Intestinal Bacterial Overgrowth Syndrome Research Articles

Нарушение микробиоценоза толстого кишечника и частота синдрома избыточного бактериального роста у больных хроническими воспалительными заболеваниями кишечника

Актуальность. В настоящее время хронические воспалительные заболевания кишечника (ХВЗК), яркими представителями которых являются болезнь Крона (БК) и неспецифический язвенный колит (НЯК), в связи с высокой распространенностью и заболеваемостью, тяжестью течения заболевания и трудностями диагностики остаются одной из наиболее сложных и нерешенных проблем современной гастроэнтерологии. К сожалению, и сегодня этиология ХВЗК точно неизвестна, однако наиболее вероятной считают гипотезу иммунного «гиперответа», вызванного факторами окружающей среды к измененной микробиоте кишечника или патогенным микроорганизмам у генетически склонного хозяина. Изменения микробиоты при ХВЗК общепризнанны, а их исследование имеет большое значение для более глубокого понимания этиологии и патогенеза этих заболеваний и поиска новых альтернативных методов лечения. Именно поэтому исследования дисбиоза кишечника при ХВЗК привлекают все большее внимание ученых всего мира. Цель исследования: исследовать особенности дисбиоза кишечника и частоту синдрома избыточного бактериального роста (СИБР) у пациентов с ХВЗК в зависимости от нозологии и пола. Материалы и методы. Проведено обследование 46 больных ХВЗК в возрасте от 20 до 79 лет, в среднем (47,4 ± 2,4) года. В зависимости от нозологии все пациенты были разделены на 2 группы. Первую составляли 15 пациентов с БK, вторую — 31 больной НЯК. Среди пациентов было 19 женщин и 27 мужчин. Всем больным был проведен водородный дыхательный тест (ВДТ) для выявления СИБР и бактериологическое исследование кала. Результаты. Микробиологические исследования выявили наличие глубоких изменений качественного и количественного состава микрофлоры толстой кишки у 97,8 % больных ХВЗК, с преобладанием дисбиоза II степени у 48,4 % больных НЯК и дисбиоза II и III степени у 33,3 % больных БК. Эти изменения были обусловлены уменьшением количества бифидо- и лактофлоры, повышением концентрации условно-патогенных микроорганизмов и дрожжеподобных грибов. Результаты, полученные при проведении ВДТ, свидетельствуют о высокой частоте СИБР у пациентов с ХВЗК (50 %). При анализе данных выявлено, что СИБР преимущественно определялся у больных НЯК (51,6 %). По гендерному признаку в обеих нозологических группах больных с выявленным СИБР преобладали мужчины. Выводы. Полученные результаты свидетельствуют о том, что практически всем больным с ХВЗК присущи изменения микробиоты кишечника, главным образом за счет резкого снижения численности основных симбионтов толстокишечного микробиоценоза и роста концентрации условно-патогенной микрофлоры. Микробиологическое исследование кала и ВДТ являются самыми доступными неинвазивными методами, позволяющими быстро выявить нарушения микрофлоры кишечника.

Small Intestinal Bacterial Overgrowth Syndrome Is Not Associated With Thermal Food Processing Pattern

Abstract Objectives To compare the patterns of thermal food processing methods in patients with and without the syndrome intestinal bacterial overgrowth (SIBO). Methods It was retrospective single-center study. Data of patients with lactulose breath test GastroCheck Gastrolyser (Bedfont, UK) and diet assessment (24-hours dietary recall) were enrolled. Those with excessive production of hydrogen, methane, both or neither gases were identified. All dishes and products consumed by a patient we divided to 6 categories depending on thermal food processing method: those that were not processed (raw) (Cat-r), boiled (Cat-bl), fried (Cat-f), stewed (Cat-s), baked (Cat-bk) in the oven or grilled (Cat-g). To analyze the structure of thermal food processing, we divided the weight of all products or dishes that underwent specific method of processing to the total weight of the food consumed. The pattern of thermal food processing within each group was obtained as a quotient of the total percentage (by weight) of the food processed with the certain method by the number of patients in the group. Results The data of 1200 patients were available for the final analysis: 640 patients in the SIBO-H2 group, 162 in the SIBO-CH4 group, 270 in the SIBO-CH4-H2 group, and 128 patients in the control group. The distribution of thermal food processing categories was as follows: in patients with SIBO-H2 (Cat-r: 45.3 ± 17.2%, Cat-bl: 31.8 ± 15.6%, Cat-s: 3.5 ± 7.7%, Cat-f: 6.5 ± 10.5%, Cat-bk: 12.4 ± 10.3%, Cat-g 0.3 ± 3.3%); with SIBO-CH4 (Cat-r: 47.2 ± 16.6%, Cat-bl: 29.5 ± 15.1%, Cat-s: 4.3 ± 7.4%, Cat-f: 5.8 ± 10.0%, Cat-bk: 12.4 ± 10.3%, Cat-g: 0,4 ± 3,9%); with SIBO-CH4-H2 (Cat-r: 45.5 ± 16.3%, Cat-bl: 31.0 ± 16.1%, Cat-s: 4.0 ± 8.0%, Cat-f: 5.4 ± 9.9%, Cat-bk: 13.4 ± 11.0%, Cat-g: 0.3 ± 2.2%); in the control group (Cat-r: 44.8 ± 16.8%, Cat-bl: 32.4 ± 16.4%, Cat-s: 3.0 ± 6.5%, Cat-f: 5.2 ± 7.7%, Cat-bk 14.1 ± 10.4%, Cat-g: 0.2 ± 1.9%). No significant difference was found between the study groups and the control group by mean percentage of raw, boiled, stewed, fried, baked and grilled food intake. Conclusions We found no association between thermal food processing patterns and SIBO. Funding Sources The study was supported by Russian Scientific Foundation grant No. 19-76-30014.

