Disorder of excessive bacterial growth in the small intestine

Aetiology

Causative organisms

• E. coli
• Bacteroides

Risk factors

• Dysmotility - absence/impairment of the migrating motor complex
• Anatomical disturbances in the bowel
  • Fistulae
  • Diverticula
  • Blind loops created after surgery
  • Resection of the ileo-cecal valve
• Gastroenteritis-induced alterations to the small intestine
• Certain medications, including proton pump inhibitors
• Disorders of the immune system

Clinical features

• Loss of appetite
• Bloating
• Diarrhoea
• Malnutrition
• Abdominal pain

Investigations

• Endoscopy:
  • Anatomical disturbances visible (diverticula, fistulas, strictures etc.)
  • Functional stasis
• Bloods:
  • Low cobalamin (Schilling test)
  • High folate levels