Intestinal dysbiosis is the appearance of a significant number of microbes in the small intestine and a change in the microbial composition of the large intestine. The extreme degree of dysbacteriosis is dysbiosis.
Content
What does this concept include?
Dysbacteriosis is not a diagnosis. This is a symptom, a microflora disorder caused by other pathologies. However, modern medicine has proven that it is impossible to cure the underlying disease without paying attention to restoring the bacterial balance of the intestine.
These or other manifestations of dysbiosis are found in all patients with chronic intestinal diseases, with a sharp change in the nutritional system, exposure to environmental factors, or taking antibacterial drugs.
Symptoms depend on the location of dysbiotic changes. In the colon, the number and properties of microorganisms change, and their aggressiveness increases. The small intestine normally does not contain microorganisms; in case of disturbances, they appear there in significant quantities.
If left untreated, bacteria can even appear in the stomach and blood, which is very dangerous.
Syndrome of increased bacterial colonization of the small intestine
Normally, the environment in the small intestine of healthy people should be sterile. But with modern ecology and food quality, as a rule, streptococci, staphylococci, lactic acid bacilli, other gram-positive bacteria and fungi are found in the upper sections.
The total number of bacteria in the jejunum on an empty stomach should not exceed 10⁴—10⁵ per 1 ml of intestinal contents.
In parts of the small intestine close to the large intestine, the number of microbes increases to 10⁷-10⁸.
Increased numbers of bacteria in the small intestine may be due to three factors:
- increased intake of bacteria into the intestine,
- favorable conditions for their development,
- motor impairments.
Excessive amounts of bacteria enter the small intestine when gastric secretion decreases (anacidic gastritis) and when the ileocecal valve is malfunctioning or is removed.
Conditions favorable for the development of bacteria are created when intestinal digestion and absorption are impaired, as well as when the immune system is weakened.
Disorders of small intestinal motility can be caused by intestinal obstruction (narrowing, adhesions, tumors), diverticula, scleroderma, intestinal pseudo-obstruction, etc.
How does excess bacteria affect digestion?
When bacterial contamination of the small intestine occurs, premature breakdown of primary bile acids occurs. The secondary bile acids formed in this process cause diarrhea and are lost in large quantities in the feces. As a result, gallstone disease may develop.
Toxins released by bacteria bind vitamin B₁₂, which leads to the development of anemia.
In addition, bacterial toxins damage the epithelium of the small intestine and lead to villous degeneration. This disrupts the absorption of microelements, especially fat-soluble vitamins A, D, K.
Almost always, dysbiosis of the small intestine is accompanied by diarrhea (diarrhea). And undigested fats are excreted in the feces and lead to steatorrhea (a large amount of fat in liquid stool).
Colon dysbiosis
All colon microbes are divided into three groups:
- main (bifidobacteria and bacteroides), which make up 90% of all bacteria,
- accompanying (lactic acid bacilli, Escherichia coli, enterococci),
- residual (staphylococci, Proteus, fungi).
And all three groups play their positive role. A group of “beneficial” bacteria ensures the digestion of food and the production of vitamins. And groups of “harmful” bacteria, affecting the immune system, strengthen it.
Dysbacteriosis appears when, for certain reasons, a person’s defense mechanisms are weakened and “harmful” bacteria begin to multiply intensively, suppressing the activity of “useful” ones and having a toxic effect on the body.
Causes
The following factors can cause this state of affairs:
- extreme climatic conditions,
- air pollution from industrial waste,
- infectious diseases,
- diseases of the digestive system,
- parasitism of helminths or protozoa in the intestines,
- poor nutrition (mono-diet, fasting, insufficient fiber),
- consumption of foods containing a lot of dyes, preservatives,
- ionizing radiation (x-ray therapy),
- taking antibacterial drugs, antibiotics, sulfonamides, immunosuppressants, corticosteroids,
- surgical interventions,
- stress,
- long trips.
Antibacterial drugs suppress not only pathogenic microbial flora, but also the growth of normal microflora in the colon. As a result, microbes that have come from outside or are already in the intestines and are resistant to drugs multiply (staphylococci, Proteus, yeast, enterococci, Pseudomonas aeruginosa).
Symptoms
Small changes in the intestinal microflora may be asymptomatic.
Characteristic signs are flatulence, nausea, uneven coloring of stool.
The most commonly reported is recurrent diarrhea, sometimes developing into steatorrhea and B₁₂-deficiency anemia, which can cause degenerative changes in the dorsal horns of the spinal cord and cause neuropathy (which can be manifested by loss of sensitivity of the skin in certain areas).
Pseudomembranous colitis, which is caused by clostridia toxins, is especially dangerous.
This microorganism multiplies when the intestinal microflora is suppressed as a result of treatment with broad-spectrum antibiotics.
The symptoms are described in detail in the article on clostridia .
Diagnostic methods
Direct and indirect methods are used to diagnose small intestinal dysbiosis.