Irritable Bowel and Bacterial Overgrowth Syndromes: a Bacterial Link Hypothesis of Functional Disease

Aim. Assessment of the irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth syndrome (SIBO) interlinkage.Key points. SIBO may represent a "peripheral" mechanism of IBS, aside to nonspecific inflammation, increased epithelial permeability and local immune system activation. In various assays, the SIBO rate in IBS patients was 4-46% vs. 0-13% in an intact cohort. A limited diagnosability of SIBO obscures the SIBO-IBS causal interplay. Impaired motility in IBS may predispose to the SIBO development. Proinflammatory cytokines and mediators in SIBO, in turn, provoke visceral hypersensitivity and intense motility, the key IBS factors. Both conditions relate to qualitative and quantitative changes in microbiota, which warrants the application of probiotic Lactobacillus and Bifidobacterium strains.Conclusion. Further research into the SIBO-IBS interface is required for developing optimal probiotic-based therapies.

Small Intestinal Bacterial Overgrowth Syndrome

Abstract Small intestinal bacterial overgrowth syndrome (SIBO) is a heterogeneous syndrome characterized by an increase in the number and/or presence of atypical bacteria in the small intestine. Aetiology of SIBO is usually complex, associated with disorders of protective antibacterial mechanisms such as achlorhydria, pancreatic exocrine insufficiency, immunodeficiency syndromes and anatomical abnormalities such as small intestinal obstruction, diverticula, fistulae, surgical blind loop, previous ileo-caecal resections and motility disorders. Clinical signs of SIBO may be non-specific. Most often there is dyspepsia, diarrhoea, bloating and abdominal discomfort. SIBO can sometimes lead to malebsorption, severe malenutrition and/or other syndromes associated with nutritional deficiency. The gold standard for diagnosing SIBO is still microbial investigation of jejunal aspirates. Non-invasive hydrogen breath tests are most commonly used for diagnosis of SIBO. Therapy for SIBO must be complex. It should include treatment of the underlying disease, nutritional support and cyclical gastro-intestinal selective antibiotics. Prognosis is usually serious, determined mostly by the underlying disease that led to SIBO.

Pn-Heterojunction of the SWCNT/ZnO nanocomposite for temperature dependent reaction with hydrogen

A hydrogen breath test is a non-invasive and safe diagnostic tool to explore the functional gastrointestinal disorders. For the diagnosis of small intestinal bacterial overgrowth syndrome as well as carbohydrate malabsorption such as fructose, lactose, and sorbitol malabsorption, a hydrogen breath test is considered one of the gold criterions. Since the more sensitive hydrogen sensor enables the more accurate prediction about the disease, many efforts have been to the development of the high performance H2 sensor. Herein, we fabricate the pn-junction type composite sensors using single wall carbon nanotube (SWCNT) and zinc oxide and thoroughly investigate their hydrogen sensing properties at various temperatures. We discuss the origin of sensing performance enhancement mechanism in the composite sensors, while the composite sensor with high H2 sensing performance, linearity, repeatability, and selectivity can be prepared.

Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome - An Update.

