.

Conclusion

Small bowel bacterial overgrowth syndrome is a severe disease that affects the small intestine that leads to excess bacterial growth in the small intestine. It is triggered by consuming sugary foods, dairy products, fruits, and starchy vegetables like corn, potatoes, beetroot, green peas, and turnips. It causes symptoms like stomach pain, bloating, frequent gas passing, weight loss, nausea, and malabsorption of fats, vitamins, minerals, and calcium. It is treated by rectifying the underlying cause, like getting rid of bacterial growth and providing medications to increase bowel motility. Nutritional supplements and fluid therapy are also recommended. Though this condition cannot be prevented, the symptoms can be reduced, and the patient's lifespan can be improved with certain diet modifications.