Small intestinal bacterial overgrowth syndrome

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The patient serving as a focus for our discussion had many symptoms and findings characteristic of the proliferation and overgrowth of a bacterial microflora in the small intestine. This syndrome has been recognized by several descriptive terms: blind-loop syndrome (BLS), small intestinal stasis syndrome, contaminated small bowel syndrome, and stagnant loop syndrome. Each emphasizes that alterations in intestinal structure or function permit the development of an abnormal small bowel flora which is the major pathophysiologic determinant of those clinical features which distinguish the syndrome (l-4). The classic syndrome is characterized by megaloblastic anemia due to vitamin B,, deficiency, and weight loss and diarrhea due to fat malabsorption. There are many causes for the syndrome. With each, there is some disruption or normal processes which prevent small intestinal bacterial overgrowth, such as intestinal motility, mucosal antibacterial defenses, and gastric acidity (5). The syndrome may occur at all ages but is primarily recognized in later life. It also may occur in a less florid manner when associated with or superimposed on other disorders of the gastrointestinal tract.