Small intestinal bacterial overgrowth (SIBO) is one manifestation of gut microbiome dysbiosis and is highly prevalent in IBS (Irritable Bowel Syndrome). SIBO can be diagnosed either by a small bowel aspirate culture showing ≥103 colony-forming units (CFU) per mL of aspirate, or a positive hydrogen lactulose or glucose breath test. Numerous pathogenic organisms have been shown to be increased in subjects with SIBO and IBS, including but not limited to Enterococcus, Escherichia coli, and Klebsiella. In addition, Methanobrevibacter smithii, the causal organism in a positive methane breath test, has been linked to constipation predominant irritable bowel syndrome (IBS-C). As M. smithii is an archaeon and can overgrow in areas outside of the small intestine, it was recently proposed that the term intestinal methanogen overgrowth (IMO) is more appropriate for the overgrowth of these organisms. Due to gut microbiome dysbiosis, patients with IBS may have increased intestinal permeability, dysmotility, chronic inflammation, autoimmunity, decreased absorption of bile salts, and even altered enteral and central neuronal activity. As a consequence, SIBO and IBS share a myriad of symptoms including abdominal pain, distention, diarrhea, and bloating. Furthermore, gut microbiome dysbiosis may be associated with select neuropsychological symptoms, although more research is needed to confirm this connection. This review will focus on the role of the gut microbiome and SIBO in IBS, as well as novel innovations that may help better characterize intestinal overgrowth and microbial dysbiosis.

РАСПРОСТРАНЕННОСТЬ СИНДРОМА ИЗБЫТОЧНОГО БАКТЕРИАЛЬНОГО РОСТА ТОНКОЙ КИШКИ У ДЕТЕЙ С РАЗЛИЧНЫМИ ФУНКЦИОНАЛЬНЫМИ АБДОМИНАЛЬНЫМИ БОЛЕВЫМИ РАССТРОЙСТВАМИ

Функциональные гастроинтестинальные расстройства занимают одно из ведущих мест в структуре патологии органов пищеварения у детей. Основополагающим документом по диагностике и лечению функциональных гастроинтестинальных расстройств у пациентов разного возраста являются Римские критерии IV. Целью работы было изучить распространенность синдрома избыточного бактериального роста тонкой кишки у детей школьного возраста с различными функциональными абдоминальными болевыми расстройствами. Было обследовано 230 детей с функциональными абдоминальными болевыми расстройствами: 110 пациентов младшего школьного возраста и 120 детей старшего школьного возраста. Установлено, что развитие функциональных абдоминальных болевых расстройств ассоциировано с наличием синдрома избыточного бактериального роста в тонкой кишке у детей как младшего, так и старшего школьного возраста.

Intestinal dysbiosis, obesity and metabolic syndrome: how to quit this tricky triangle?

The paper presents analysis of the data of worldwide literature, results of evidence-based experimental and clinical trials on the relationship between dietary habits and intestinal microbiota. The particular attention is paid to the involvement of intestinal dysbiosis and small intestinal bacterial overgrowth syndrome in the pathogenesis of obesity and metabolic syndrome. The arguments in favour of two leading hypotheses have been outlined: hypothesis of metabolic endotoxemia and «storage» hypothesis. The first one considers mechanisms of the effects of lipopolysaccharide Gram-negative intestinal flora, increased permeability of intestinal wall, endocannabinoid system, and intestinal alkaline phosphatase. The «storage» hypothesis takes into account the peculiarities of food polysaccharides’ fermentation, monosaccharides’ absorption, and the role of intestinal microbiota and metabolites of its vital activity (in particular, short-chain fatty acids) in the regulation of lipid metabolism. Particular attention is paid to the treatment: dietary changes, the use of pro- and prebiotics, fecal transplantation. The effects of food components on the intestinal microbiota have been analysed, including the dietary fiber, such as resistant starch and inulin, and fats and proteins. It has been shown that the composition of the intestinal microbiota reflects the dietary habits and composition of the diet. A high-fat diet dramatically increases the intestinal permeability due to a mechanism associated with reduced expression of proteins of epithelial tight junction, including zonulin and occludin. The substantiation has been given to the hypothesis that the intestinal microbiome associated with obesity has an increased ability to receive energy from food («accumulation effect»). Benefits of an antibiotic with a low intestinal absorption (rifaximin) have been analysed. The results of studies supporting the eubiotic properties of rifaximin and its effectiveness at intestinal dysbiosis have been presented.

