Bakterielle Fehlbesiedlung des Dünndarms

SIBO (Small Intestinal Bacterial Overgrowth) ist durch eine bakterielle Überwucherung oder Fehlbesiedlung des Dünndarms in Kombination mit intestinalen Symptomen definiert. Intestinale Stase, Hypochlorhydrie, Immundefizienz, Alter u.a. sind auslösende Faktoren. Die Therapie beinhaltet die Behandlung der auslösenden Grunderkrankung, den Ausgleich einer Mangelernährung, den Einsatz von Antibiotika und Probiotika sowie diätetische Maßnahmen.

Abstract

Bacterial overgrowth of the small intestine (SIBO) is defined as the presence of excessive numbers of bacteria causing gastrointestinal symptoms such as bloating, nausea, abdominal pain, diarrhea and malabsorption.

Diagnosis is made through cultural detection of bacteria from small intestinal aspirates or indirectly through breath tests, which can detect the bacterial fermentation products hydrogen (H₂) and methane (CH₄) in exhaled air after carbohydrate provocation.

SIBO can be caused by various mechanisms such as reduced intestinal motility, altered gastrointestinal anatomy, reduced gastric acid or pancreatic enzyme production, altered bile acid metabolism, or immune defects. Accordingly, SIBO often develops secondary to different underlying diseases such as blind loop syndromes, gastrointestinal motility disorders including scleroderma and several neurological diseases, several chronic diseases of the gut, liver and pancreas including irritable bowel syndrome and others. Symptoms are triggered by direct bacteria-induced damage of the intestinal barrier or by bacterial metabolism such as the fermentation of dietary carbohydrates with increased gas production.

The therapy includes the treatment of the underlying disease to eliminate the causal factors as much as possible, compensation for micro- and macronutrient deficiencies and treatment with antibiotics. Moreover, probiotics and dietetic therapy such as a low FODMAP diet should be considered. Recurrences are common and may necessitate repeated therapy.

This review summarizes the current knowledge on SIBO pathophysiology, prevalence, diagnosis, and treatment.

Zusammenfassung

Unter bakterieller Fehlbesiedlung des Dünndarms (SIBO) versteht man das Vorhandensein einer übermäßigen Anzahl von Bakterien, die gastrointestinale Symptome, wie Blähungen, Nausea, abdominelle Schmerzen, Diarrhöen und Malabsorption verursachen. Die Diagnose erfolgt durch einen kulturellen Nachweis von Bakterien aus Dünndarmaspiraten oder indirekt durch Atemteste (AT), welche nach Kohlenhydratprovokation die bakteriellen Fermentationsprodukte Wasserstoff (H₂) und Methan (CH₄) in der Ausatemluft nachweisen können. SIBO kann durch verschiedene Mechanismen verursacht werden, wie z. B. eine verminderte Darmmotilität, eine veränderte Magen-Darm-Anatomie, eine verminderte Produktion von Magensäure oder Pankreasenzymen, einen veränderten Gallensäurestoffwechsel oder Immundefekte. Dementsprechend entwickelt sich SIBO häufig sekundär zu verschiedenen Grunderkrankungen wie Blind-Loop-Syndromen, gastrointestinalen Motilitätsstörungen einschließlich Sklerodermie und verschiedenen neurologischen Erkrankungen, mehreren chronischen Erkrankungen des Darms, der Leber und der Bauchspeicheldrüse einschließlich Reizdarmsyndrom und anderen. Symptome werden durch eine direkte bakterielle Schädigung der Darmbarriere oder durch den bakteriellen Stoffwechsel wie z.B. der Fermentation von Nahrungskohlenhydraten mit erhöhter Gasproduktion ausgelöst. Die Therapie beinhaltet die Behandlung der Grunderkrankung zur weitestgehenden Beseitigung der ursächlichen Faktoren, der Ausgleich von Mikro- und Makronährstoffdefiziten sowie die Behandlung mit Antibiotika. Darüber hinaus sollten Probiotika und diätetische Therapien wie eine Low-FODMAP-Diät in Betracht gezogen werden. Rezidive sind häufig und können eine wiederholte Therapie erforderlich machen. Diese Übersicht fasst den aktuellen Wissensstand zur Pathophysiologie, Prävalenz, Diagnose und Behandlung von SIBO zusammen.

Schlüsselwörter

bakterielle Fehlbesiedlung des Dünndarms - SIBO - Malabsorption - Diarrhö - Reizdarmsyndrom

Key words

small intestinal bacterial overgrowth - SIBO - malabsorption - diarrhea - irritable bowel syndrome

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