Small intestinal bacterial overgrowth syndrome
Small intestinal bacterial overgrowth syndrome
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DOI：
10.3748/wjg.v16.i24.2978
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发表时间：
2010-06-28
影响因子：
4.3
通讯作者：
Kopacova, Marcela
中科院分区：
文献类型：
--
作者：
Bures, Jan;Cyrany, Jiri;Kopacova, Marcela
人类肠道菌群形成了一个复杂的多微生物生态系统。其特点是人口密度高，多样性广，相互作用复杂。这种复杂的肠道微生物群的任何不平衡，无论是定性的还是定量的，都可能对包括小肠细菌过度生长综合征（SIBO）在内的大型生物造成严重的健康后果。SIBO被定义为上消化道细菌数量的增加和/或类型的改变。有几种内源性防御机制可以防止细菌过度生长：胃酸分泌、肠道运动、完整的回肠-盲肠瓣膜、肠道分泌物中的免疫球蛋白以及胰腺和胆道分泌物的抑菌特性。SIBO的病因通常是复杂的，与保护性抗菌机制紊乱（如胃酸过少、胰腺外分泌功能不全、免疫缺陷综合征）、解剖异常（如小肠梗阻、憩室、瘘管、手术盲环、以前的回肠盲肠切除术）和/或运动障碍（如硬皮病、糖尿病自主神经病变、放射后肠病、小肠假性梗阻）有关。在一些患者中，可能涉及不止一种因素。SIBO的相关症状有腹胀、腹泻、吸收不良、体重减轻和营养不良。诊断SIBO的金标准仍然是空肠吸入物的微生物检查。无创氢气和甲烷呼吸试验是最常用的诊断SIBO使用葡萄糖或乳果糖。SIBO的治疗必须是复杂的，针对所有病因、症状和并发症，并充分个性化。它应该包括治疗基础疾病，营养支持和周期性胃肠道选择性抗生素。预后通常很严重，主要由导致SIBO的潜在疾病决定。(C) 2010年白石登。版权所有。
Human intestinal microbiota create a complex polymicrobial ecology. This is characterised by its high population density, wide diversity and complexity of interaction. Any dysbalance of this complex intestinal microbiome, both qualitative and quantitative, might have serious health consequence for a macro-organism, including small intestinal bacterial overgrowth syndrome (SIBO). SIBO is defined as an increase in the number and/or alteration in the type of bacteria in the upper gastrointestinal tract. There are several endogenous defence mechanisms for preventing bacterial overgrowth: gastric acid secretion, intestinal motility, intact ileo-caecal valve, immunoglobulins within intestinal secretion and bacteriostatic properties of pancreatic and biliary secretion. Aetiology of SIBO is usually complex, associated with disorders of protective antibacterial mechanisms (e.g. achlorhydria, pancreatic exocrine insufficiency, immunodeficiency syndromes), anatomical abnormalities (e.g. small intestinal obstruction, diverticula, fistulae, surgical blind loop, previous ileo-caecal resections) and/or motility disorders (e.g. scleroderma, autonomic neuropathy in diabetes mellitus, post-radiation enteropathy, small intestinal pseudo-obstruction). In some patients more than one factor may be involved. Symptoms related to SIBO are bloating, diarrhoea, malabsorption, weight loss and malnutrition. The gold standard for diagnosing SIBO is still microbial investigation of jejunal aspirates. Non-invasive hydrogen and methane breath tests are most commonly used for the diagnosis of SIBO using glucose or lactulose. Therapy for SIBO must be complex, addressing all causes, symptoms and complications, and fully individualised. 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. (C) 2010 Baishideng. All rights reserved.