Frequency and features of gut dysbiosisin patients with obesity and diabetes mellitus type 2

Background. A large difference in the composition of gut microbiota (GM) in healthy people, obese pa­­tients and patients with diabetes mellitus (DM) suggestsgut dysbiosis can have a significant role in the development of both obesity and type 2 diabetes and its complications and consequences. Nevertheless, the question of whether these changes in GM cause or result of obesity and diabetes is still open. The aim study was to examine the prevalence and characteristics of gut dysbiosis, as well as small intestinal bacterial overgrowth syndrome (SIBO) in patients with obesity and type 2 diabetes of varying degrees of severity. Material and methods. 97 patients were examined, of which 33 with obesity (1 group), 64 patients with type 2 diabetes (group 2) aged 30—72 years, and 30 healthy controls (group 3). In all patients, based on the bacteriological examination of the feces, the quantitative and qualitative composition of colon microbiotawas evaluated by Epstein-Litwak R. V. and Vilshansky O. F. method. At the same time, in the feces, the quantitative content of Bifidobacteria, Lactobacilli, Enterobacteria, Proteus, Staphylococci, Candida, etc. were studied, with stratification ofdysbiosis on 4 deg­rees of severity. The microbial composition at the level of the main microbial phylotypes was studied by identifying the total amount of DNAs, with DNAs of Firmicutes, Bacteroidetes, and Actinobacteria were quan­tified based on RNA in real-timePCR. The composition of the small intestine microbiotawas determined in­­directly by the presence of SIBO, diagnosed with the H2-lactulose breath test. Results and discussion. In majority of patients with obesity and type 2 diabetes, changes in quantitative and qualitative composition of GM were noted, de­­pending on body mass index and severity of diabetes. Thus, gut dysbiosis of varying degrees was found in 84.8 % of obese patients and 93.8 % of patients with diabetes, which is believed to exceed its frequency in the control group (40 %). The severity of gut dysbiosis correlated with the presence of obesity and the severity of diabetes. Thus, gut dysbiosis of the 2nd and 3rd degree in patients with moderate-to-severe diabetes was present more often than in patients with mild diabetes or obesity without diabetes. Relative content of the main microbial phylotypes significantly differs in healthy people compared with obese and diabetes patients, as well as at varying degrees of severity of diabetes. Thus, Firmicutes content in obese and diabetic patients was significantly higher, and the Bacteroidetes content was significantly lower than normal. As the severity of diabetes increased, Firmicutes content also increased significantly, while the content of Bacteroidetessignificantly declined. SIBO was detected in 30.3% of obese patients, 45.3% of patients with diabetes and 6.6% of healthy individuals. SIBO were more likely to be detected with a history of diabetes for more than 10 years, decompensation of diabetes and the presence of autonomous diabetic neuropathy. Conclusions. Abnormalities of GM, in particular, increase of Firmicutes and decline of Bactero­idetes ­content, can have pathogenic role in the development of diabetes, and also contribute to worsening of its compensation and natural course. In many patients with obesity and DM, there is gut dysbiosis and SIBO which may also contribute to the sub-and decom­pensation of diabetes and the development of auto­nomic diabetic neuropathy.

Small Intestinal Bacterial Overgrowth Syndrome as a Risk Factor for Ventricular Tachycardia in Chronic Heart Failure with Left Ventricular Systolic Dysfunction

Aim.To identify the relationship between rhythm disturbances, including ventricular tachycardia (VT), and the small intestinal bowel bacterial overgrowth syndrome in chronic heart failure (CHF) with left ventricular systolic dysfunction.Materials and methods.The study included 60 patients with CHF with systolic dysfunction of the left ventricle (left ventricular ejection fraction less than 50 %). Conventional biochemical and hematological tests , ECG and echocardiography were performed. The level of the N-terminal fragment of the brain natriuretic peptide (NT-proBNP) and nonspecific inflammatory markers (C-reactive protein (CRP), fibrinogen, leukocytes, lymphocytes, neutrophil to lymphocyte ratio) were studied. Lactulose hydrogen breath test was fulfiled to detect the small intestinal bowel bacterial overgrowth syndrome (SIBOS). In the presence of complaints of palpitation and interruptions in the heart work or other indications, Holter ECG monitoring was performed. The control group consisted of 20 patients comparable to the main group by sex, age and major diseases in the absence of CHF and SIBOS.Results.The prevalence of SIBOS among patients with CHF significantly exceeded its prevalence in the group of patients without CHF (SIBOS was detected in 25 of 60 patients with CHF (42 %) and in 2 of 22 patients without CHF (9 %); p = 0.0034). The small bowel bacterial overgrowth syndrome with CHF did not have a significant impact on the functional class and the indicators of clinical and biochemical analysis of blood as well as on echocardiographic data and the number of supraventricular and ventricular extrasystoles. However, in patients with SIBOS, higher CRP values were observed (median and interquartile range: 3.6 (2.5; 4.1) vs 2.15 (0.4; 5.1); p = 0.041). In addition, among patients with CHF and a positive SIBOS test, ventricular tachycardia was significantly more common (in 45 % of patients with SIBOS and in 10.71 % of patients without SIBOS; p = 0.01555). The presence of SIBOS increased the risk of VT in patients with CHF (OR = 6.818, 95 % CI: 1.542 - 30.153; P = 0.011)). The development of VT in patients with SIBOS was associated rather with systemic inflammation than with the severity of CHF characterized by high NTproBNP numbers, while in the absence of SIBOS the opposite trend was noted.Conclusion.The development of VT in patients with SIBOS is associated rather with systemic inflammation rather than with the severity of CHF. SIBOS can be considered as an additional risk factor in the development of systemic inflammation and ventricular tachycardia in patients with CHF.