The direct method involves taking duodenal and jejunal contents with a sterile probe and examining it for the presence of bacteria. The number of bacteria exceeding 10⁵/ml is considered excessive. Dysbacteriosis is also indicated by the presence of microorganisms from the large intestine in the small intestine.
During the digestion of carbohydrates, a large amount of gases, including hydrogen, are formed in the colon. This fact served as the basis for the creation of the hydrogen test . The degree of bacterial contamination of the small intestine is directly dependent on the concentration of hydrogen in the exhaled air on an empty stomach.
The normal value is 15 ppm. In case of microflora disturbances, this figure is significantly exceeded.
The composition of bacteria in the intestines is also determined through stool analysis.
You can see about the normal indicators and how to take the test in the article “Coprogram” .
Treatment
To eliminate the problem, comprehensive treatment is necessary, which includes:
- elimination of excessive bacterial contamination of the small intestine,
- restoration of normal microbial flora of the colon,
- improving intestinal digestion and absorption,
- restoration of impaired intestinal motility,
- restoration of immunity.
Recently, an effective and safe treatment method has emerged - fecal transplantation .
Antibacterial drugs
This group of drugs is used only for diseases in which a pronounced growth of microbial flora develops in the lumen of the small intestine, since they suppress normal microorganisms.
These are antibiotics from the group of tetracyclines, penicillins, cephalosporins, quinolones and metronidazole.
They are prescribed in usual doses for 7-10 days.
For diseases accompanied by colon dysbiosis, drugs are selected that have a minimal effect on the “beneficial” microflora and suppress pathogenic microbes.
These include antiseptics: intetrix, ersefuril, nitroxoline, furazolidone, etc.
For severe forms of staphylococcal dysbiosis, antibiotics are recommended: tarivid, palin, trichopolum, as well as biseptol-480, nevigramon.
The drugs are prescribed for 10-14 days, and a stool test must be done at the same time. If fungi are found in it, nystatin or levorin is used.
Bacterial preparations
This group of drugs is prescribed for colon dysbiosis. They can be used without prior antibiotic therapy or after it.
Good results have been recorded when taking: bifidumbacterin, bificol, lactobacterin, bactisubtil, linex, enterol. The course of treatment is 1-2 months.
The drug Hilak forte, which contains waste products of normal microorganisms, has a depressing effect on pathogenic microbial flora. It is prescribed 40-60 drops 3 times a day for 4 weeks in combination with antibacterial drugs or after their use.
Regulators of digestion and intestinal motility
Restoration of the digestive process is achieved by following a therapeutic diet and taking enzyme preparations. Diet 4b is recommended . You can read about remedies for diarrhea here .
In case of disturbances in the functioning of the pancreas, the enzymes Creon and pancitrate are used.
For the treatment of steatorrhea caused by liver dysfunction, drugs containing bile are recommended - panzinorm, digestal, festal, enzistal.
In case of gastrogenic insufficiency of digestion, it is advisable to use panzinorm.
How to eliminate flatulence is described in the article “Flatulence” .
In order to improve the absorption function, Essentiale, Legalon, Kirsil are prescribed.
Imodium (loperamide) and trimebutine (debridate) contribute to the restoration of motor skills.
To increase immunity, general healing procedures and taking vitamins are necessary.
Prevention
The main preventive measures are
- balanced diet,
- healthy lifestyle,
- outdoor recreation,
- rational use of antibiotics and other medications,
- timely treatment of the digestive system.
Medical nutrition
To restore normal intestinal microflora, it is necessary to create an environment favorable for its development. To do this, it is recommended to consume fermented milk products (kefir, acidophilus, yogurt) daily. They delay the development of pathogenic microorganisms.
Increasing fiber and pectin in the diet facilitates the development of beneficial bacteria. In addition, they act as sorbents. Fiber and pectin are found in vegetables and fruits - carrots, beets, pumpkins, apples, plums, melons, etc. Heat treatment or fermentation and salting significantly increases their therapeutic and prophylactic effect.
Carrots are especially beneficial because they contain specific sulfur compounds that stimulate the growth of beneficial intestinal bacteria.
To suppress “harmful” microorganisms, it is good to use berries and fruits with a sweet and sour taste, for example, black currants, strawberries, apples, pomegranates, and cranberries. Spicy vegetables such as onions and garlic also contribute to the suppression process.
For dysbiosis, bread with bran, grains, and sprouted wheat are useful, especially for vitamin B deficiency.
Oatmeal jelly is very useful.
Wash the oat grains, dry them and grind them in a coffee grinder. 2 tbsp. l. pour the resulting powder into a thermos and pour 500 ml of boiling water, leave for 3-4 hours and strain. Drink in small sips throughout the day. In addition, it is necessary to strengthen the barrier function of the stomach. The higher the acidity of the intestinal contents, the more pathogenic bacteria in it will die.
You can enhance the secretion of gastric juice by consuming spicy plants (dill seeds, cumin, horseradish, cilantro) and fruits containing organic acids (raspberries, mountain ash, blueberries, apples, grapes, lemons, red and black currants).
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