Overgrowth of the small intestine

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Classification according to ICD-10
K59.9 Functional bowel disorder, unspecified
K63.8 Other specified diseases of the intestine
ICD-10 online (WHO version 2019)

Under a small intestinal bacterial overgrowth (abbr .: DDFB, English small bowel (bacterial) overgrowth (syndrome). ; And SIBO for Small Intestinal Bacterial Overgrowth ) is understood to mean a bacterial false colonization of the small intestine with more than 10 5 organisms per ml . It can be the cause of various complaints .

causes

DDFB typically occurs in short bowel syndrome , a defect of the ileocecal valve , diverticula or small bowel stenosis as a result of e.g. B. Crohn's disease , in chronic intestinal pseudo-obstruction, in the syndrome of the blind or deactivated loop after operations on the small intestine and in exocrine pancreatic insufficiency . Peristalsis disorders, for example as a result of scleroderma or diabetic enteropathy, can also be the cause.

Clinical picture

DDFB can lead to various health disorders and complaints such as arthritis , flatulence, colitis , chronic diarrhea, steatorrhea , weight loss, deficiency symptoms, abdominal pain , in particular due to the associated damage to the intestinal villi and the associated disruption of absorption ( malassimilation syndrome ) and lead to anemia .

Diagnosis

Evidence is provided by a strictly anaerobic endoscopic sample ( aspirate ) of fluid from the small intestine, in which more than 10 5 germs per ml are found. Additional laboratory findings are anemia, hypoalbuminemia and a deficiency in vitamins A, D, K and B 12 . If the folic acid level is normal at the same time, a deficiency in vitamin B 12 that cannot be remedied by the administration of intrinsic factors is typical.

If the DDFB leads to increased sugar fermentation (for example after oral administration of glucose or lactulose ), the hydrogen breath test shows an increased hydrogen content. This value is also increased in the fasting state, since the DDFB leads to a continuous conversion of the digestive juices continuously produced by the body in the small intestine. The limit value for the increase in the hydrogen concentration in the breath in a hydrogen breath test, from which the test is to be assessed as positive, is set differently by experts:

  • 20 ppm
  • 10 ppm if no symptoms occur during the test
  • 5 ppm if symptoms occur during the test.

To clarify the cause, an imaging procedure, e.g. B. MRI of the small intestine according to Sellink, or an enteroclysis (double-contrast X-ray image according to Sellink) required.

therapy

Causal therapy can be done through surgery, e.g. B. stenoses or blind loops can be eliminated. For conservative therapy, antibiotics can be used - usually only temporarily effective . If the symptoms improve in the course of antibiotic therapy, one also speaks of “antibiotic-responsive enteritis ” (ARE).

Individual evidence

  1. ↑ a b c d e f G. Michels and others: Clinic manual for internal medicine. Springer, 2009, ISBN 978-3-540-89109-3 , pp. 354-355. (on-line)
  2. ↑ a b J. Schölmerich: Medical Therapy 2007 / 2008. Springer, 2007, ISBN 978-3-540-48553-7 , p. 828. (online)
  3. ^ WG Guder: The laboratory book for clinic and practice. Urban & Fischer, 2005, ISBN 3-437-23340-8 , p. 202. (online)
  4. ↑ a b P. Layer, U. Rosien et al. (Ed.): Practical gastroenterology. 4th edition. Urban & Fischer, 2011, ISBN 978-3-437-23372-2 , p. 219.
  5. ↑ a b c W. Piper: Internal medicine. Springer, 2006, ISBN 3-540-33725-3 , p. 387. (online)
  6. ^ WG Guder: The laboratory book for clinic and practice. Urban & Fischer, 2005, ISBN 3-437-23340-8 , pp. 199 and 690. (online)
  7. ↑ a b M. Ledochowski: H2 breath tests . Ledochowski Verlag, 2008, ISBN 978-3-9502468-0-3 .