The peculiarities of using and reading of hydrogen breath test results with lactose load in young children and their mothers

Purpose of the work is to evaluate efficacy of using hydrogen breath test with nutritional lactose load among young children and their mothers and correlation of the test results with manifestation of functional gastrointestinal disorders in children. Materials and methods . Hydrogen breath test with nutritional lactose load, genetic marker C (-13910)T of the gene MCM6 investigation by buccal scraping, microbiological investigation of stool were carried out in 32 young children between 1 month and 2 years of age with different manifestations of functional gastrointestinal disorders. HBT was carried out in mothers of investigated children. Results. 18.8 % of children had positive HBT (lactose intolerance – LI), 31.2 % of young children had doubtful result (small intestinal bacterial overgrowth syndrome – SIBO). Positive results of HBT were received in 43.7% of cases, doubtful ones were received in 9.4 % of women among mothers of investigated children. Maximal level of hydrogen in children with LI is 45.5 (40.0–53.0) ppm, it has been fixed on the 180 th (150–180) minute, that is likely later than in adults. Investigation of children intestinal microbiota showed decreasing of bifidobacteria and lactobacteria in 43.8% of cases and increasing of opportunistic flora in 93.8 % against this background including K. pneumoniae – 46.9 %, S. aureus – 53.1%, K. oxytoca – 18.8 %, E. Coli – 31.2 %, E. Faecalis – 6.2 %, E. Cloacae – 6.2 %, Clostridia – 9.4 %, C. freundi – 6.2 %. Almost all children (93.8 %) were carriers of the main allele C with equal relations (in 46.9 %) between the genotypes C/C and C/T and absence of significant correlation with results of HBT according to the investigation of lactase intolerance genetic marker C (-13910)T. Conclusions. The performed investigations have proved that associations of different opportunistic flora including S. aureus and K. pneumoniae on the background of decreasing of lactobacteria (50.0 %) with the high rate of functional diarrhea and intensity of manifestations of regurgitation syndrome, were revealed in many young children with SIBO (80.0 %) and LI (83.3 %). The lack of statistically significant correlations between the results of HBT in children and their mothers, as well as with genetic marker C (-13910) T of the gene MCM6 investigation demonstrates low level of information content of these investigations for the evidence of transient lactose intolerance in young children.

THE INFLUENCE OF BACTERIAL OVERGROWTH SYNDROME ON THE EFFECTIVENESS OF ANTI-HELICOBACTER THERAPY IN PATIENTS WITH CHRONIC GASTRITIS AND TYPE 2 DIABETES MELLITUS

Diabetic neuropathy often results in dysmotility of the gastrointestinal tract that induces further changes in its microbiotic spectrum. This can influence the course of concomitant diseases not related to diabetes mellitus and determine the effectiveness of their treatment. Aim: to investigate the effectiveness of anti-Helicobacter therapy in patients with chronic gastritis and concomitant type 2 diabetes, considering small intestinal bacterial overgrowth syndrome. Materials and methods: 64 patients with chronic Helicobacter pylori-positive gastritis were examined, 34 out of them had type 2 diabetes mellitus. Pantoprazole 40 mg, clarithromycin 500 mg, amoxicillin 1000 mg bid were prescribed to all the patients for 10 days. Before the treatment, on the 14th and 28th days of the therapy, a hydrogen breath test with lactulose to reveal small intestinal bacterial overgrowth, gastrointestinal symptoms monitoring, and re-determining Helicobacter pylori focal antigen on 28th day were performed. Results: on the 14th day of the treatment a decrease in the pain syndrome (n=28, 93% vs. n=10, 33%; p> 0.05), postprandial fullness (n=14, 47% vs. n = 4, 13% p>0.05) and nausea (n=13, 43% vs. n=4, 13% p>0.05) was observed among the non-diabetic patients with chronic gastritis. No statistical significance regarding abdominal pain regressing in patients with type 2 diabetes mellitus was found (n=16, 47% vs. n=9, 26%), postprandial fullness did not change noticeably (n=27, 79% vs. n=26, 76%), while the frequency of nausea increased (n=14, 41% vs. n=18, 53%). The incidence of small intestinal bacterial overgrowth significantly increased compared with the data before the therapy (n=16, 47% vs. n=27, 79%; p>0.05) and with non-diabetic patients (n = 15, 50% vs. n = 27,79%; p> 0.05). The effectiveness of H. pylori therapy was higher among patients without diabetes mellitus (77% vs. 65%). Conclusions: it has been found out anti-Helicobacter therapy is less effective in the patients with chronic gastritis and concomitant type 2 diabetes mellitus that is accompanied by the enhancement of bacterial overgrowth syndrome and associated with worse clinical dynamics compared to patients without carbohydrate metabolism disorders.

