Letzte Aktualisierung am 7. December 2023 von Dr. Michael Zechmann-Khreis
Small intestinal mal-colonization occurs in about 10-20% of the population, so it is not uncommon. This mal-colonization is often the result of untreated or undetected food intolerances, but can also be caused by other diseases or circumstances, such as Crohn’s disease, short bowel syndrome or advanced age.
Bacteria in the gut
Not only in our large intestine, but in the entire digestive tract live bacteria. Depending on the section, different types of bacteria – and we are talking about thousands of different species. At the beginning of the Bacteria of the genus Streptococcus and Lactobacillus tend to be found in the digestive tract, and Clostridia or Bifidobacteria, for example, in the large intestine.
Bacteria usually live in colonies, i.e. they are not isolated on the move, but appear in clusters. While the stomach and At the beginning of the small intestine, tens of thousands of such bacterial colonies can be found, there are several billion in the large intestine. This microbiome (formerly known as the “intestinal flora“) is a very important factor in digestion. The bacteria help us to break down food, defend ourselves against pathogens or produce vitamins for us. Just a few For years, it was assumed that although the intestinal flora was “there”, it was not great importance. Science is slowly beginning to Understanding the relevance of the microbiome. Microbiome research is a young discipline and is still at the very beginning, many new findings can be expected in the coming years.
Bacteria in the wrong section of the intestine cause discomfort
Carbohydrates are absorbed in the small intestine. Everything that is not processed in the small intestine ends up in the large intestine. These two sections of the intestine are separated from each other by the so-called ileocecal valve. If this valve does not close properly or is pushed open by increased flatulence, bacteria from the large intestine can migrate into the small intestine and begin to digest carbohydrates there. This is called “small intestine bacterial overgrowth syndrome” and is abbreviated to“DDFB” or “SIBO” in accordance with the term “small intestine bacterial overgrowth syndrome”. The typical symptoms are flatulence, diarrhea, frequent urge to defecate and defecation, pain and, of course, long-term deficiency symptoms. Symptoms as a result of DDFB usually occur relatively soon after eating, as these bacteria live very far forward in the intestine, i.e. at the beginning of the digestive system.
Symptoms of small intestine colonization
The symptoms are flatulence, diarrhea, frequent urge to defecate and defecation, pain and, of course, long-term deficiency symptoms. The symptoms of small intestinal colonization usually appear relatively soon after eating, as these bacteria live very far forward in the intestine, i.e. at the beginning of the digestive system. The symptoms usually occur 20-30 minutes after eating.
Diagnosis and treatment of small bowel malabsorption
Small intestinal colonization can be very easily detected by an H2 breath test and can be treated well with appropriate antibiotics. For the H2 breath test, glucose or lactulose is used as a test substance if there is a suspicion of small intestinal colonization, but DDFB can also be detected during the fructose H2 test. However, the test interpretations are then different.
For lactulose: Test with 10g lactulose. Is the value has already risen by more than 20 ppm or higher after 90 minutes than the values after 120 or 180 minutes, is a Small intestinal colonization.
For glucose: The test is performed with 50g glucose. An increase of more than 20 ppm from the initial value is generally considered a positive finding. Glucose is absorbed very quickly and often does not even reach the posterior sections of the small intestine, which is why the lactulose test should be preferred for the diagnosis of small intestinal colonization.
A fructose breath test (tested with 25g fructose), which is carried out if fructose intolerance is suspected, can provide information. For this it is important that in the first hour every 10-15 minutes and then approx. every 30 minutes. Results in the measurement curve shows two extreme values, once after approx. 30 minutes and then after once from approx. 110 minutes, one must assume a DDFB and a fructose intolerance. If there is only the first extreme value, you have only one DDFB, if there is only the second extreme value, there is no DDFB, but a fructose intolerance.
Is an intestinal flora analysis useful?
Not really. Home tests only reveal which bacterial genera (but not the diagnostically relevant species or subspecies!) are present in the intestine, especially in the rectum. They cannot make any statement about the different intestinal sections and their colonization.
Figuratively speaking: Imagine you are driving a convertible through a tunnel. Either red trickles in three places in the tunnel, blue or green sand from the ceiling. When the car comes out of the tunnel When you drive out, there is red, blue and green sand in the driver’s compartment. The airstream naturally swirls the sand around and sometimes blows it away. out of the car again. Due to the sand mixture (or from a small sample of the sand mixture) you cannot possibly say where in the Tunnel which sand trickled from the ceiling and also not how much. Say we, you have a lot more green sand in your car. That could mean, that the green sand trickles down at the end, but it could also mean, that it trickled down in enormous quantities at the beginning.
So if you imagine our intestines as a tunnel and the bacteria than colored sand, a home test cannot show where in the intestine how many bacteria of which genus are present.
Treatment of small bowel colonization
Treatment is uncomplicated and is carried out using antibiotics and intestinal flora supplements ( no intestinal flora analysis is necessary for their selection). Of course, it is also important to treat or eliminate the cause of the small intestine colonization. This is because different underlying diseases naturally require different treatment methods.
- Zechmann, M, Masterman, G., “First aid after diagnosis”, 2017, Berenkamp-Verlag; 5th edition
- World J Gastroenterol. 2014 Mar 14;20(10):2482-91. doi: 10.3748/wjg.v20.i10.2482 / Irritable bowel syndrome and small intestinal bacterial overgrowth: meaningful association or unnecessary hype.
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