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Bacterial Overgrowth
Published in Marc A. Levitt, Pediatric Colorectal Surgery, 2023
Clinical manifestations of SIBO include weight loss, dehydration, diarrhea, and nutritional deficiencies. Patients with HD and SIBO may have a presentation similar to that of enterocolitis, with abdominal pain and distension requiring irrigations to empty. These episodes may be recurrent and may come back after completion of a course of antibiotics.
Intestinal Failure
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Rashmi Patil, Elizabeth King, Jeffrey Rudolph
In addition to complications specifically related to PN administration, children with intestinal failure are subject to other complications as well. Contributing factors for IFALD, other than PN, include bloodstream infections and gallbladder disease. SIBO is often the result of altered motility and can be an issue in intestinal transplant as well as intestinal failure. Symptoms include increased diarrhea, vomiting, excessive gas, as well as D-lactic acidosis. In SIBO, excessive numbers of small bowel bacteria produce negative consequences. The diagnosis is usually made clinically based on symptoms, although hydrogen breath tests or small bowel aspirates can be obtained as confirmatory testing.
Common gastrointestinal investigations and psychological concerns
Published in Simon R. Knowles, Laurie Keefer, Antonina A. Mikocka-Walus, Psychogastroenterology for Adults, 2019
The hydrogen breath test is used to evaluate patients for possible carbohydrate malabsorption and/or small intestinal bacteria overgrowth (SIBO). Hydrogen is normally produced by colonic bacteria. Carbohydrate that is not absorbed completely in the small intestine passes into the colon where it is metabolised with the production of hydrogen, which diffuses into the bloodstream and is exhaled by the lungs. The amount of hydrogen is measured with a breath-analysing machine.
Dietary fiber-based regulation of bile salt hydrolase activity in the gut microbiota and its relevance to human disease
Published in Gut Microbes, 2022
Arthur Kastl, Wenjing Zong, Victoria M. Gershuni, Elliot S. Friedman, Ceylan Tanes, Adoma Boateng, William J. Mitchell, Kathleen O’Connor, Kyle Bittinger, Natalie A. Terry, Christina Bales, Lindsey Albenberg, Gary D. Wu
Bile acids play a fundamentally important role in nutrient absorption through the emulsification and solubilization of fat in the small intestine. Additionally, they regulate mammalian physiology via activation of nuclear hormone and G-protein coupled receptors.1 Amino acid conjugation of bile acids to either glycine or taurine increases their solubility and reduces epithelial passive absorption, thereby preserving high levels of functional bile acids in the small intestine.2 Bacterial bile salt hydrolases (BSHs) are responsible for the rate-limiting step of bile acid deconjugation which is followed by conversion of primary into secondary bile acids via bacterial dehydroxylation.3 While these processes occur normally in the colon, deconjugation of bile acids may occur abnormally in the small intestine. This is clinically relevant in patients with small intestinal bacterial overgrowth (SIBO), where a high deconjugated bile acid load may lead to reduced nutrient absorption and lipid malabsorption.4 SIBO occurs when there is an abnormally high biomass of the gut microbiota in the small intestine which may lead to altered bile acid profile, carbohydrate fermentation, nutrient competition, and epithelial dysfunction. The pathophysiologic effects of SIBO are particularly deleterious in patients with short bowel syndrome (SBS) who are already at risk for poor nutrient assimilation.
Breathing new life into clinical testing and diagnostics: perspectives on volatile biomarkers from breath
Published in Critical Reviews in Clinical Laboratory Sciences, 2022
Jordan J. Haworth, Charlotte K. Pitcher, Giuseppe Ferrandino, Anthony R. Hobson, Kirk L. Pappan, Jonathan L. D. Lawson
Hydrogen and methane breath tests (HMBTs) are widely used for the diagnosis of SIBO. The development of SIBO is associated with motility disorders, after effects of surgery, structural disease, and stomach acid-suppression (i.e. achlorhydria or use of proton pump inhibitor drugs) [36]. There is no established gold standard investigation for SIBO [37]. Microbial culture of a jejunal aspirate has been used but is invasive, expensive, and not widely performed in clinical practice. In addition, aspirate cultures pose high risks of both false positives, through contamination by oral bacteria or saliva, and false negatives, through irregular distribution of bacteria through the bowel causing aspiration of a non-representative sample or of cultivation-resistant species [38]. Consequently, the use of HMBT for the assessment of SIBO has been widely adopted in clinical practice as a safe and noninvasive alternative.
Assessment of small intestinal bacterial overgrowth in chronic pancreatitis patients using jejunal aspirate culture and glucose hydrogen breath test
Published in Scandinavian Journal of Gastroenterology, 2021
Rajesh Sanjeevi, Kapil Dev Jamwal, Sudipta Dhar Chowdhury, Balamurugan Ramadass, R. Gayathri, Amit Kumar Dutta, Anjilivelil Joseph Joseph, Balakrishnan S. Ramakrishna, Ashok Chacko
Chronic pancreatitis is a syndrome of chronic progressive pancreatic inflammation and scarring, leading to irreversible damage of the pancreas with resultant loss of exocrine and endocrine function [1]. Pancreatic exocrine insufficiency (PEI) is an under-recognized problem amongst patients with chronic pancreatitis [2]. Destruction of pancreatic acini reduces pancreatic enzyme secretions resulting in PEI. Though lipid digestion is predominantly affected, PEI can also lead to carbohydrate and protein maldigestion [3]. PEI can lead to bloating, steatorrhoea or diarrhea and significantly impair the quality of life [4]. Changes in pancreatic exocrine function have been shown to produce changes in microbial diversity within the gastrointestinal tract [5]. One such pathological form of microbial dysbiosis that occurs in chronic pancreatitis is small intestinal bacterial overgrowth (SIBO). SIBO has been defined as a clinical syndrome caused by the presence of an excess amount of bacteria in the small bowel [6]. Symptoms of SIBO can mimic symptoms of PEI. Factors that predispose chronic pancreatitis patients to SIBO include decreased pancreatic proteolytic enzymes, use of narcotics, ethanol use, use of proton pump inhibitors (PPIs) and diabetic neuropathy [7–10].