ASSOCIATION OF INTESTINAL BACTERIAL OVERGROWTH AND DISEASES OF HEPATOBIARY TRACT

The aim. Find out the nature of the changes of the hepatobiliary system in patients with intestinal bacterial overgrowth and study the possible mechanisms of their association.Materials and methods. 148 patients with intestinal bacterial overgrowth and intestinal dysbiosis were examined. The level of total cholesterol, cholestasis and cytolysis markers was determined in the blood using the analyzer «Labsystems» (Finland). Intestinal bacterial overgrowth syndrome was assessed using a hydrogen breath test with lactulose on the LactophaH2 apparatus of AMA (St. Petersburg). Intestinal dysbiosis was determined by plating feces on nutrient media. Bile acids in bile were determined on the AmazonX mass spectrometer (Bruker Daltonik GmbH, Bremen, Germany). Ultrasound examination of the abdominal cavity performed with the apparatus «SHIMADZU SDN-500» (Japan). Liver elastography was performed using the AIXPLORER apparatus (France).Results. The syndrome of intestinal bacterial overgrowth in 67% of cases was established in the presence of ileocecal insufficiency, in 33% of cases — with preserved ileocecal function. The combination of intestinal bacterial overgrowth syndrome and intestinal dysbiosis was detected in 81,8% of patients. The majority of the examined patients showed clinical symptoms of damage the hepatobiliary system and intestines, which was confirmed by change laboratory parameters — increase the level of total cholesterol, markers of cholestasis and cytolysis compared with the control group. In the study of bile acids in bile, decrease free (mainlycholic) and increase conjugated (glycodesoxycholic, taurodesoxycholic, glycocholic, taurocholic) bile acids was observed compared with the control group. In general, patients with the syndrome of intestinal bacterial overgrowth revealed the presence of non-calculous cholecystitis — in 11,5% of cases, I stage of cholelithiasis — in 25,7%, II stage of cholelithiasis — in 18,9%, non-alcoholic fatty liver disease on stage steatosis and steatohepatitis — in 43,9% of cases.Conclusion. Intestinal bacterial overgrowth syndrome is the beginning of bacterial translocation, which is the triggering factor in inflammation of the liver and biliary tract. In turn, diseases of the hepatobiliary system contribute to the development of intestinal dysbiosis by reducing the synthesis of bile acids with antibacterial action, as well as violations of their excretion. Thus, strong association of intestinal bacterial overgrowth syndrome with damage to the hepatobiliary system has been established.

