Log-transformed total microbial loads spanned 5 logs and were normally distributed. Using quantitative sequencing, we evaluated total and taxon-specific absolute microbial loads from 250 duodenal-aspirate samples and 21 paired duodenum-saliva samples from participants in the REIMAGINE study. The small intestine is the major site for immune surveillance in the gut, and compared with the large intestine, it has greater than 100 times the surface area and a thinner and more permeable mucus layer. Although large-intestine microbiota have been linked to several GI diseases, the microbiota of the human small intestine and its relation to human disease has been understudied. Upper gastrointestinal (GI) disorders and abdominal pain afflict between 12 and 30% of the worldwide population and research suggests these conditions are linked to the gut microbiome. Early recognition and diagnosis of SIBO is critical in minimizing patient morbidity and mortality. Presentation of severe SIBO in the setting of intestinal stasis secondary to gastric outlet after initiation of enteral feeds is a rare phenomenon. Histologic findings were consistent with SIBO. Surgical exploration confirmed segmental bowel necrosis requiring resection. Imaging revealed diffuse pneumatosis and portal venous gas. Here we describe a severe case of SIBO leading to small bowel necrosis requiring surgical intervention.Ī 55-year-old Hispanic female with gastric outlet obstruction secondary to a newly diagnosed gastric adenocarcinoma, receiving neoadjuvant chemotherapy, developed bloody gastrostomy output and rapidly progressing nausea and abdominal distention 3 days after jejunostomy tube placement and initiation of jejunal enteral nutrition. In cases of primary SIBO without any complicating factors, the prognosis is usually good.Small intestinal bacterial overgrowth (SIBO) is a condition of unknown prevalence characterized by an excessive amount of bacteria in the small bowel, typically resulting in vague gastrointestinal symptoms with bloating being most commonly reported. Tylosin (Tylan®), oxytetracycline and metronidazole (Flagyl®) are common antibiotic choices that are usually combined with special diets to treat this condition. Many cases respond to long term antibiotics. SIBO is frequently associated with exocrine pancreatic insufficiency (EPI). Many cases are idiopathic (unknown cause). Dogs with malabsorption often do not have as voracious an appetite and the diarrhea is usually not as voluminous as EPI. Specific blood and fecal tests are necessary to differentiate EPI and SIBO. Most dogs will have a normal or increased appetite but continue to lose weight.Ĭan it be differentiated from pancreatic insufficiency based on the symptoms? The principal sign is weight loss with chronic diarrhea. What are the common clinical signs of malabsorption? See handout “Exocrine Pancreatic Insufficiency in Dogs” for more information about this condition. These problems are frequently associated with exocrine pancreatic insufficiency (EPI) but SIBO can occur either with or without EPI. German Shepherds appear to have a higher incidence of malabsorption problems. However, with bacterial overgrowth the diarrhea is chronic in nature, often lasting weeks or months.Īre some dogs more susceptible than others? Malabsorption and SIBO both result in diarrhea, similar to that associated with enteritis. Is this the same as an infection causing enteritis? The bacteria cause damage to the absorptive surface of the bowel so digested food cannot be absorbed through the bowel and into the body, resulting in malabsorption of nutrients. The major concern with bacterial overgrowth is the development of a condition called small intestinal bacterial overgrowth (SIBO). What is malabsorption and bacterial overgrowth?īacterial overgrowth is a condition of the small intestine resulting in increased numbers of bowel bacteria.
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