Malabsorption in Intestinal Scleroderma

Kahn, Ivan J.; Jeffries, Graham H.; Sleisenger, Marvin H.

doi:10.1056/nejm196606162742402

Cited by 102 publications

(17 citation statements)

References 15 publications

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“…The reasons for such a high prevalence of SIBO in NASH are not fully known, but disorders associated with reduced peristaltic activities or low gastric acidity are common risk factors for SIBO 48–51 . Several factors may be relevant in these patients.…”

Section: Discussionmentioning

confidence: 99%

Ciprofloxacin suppresses bacterial overgrowth, increases fasting insulin but does not correct low acylated ghrelin concentration in non‐alcoholic steatohepatitis

Sajjad¹,

Mottershead²,

Syn³

et al. 2005

Aliment Pharmacol Ther

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SUMMARYBackground: Insulin resistance and oxidative stress induced by products of small intestinal bacterial activity are putative factors in the pathogenesis of non-alcoholic steatohepatitis. Acylated ghrelin is the biologically active form of an orexigenic gastric hormone that modifies insulin sensitivity and body composition. Aim: To investigate the effect of ciprofloxacin on small intestinal bacterial activity, ethanol, ghrelin and insulin in non-alcoholic steatohepatitis patients. Methods: Twelve non-alcoholic steatohepatitis patients and 11 controls were studied before and after ciprofloxacin 500 mg b.d. for 5 days. After an overnight fast, 75 g glucose was ingested and blood was sampled every 20 min for 120 min. Acylated and total ghrelin, ethanol and insulin were measured. Small intestinal bacterial activity was detected by glucose hydrogen breath test. Results: Mean (range) integrated plasma acylated ghrelin which was 102 (21-241) and 202 (88-366) pg/ mL AE 2 h in non-alcoholic steatohepatitis and controls

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Section: Discussionmentioning

confidence: 99%

Ciprofloxacin suppresses bacterial overgrowth, increases fasting insulin but does not correct low acylated ghrelin concentration in non‐alcoholic steatohepatitis

Sajjad¹,

Mottershead²,

Syn³

et al. 2005

Aliment Pharmacol Ther

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“…When present, intestinal clearance is usually impaired because of shallow contractions resulting in ineffective peristalsis and clearance. This can lead to overgrowth with Gram-negative bacilli, in part responsible for the malabsorption [161].…”

Section: Diseases and Injury Of The Gut Wallmentioning

confidence: 99%

The Pathogenesis of Gastrointestinal Bacterial Overgrowth

Husebye

2005

Chemotherapy

138

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The normal indigenous intestinal microflora consists of about 10¹⁵ bacteria that under physiological conditions reside mainly in the lower gastrointestinal tract. Bacterial overgrowth implies abnormal bacterial colonization of the upper gut, resulting from failure of specific defense mechanisms restricting colonization under physiological conditions. At present two types of bacterial overgrowth with defined pathogenesis can be distinguished: (1) gastric overgrowth with upper respiratory tract microflora resulting from selective failure of the gastric acid barrier, and (2) gastrointestinal overgrowth with Gram-negative bacilli (enteric bacteria) resulting from failure of intestinal clearance. Helicobacter pylori-induced gastritis of the oxyntic mucosa is the main cause of acquired failure of the gastric acid barrier, which is common among the healthy elderly. Intestinal clearance may fail as the result of impaired intestinal peristalsis or anatomical abnormalities that alter luminal flow. Impaired peristalsis is associated with conditions interfering with intestinal neuromuscular function including myopathic, neuropathic, autoimmune, infectious, inflammatory, metabolic, endocrine, and neoplastic diseases. Anatomical abnormalities are mainly the result of gastrointestinal surgery, intestinal diverticula or fistula. Combined failure of intestinal clearance and the gastric acid barrier results in more severe colonization with Gram-negative bacilli. Gram-negative bacilli are uncommon in the upper gut of otherwise healthy individuals with gastric hypochlorhydria, being acquired (H. pylori) or drug-induced. Significant bacterial overgrowth with Gram-negative bacilli is a rational in the search for an explanation to optimize clinical management. The clinical significance of colonization with upper respiratory tract microflora remains unclear. Translocation of live bacteria, their metabolic products, or antigens from a small bowel colonized by Gram-negative bacilli play a role in the pathogenesis of spontaneous bacterial peritonitis in hepatic disease and in certain types of sepsis, indicating that further studies can point to new patient populations with potential benefit from medical treatment.

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“…In general, IBS patients are not known to suffer from abnormalities of these gut systems. However, motor activity of the small bowel is also important in preventing small bowel bacteria [40,41]. In the mid 1970s, Vantrappen et al [42] discovered that patients with bacterial overgrowth had a reduction in the frequency of a specialized motor function of the small bowel called phase III of interdigestive motility.…”

Section: Mechanisms For Bacterial Overgrowthmentioning

confidence: 99%

Irritable bowel syndrome: Bacterial overgrowth—What’s known and what to do

Pimentel

Lezcano²

2007

Curr Treat Options Gastro

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Irritable bowel syndrome (IBS) is a common gastrointestinal condition whose cause remains unknown. Therefore, most of our effort in treating IBS has been based on a symptom approach. Recent evidence is beginning to suggest that subjects with IBS may have an alteration in gastrointestinal flora. Specifically, findings suggest that IBS patients have excessive bacteria in the small bowel, known as bacterial overgrowth. Although diagnostic testing for bacterial overgrowth is somewhat controversial, as there is no true gold standard test for bacterial overgrowth, antibiotic-based therapies for IBS are now shown to be very effective in treating IBS. Follow-up work in this area has even begun to demonstrate associative factors between gut bacteria and IBS that may explain the different types of IBS. The best example of this is the finding that methanogenic organisms in IBS patients are wholly associated with constipation-predominant IBS. It seems that the methane gas emitted during fermentation may have an influence on gut motility. In this review, the evidence for gut ecology associations in IBS is presented. A treatment algorithm also is proposed based on these findings. New areas of research in IBS such as gut bacteria are changing the treatment approach in IBS from a symptom-based style to one that is hypothesis driven.

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Malabsorption in Intestinal Scleroderma

Cited by 102 publications

References 15 publications

Ciprofloxacin suppresses bacterial overgrowth, increases fasting insulin but does not correct low acylated ghrelin concentration in non‐alcoholic steatohepatitis

Ciprofloxacin suppresses bacterial overgrowth, increases fasting insulin but does not correct low acylated ghrelin concentration in non‐alcoholic steatohepatitis

The Pathogenesis of Gastrointestinal Bacterial Overgrowth

Irritable bowel syndrome: Bacterial overgrowth—What’s known and what to do

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