Роль короткоцепочечных жирных кислот в оценке состояния микробиоценоза

Aim of investigation: to study the content and qualitative profile of shot-chain fatty acids in feces and blood serum in patients with NAFLD of different stages as indicators of intestinal microbiocenosis status and systemic lipid metabolism, and to evaluate the effectiveness of course antibacterial (rifaximin) and prebiotic (psyllium) therapy in the period of 6 months for the correction of gut microbiocenosis disorders. Material and methods: The survey included 115 patients (82 (71,3%) men, 33 (28,7%) women) with NAFLD of different stages (steatosis - 40 people, nonalcoholic steatohepatitis (NASH) of minimal activity - 30 people, NASH of moderate activity - 30 people, liver cirrhosis class A Child-Pugh - 15 people) at the average age of 51,83±8,48 years old. All the patients were examined by research of short-chain fatty acids (SCFA) using gas-liquid chromatographic analysis in various biological substrates (blood serum and feces). According to the management scheme, the patients with NAFLD were divided into 3 groups. The first group of 30 people (on the background of lifestyle modification) received a 6-month intake of psyllium. The second group of 35 people in addition to lifestyle modification received a 7-day course of rifaximin (7 - days/800 mg/d) and psyllium during the period of observation (6 months). The third group of 35 people received standard therapy of NAFLD without pharmacotherapy aimed to correction of gut microbiocenosis disorders. In the course of treatment the frequency and severity of clinical manifestations of intestinal bacterial overgrowth syndrome (SIBO) reduced in patients of groups 1 and 2 (in group 1 the complaints on abdominal pain and flatulence decreased by 11%, in group 2 - by 37%, the normalization of stool occurred in both groups), SIBO was not detected according to the results of the hydrogen breath test with lactulose, the level of total endotoxin was determined within normal values. Negative dynamics was noted in group 3: the increase in the number of complaints of abdominal pain by 16%, flatulence and unstable stool - by 10%, the frequency of registration of SIBO increased by 20%, increased level of total endotoxin was detected in 5.7% of patients. Results. The absolute concentration of SCFA in feces in patients with NAFLD (steatosis) is reduced, in patients with NASH of minimal activity, NASH of moderate activity and liver cirrhosis is increased, in the profile of C2-C4 acids there was the increase in the share of propionic and butyric acids and the decline in the share of acetic acid, the anaerobic index (AI) deflected in the region of strongly negative values, the total relative content of isoacids increased in all groups of patients, worsening with the severity of the pathological process (at normal Σ(C2-C6)=10.51±2.50 mg/g, C2=0.634±0.004, C3=0.189±0.001, C4=0.176±0.004, AI= -0.576(±0.012), Σ(isoCn)=0.068±0.004). The obtained results indicate marked changes in the qualitative and quantitative composition of the microflora, the decrease in the number and activity of obligate microorganisms and the increase in facultative and residual anaerobic bacteria. These changes in the microbial landscape lead to the marked disorders in the intestinal phase of lipid metabolism. The absolute concentration of SCFA in serum in patients with NAFLD (steatosis) is reduced, in patients with NASH of minimal activity, NASH of moderate activity is increased, in the profile of C2-C4 acids there is the decrease in the share of propionic acid and the increase in the share of butyric acid, most pronounced in steatosis and NASH of minimal activity. In patients with liver cirrhosis, the absolute concentration of SCFA in serum is increased, in the profile of C2-C4 acids, the share of acetic acid is sharply reduced with an increase in the share of propionic and butyric acids and the total relative content of isoacids. The content of caproic and isocaproic acids is increased in all groups (at normal Σ (C2-C6)=0.195±0.011 mg/g, C2=0.902±0.006, C3=0.071±0.004, C4 = 0.027±0.002, Σ (isoCn)=0.040±0.007, isoC6+C6=0.025±0.004). This fact can be explained by the changes in the functional state of hepatocytes, and, consequently, in the metabolic function of the liver (in particular with respect to lipid metabolism). The clinical efficacy of therapeutic management with the use of drugs aimed at the relief of the intestinal microflora disorders (course of rifaximin (if SIBO is identified) on the background of prolonged ingestion of psyllium) in patients with NAFLD of different stages, is supported by the normalization of the content and profile of SCFA in various biological substrates. In patients of group 3 there was noted the negative dynamics of estimated parameters SCFA. Thus, the results of the undertaken research of the parameters of SCFA in various biosubstrates indicate the marked changes in the intestinal microbiocenosis and their contribution to the development and enhancement of systemic metabolic processes. The inclusion of means aimed at correcting the microecological status disorders in the complex management of NAFLD is not only effective, but also pathogenetically necessary.

The role of in the development of small intestinal bacterial overgrowth syndrome

The role of in the development of small intestinal bacterial overgrowth syndrome

Gastrointestinal Motility and Functional Disorders

Gastrointestinal (GI) motility disorders represent diseases characterized by abnormal, predominantly impaired, sometimes exaggerated, movement of contents through the GI tract due to neuromuscular dysfunctions in the absence of mucosal disease and mechanical causes of impaired passage. By contrast, functional GI disorders represent illnesses, defined only by GI symptoms, which occur in the absence of mucosal or structural abnormality or of known biochemical or metabolic disorders. The first section of this chapter discusses the enteric and extrinsic neural regulation of GI sensorimotor functions and normal GI motility in humans. Disorders such as gastroparesis (including diabetic gastroparesis, idiopathic gastroparesis, and postsurgical gastroparesis), dumping syndrome, intestinal pseudo-obstruction, small intestinal bacterial overgrowth, megacolon (including Hirschsprung disease, toxic megacolon, and colonic pseudo-obstruction), chronic constipation (including defecatory disorders, normal transit constipation, and slow transit constipation), functional dyspepsia, functional diarrhea and irritable bowel syndrome, and fecal incontinence are then discussed in depth. Tables present a comparison of GI motility and functional disorders, the causes of gastroparesis, the etiology of intestinal pseudo-obstruction and fecal incontinence, common medical conditions and medications associated with constipation, and the symptom severity scale in fecal incontinence. Illustrations, graphs, magnetic resonance images, and algorithms are provided. This chapter contains 10 highly rendered figures, 6 tables, 92 references, and 5 MCQs.

