Small intestinal bacterial overgrowth in systemic sclerosis: a review of the literature

Abstract

Systemic sclerosis (SSc) is a chronic, connective tissue disease with an autoimmune pattern characterized by inflammation, fibrosis and microcirculation changes leading to internal organs malfunctions. Recently, the presence of uncharacteristic gastrointestinal symptoms in the course of SSc has been underlined. The possible cause of such clinical presentation is the small intestinal bacterial overgrowth (SIBO). Nevertheless, these manifestations resulting from gastrointestinal tract hypomotility may occur in numerous disease entities. The systematic review of the literature was performed on MEDLINE database using the relevant MeSH terms including all sub-headings. After further investigation, the initial number of 56 records was limited to 7 results. The study analysis showed an increased presence of SIBO in 39% of patients suffering from SSc. The average SSc duration was longer in SSc patients with coexisting SIBO. SIBO remains a diagnostic and therapeutic challenge and therefore is a significant clinical problem among patients suffering from SSc.

The duodenal microbiome is altered in small intestinal bacterial overgrowth

“…Interest in SIBO has been fueled by the ever-increasing awareness of the human microbiome and its potential relationships to human health and disease. SIBO is known to play important roles in a variety of conditions and disease states, including irritable bowel syndrome (IBS) [3,4], fatty liver [5], inflammatory bowel disease [6], and many others [7], and associated symptoms include bloating, changes in bowel function and abdominal discomfort [1,8,9]. Although SIBO may represent the most common microbiome perturbation in medicine, it was recently noted that the 'spectrum of SIBO' remains to be truly defined [10], in part due to the lack of understanding of the normal bacterial populations of the small intestine, and how these may be altered in disease states [10].…”

The gut microbiome alterations in allergic and inflammatory skin diseases – an update

“…The proximal small intestine consists of a minor number of bacteria, estimated at the maximum of 10 3 CFU/mL (colony forming units), whereas in the large intestine, the number of bacteria reaches 10 4 CFU/mL. The increase in the number of bacteria to over 10 5 CFU/mL or the presence of atypical flora is defined as the small intestinal bacterial overgrowth (SIBO) . The imbalance of specific defence mechanisms, anatomical abnormalities or intestinal motility disorders may lead to SIBO development.…”

“…The imbalance of specific defence mechanisms, anatomical abnormalities or intestinal motility disorders may lead to SIBO development. Some of the most common SIBO manifestations include flatulence, diarrhoea, steatorrhoea, fat‐soluble vitamins deficiency symptoms, neurological and psychiatric symptoms of malignant anaemia, malabsorption syndrome symptoms, systemic disorders (such as glomerulonephritis, hepatitis, fatty liver disease, arthritis and tendonitis) and cutaneous lesions . In colon, nine major types of bacteria are observed with the predominance of Firmicutes and Bacteroidetes …”

“…The increase in the number of bacteria to over 10 5 CFU/mL or the presence of atypical flora is defined as the small intestinal bacterial overgrowth (SIBO). 15,16 The imbalance of specific defence mechanisms, anatomical abnormalities or intestinal motility disorders may lead to SIBO development. Some of the most common SIBO manifestations include flatulence, diarrhoea, steatorrhoea, fat-soluble vitamins deficiency symptoms, neurological and psychiatric symptoms of malignant anaemia, malabsorption syndrome symptoms, systemic disorders (such as glomerulonephritis, hepatitis, fatty liver disease, arthritis and tendonitis) and cutaneous lesions.…”

“…Some of the most common SIBO manifestations include flatulence, diarrhoea, steatorrhoea, fat-soluble vitamins deficiency symptoms, neurological and psychiatric symptoms of malignant anaemia, malabsorption syndrome symptoms, systemic disorders (such as glomerulonephritis, hepatitis, fatty liver disease, arthritis and tendonitis) and cutaneous lesions. [15][16][17][18][19] In colon, nine major types of bacteria are observed with the predominance of Firmicutes and Bacteroidetes. 20 The gut microbiome alterations are linked to the pathogenesis of the allergic, cardiovascular, neurodevelopmental, psychiatric and neurodegenerative diseases, cancer, diabetes mellitus, inflammatory bowel diseases, multiple sclerosis, rheumatoid arthritis, kwashiorkor, liver diseases, metabolic syndrome and obesity.…”