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home - Small Bowel - Small Bowel Infections - Bacterial Overgrowth Written by Dr Sebastian Zeki

Bacterial Overgrowth

H+ Breakdown amino acid so protein malab-sorption CARBOHYDRATES FATS Proteins 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 DiseaseSurgery 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 SupportDeficiencies 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 BacteriaAerobes 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.Cystic fibrosis.Jejunal diverticulosis.Coeliac disease.Scleroderma.Postsurgical blind loop syndrome. Bacterial Overgrowth

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