Gastrointestinal Motility and Functional Disorders

Gastrointestinal (GI) motility disorders represent diseases characterized by abnormal, predominantly impaired, sometimes exaggerated, movement of contents through the GI tract due to neuromuscular dysfunctions in the absence of mucosal disease and mechanical causes of impaired passage. By contrast, functional GI disorders represent illnesses, defined only by GI symptoms, which occur in the absence of mucosal or structural abnormality or of known biochemical or metabolic disorders. The first section of this chapter discusses the enteric and extrinsic neural regulation of GI sensorimotor functions and normal GI motility in humans. Disorders such as gastroparesis (including diabetic gastroparesis, idiopathic gastroparesis, and postsurgical gastroparesis), dumping syndrome, intestinal pseudo-obstruction, small intestinal bacterial overgrowth, megacolon (including Hirschsprung disease, toxic megacolon, and colonic pseudo-obstruction), chronic constipation (including defecatory disorders, normal transit constipation, and slow transit constipation), functional dyspepsia, functional diarrhea and irritable bowel syndrome, and fecal incontinence are then discussed in depth. Tables present a comparison of GI motility and functional disorders, the causes of gastroparesis, the etiology of intestinal pseudo-obstruction and fecal incontinence, common medical conditions and medications associated with constipation, and the symptom severity scale in fecal incontinence. Illustrations, graphs, magnetic resonance images, and algorithms are provided. This chapter contains 10 highly rendered figures, 6 tables, 92 references, and 5 MCQs.

PREVENTION OF SMALL INTESTINE BACTERIAL OVERGROWTH SYNDROME AFTER RIGHT HEMICOLECTOMY FOR COLON CANCER

Background. One of the reasons of the small intestinal bacterial overgrowth syndrome (SIBOS) is excision of a bauginiyev valve at a rightsided hemicolectomy both in planned and in the emergency order that demands not only restoration of continuity of an intestinal tube, but also a restore of the lost function of the ileocecal valval system. Objective: to develop safe, effective and generally available areflux thin-colonic anastomoses for use in planned (primary anastomosis) and emergency (delayed compression anastomosis) surgery. Materials and methods . New ways of formation the areflux thin-colonic anastomoses in the conditions of the emergency and planned surgery for prophylaxis of development of the SIBOS in a small intestine are suggested. The efficacy of the anastomoses is confirmed by the hydrogen breathing test. Results . A right-sided hemicolectomy at 20 patients with primary anastomosis without areflux structure resulted in 60 % of cases to development of SIBOS in a small intestine, at 19 patients with primary anastomosis with formation of the areflux structure reduced risk of development of the SIBOS to 16 %. When forming of the delayed areflux compression thin-colonic anastomosis by the author’s technique the SIBOS did not develop at 72 % of patients. Conclusions . Bauginiyev valve is an important structure of the human body, whose areflux function must be modeled when right-sided hemicolectomy is performed.

Treatment of helicobacter pylori contamination in patients with type 2 diabetes mellitus with gastroduodenal disorders

Background: The treatment of Helicobacter pylori (HP) infection in patients with diabetes mellitus with chronic gastroduodenal disorders is a substantial problem because of its high incidence.
 Aims: To compare between the effectiveness of triple and optimised consecutive regimens in anti-HP treatment in patients with type 2 diabetes mellitus with gastroduodenal disorders.
 Materials and methods: The study included 54 patients with diabetes mellitus and 64 healthy individuals (the control group) aged 3060 years. Gastroduodenal pathology was confirmed by gastroduodenoscopy; HР contamination was confirming using Marshalls urease method or by finding bacterial antigen in excrements. We studied the dynamics of clinical manifestations using the GSRS scale and showed remission via endoscopy and the effectiveness of HР eradication. We also analysed the effects of anti-HР therapy regimens on the presence of small intestinal bacterial overgrowth syndrome (SIBOS) in patients with diabetes mellitus. SIBOS was diagnosed via the respiratory hydrogen method.
 Results: The use of an optimised consecutive regimen resulted in HР eradication in 85.7% of patients with diabetes mellitus compared with a 65.3% eradication in patients on the triple therapy. Moreover, clinical improvement and endoscopy-confirmed remission were more frequently observed in patients on the optimised consecutive regimen. A statistically significant decrease in the number of patients with SIBOS was found only in patients who underwent the optimised consecutive therapy regimen.
 Conclusions: This study showed that the optimised consecutive therapy regimen was more effective than the triple therapy in HP eradication.

Пищевые паттерны больных с синдромом избыточного бактериального роста в кишечнике

Пищевые паттерны больных с синдромом избыточного бактериального роста в кишечнике