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Oxford Textbook of Medicine (5 ed.)

Edited by David A. Warrell, Timothy M. Cox, John D. Firth

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Latest update

The November 2012 update sees updates to over 70 chapters, focusing on Neurology and Gastroenterology. This update also incorporates a selection of 29 Case Histories taken from related titles in the Oxford Case Histories series, linked to from related chapters. Each case includes several questions followed by detailed answers and discussion to enhance diagnostic and clinical understanding.

Neurology updates include substantial updates to key chapters and new material on a wide range of topics including spinal cord injury, autonomic nervous system disorders, and inherited neurodegenerative diseases. 

Gastroenterology updates include extensive revisions of key chapters on liver failure and acute pancreatitis and new material on a wide range of matters, ranging from the common to the rare: including surgical treatments for colonic diverticular disease, antibody tests for immune disorders, and a revised treatment algorithm for small bowel bacterial overgrowth.

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Publisher:
Oxford University Press
Print Publication Date:
May 2010
Print ISBN-13:
9780199204854
Published to Oxford Medicine:
May 2012
DOI:
10.1093/med/9780199204854.001.1

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Disclaimer

Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding.

Contents

Small-bowel bacterial overgrowth

Chapter:
Small-bowel bacterial overgrowth
Author(s):

Phillip P. Toskes,

Richard A. Schatz

DOI:
10.1093/med/9780199204854.003.151002_update_001

Update:

Complications—expanded discussion of the unproven possibility that small-bowel bacterial overgrowth might cause irritable bowel syndrome.

Management—new treatment algorithm.

A relevant case history has been added.

Updated on 28 November 2012. The previous version of this content can be found here.

Malabsorption in a patient with overgrowth of bacteria in the small intestine is known as small-bowel bacterial overgrowth (SBBO). Predisposing causes include sustained hypochlorhydria induced by proton pump inhibitors, small-intestinal stagnation due to anatomical (e.g. diverticulosis, postsurgical) or motor (e.g. scleroderma) abnormalities, and chronic pancreatitis.

Presenting symptoms include diarrhoea, steatorrhoea, weight loss, and flatulence. Investigation may reveal low levels of cobalamin (metabolized by Gram-negative anaerobes), increased serum folate (synthesized by overgrowth flora), and decreased urinary excretion of xylose (intraluminal degradation of the sugar by overgrowth flora).

Definitive diagnosis is time-consuming and expensive, requiring a properly collected and appropriately cultured aspirate from the proximal small intestine revealing a total concentration of bacteria generally greater than 105 organisms/ml, with Bacteroides, anaerobic lactobacilli, coliforms, and enterococci all likely to be present. Alternative investigations are frequently employed, of which the most reliable is the 14C-xylose breath test, with elevated levels of 14CO2 found in the breath after 30 min in SBBO.

Aside from supportive care, specific treatment is with an antimicrobial that is effective against both aerobic and anaerobic enteric bacteria, e.g. tetracycline (but resistance is an increasing problem), amoxicillin-clavulanic acid, or norfloxacin.

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