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Schematic of the terminal ileum, ileocecal valve and colon. It shows the colonoscope and manometry catheter passing through the biopsy channel of the colonoscope. The 4 channel manometry catheter is placed across the ileocecal valve so that at least 1 channel is in the cecum and 1 channel in the Ileum.
Source publication
To explore whether patients with a defective ileocecal valve (ICV)/cecal distension reflex have small intestinal bacterial overgrowth.
Using a colonoscope, under conscious sedation, the ICV was intubated and the colonoscope was placed within the terminal ileum (TI). A manometry catheter with 4 pressure channels, spaced 1 cm apart, was passed throug...
Context in source publication
Context 1
... preparation was used in all subjects (polyethyl- ene glycol preparation). A custom make water perfused manometry catheter (Mui Scientific, Mississauga, Canada) with 4 pressure measurement ports spaced one cm apart was passed through the biopsy channel of the colono- scope and placed across the ICV with at least one port in the terminal ileum and one port in the cecum (Figure 1). The simultaneous video endoscopy and pressure read- ings (30 Hz) were continuously recorded on a Medical Measurement Solar System (MMS, Dover, NH) ( Figure 2). ...
Citations
... It guards the opening of the ileocecal junction (ICJ) and acts as a mechanical barrier to prevent the reflux of material from the colon into the ileum. ICV functions not just as a passive valve but also as a sphincter as the ileal papilla protrudes into the cecum [1]. The competency of ICV depends on mesenteric and other tenia, external ligaments attached to the ICJ, venous cushions in the submucosa of the terminal ileum, ileal papilla, and intussusception of terminal ileum into the cecum [2]. ...
... Primary or secondary motility abnormalities destroy the ability of the small intestine to prevent colon bacterial translocation [8]. Meanwhile, ileocaecal valve dysfunction leads to colonic bacterial regurgitation [9]. Long-term medication of proton pump inhibitors (PPIs) is associated with an increased risk of SIBO. ...
Background
Small intestinal bacterial overgrowth (SIBO) is the presence of an abnormally excessive amount of bacterial colonization in the small bowel. Hydrogen and methane breath test has been widely applied as a non-invasive method for SIBO. However, the positive breath test representative of bacterial overgrowth could also be detected in asymptomatic individuals.
Methods
To explore the relationship between clinical symptoms and gut dysbiosis, and find potential fecal biomarkers for SIBO, we compared the microbial profiles between SIBO subjects with positive breath test but without abdominal symptoms (PBT) and healthy controls (HC) using 16S rRNA amplicon sequencing.
Results
Fecal samples were collected from 63 SIBO who complained of diarrhea, distension, constipation, or abdominal pain, 36 PBT, and 55 HC. For alpha diversity, the Shannon index of community diversity on the genus level showed a tendency for a slight increase in SIBO, while the Shannon index on the predicted function was significantly decreased in SIBO. On the genus level, significantly decreased Bacteroides, increased Coprococcus_2, and unique Butyrivibrio were observed in SIBO. There was a significant positive correlation between saccharolytic Coprococcus_2 and the severity of abdominal symptoms. Differently, the unique Veillonella in the PBT group was related to amino acid fermentation. Interestingly, the co-occurrence network density of PBT was larger than SIBO, which indicates a complicated interaction of genera. Coprococcus_2 showed one of the largest betweenness centrality in both SIBO and PBT microbiota networks. Pathway analysis based on the Kyoto Encyclopedia of Genes and Genome (KEGG) database reflected that one carbon pool by folate and multiple amino acid metabolism were significantly down in SIBO.
Conclusions
This study provides valuable insights into the fecal microbiota composition and predicted metabolic functional changes in patients with SIBO. Butyrivibrio and Coprococcus_2, both renowned for their role in carbohydrate fermenters and gas production, contributed significantly to the symptoms of the patients. Coprococcus’s abundance hints at its use as a SIBO marker. Asymptomatic PBT individuals show a different microbiome, rich in Veillonella. PBT’s complex microbial interactions might stabilize the intestinal ecosystem, but further study is needed due to the core microbiota similarities with SIBO. Predicted folate and amino acid metabolism reductions in SIBO merit additional validation.
... As a first step toward mechanistic understanding of hostmicrobe interactions on the SI mucosa, we set out to answer whether our 3D imaging tools can be used to detect dense bacterial association with the mucosa of the mid SI (jejunum) indicative of colonization. We focused on the jejunum because the duodenum could be contaminated with oral or stomach bacteria due to gastric emptying 27,28 , and because the ileum may contain colonic bacteria due to retrograde transport 29 . To study bacterial association with jejunum mucosa and look for evidence of mucosal colonization, we leveraged three strategies. ...
... e, f Log-absolute 16S rRNA gene copy abundance of gavaged E. coli quantified by dPCR with Enterobacteriaceae primers in MAL + EC&BAC group (e) without tail cups (identical biological replicates as shown in (a-d)), (f) with functional tail cups that effectively prevented coprophagy, and (g) with mock tail cups that did not prevent coprophagy but recapitulated the stress of wearing them. In (e-g), each bar represents an individual mouse euthanized on the specified day of the experiment (27)(28)(29)(30)(31). ...
... The EED mouse model used here was originally developed to mimic the ingestion of fecal bacteria in contaminated food and water, a pressing problem in the developing world 15 . In the developed world, ingestion of enteropathogens and fecal bacteria with contaminated food and water is perhaps unlikely; however, fecal bacteria may reach the jejunum by retrograde transport 29 , and a number of other factors can predispose to SIBO 34 . Therefore, the tools and approaches we used and the observations we made may provide cues toward the understanding not only of EED [14][15][16] but also other diseases of the SI, including SIBO 34,52,57 , irritable bowel syndrome (IBS) 58 , and celiac disease 56 . ...
Because the small intestine (SI) epithelium lacks a thick protective mucus layer, microbes that colonize the thin SI mucosa may exert a substantial effect on the host. For example, bacterial colonization of the human SI may contribute to environmental enteropathy dysfunction (EED) in malnourished children. Thus far, potential bacterial colonization of the mucosal surface of the SI has only been documented in disease states, suggesting mucosal colonization is rare, likely requiring multiple perturbations. Furthermore, conclusive proof of bacterial colonization of the SI mucosal surface is challenging, and the three-dimensional (3D) spatial structure of mucosal colonies remains unknown. Here, we tested whether we could induce dense bacterial association with jejunum mucosa by subjecting mice to a combination of malnutrition and oral co-gavage with a bacterial cocktail ( E. coli and Bacteroides spp.) known to induce EED. To visualize these events, we optimized our previously developed whole-tissue 3D imaging tools with third-generation hybridization chain reaction (HCR v3.0) probes. Only in mice that were malnourished and gavaged with the bacterial cocktail did we detect dense bacterial clusters surrounding intestinal villi suggestive of colonization. Furthermore, in these mice we detected villus loss, which may represent one possible consequence that bacterial colonization of the SI mucosa has on the host. Our results suggest that dense bacterial colonization of jejunum mucosa is possible in the presence of multiple perturbations and that whole-tissue 3D imaging tools can enable the study of these rare events.
... Primary or secondary motility abnormalities destroy the ability of the small intestine to prevent colon bacterial translocation (Bohm et al., 2013). Meanwhile, ileocecal valve dysfunction leads to colonic bacterial regurgitation (Miller et al., 2012). It is believed that symptoms linked to SIBO consist of bloating, diarrhea and abdominal pain/discomfort. ...
Introduction: Small intestinal bacterial overgrowth (SIBO) leads to non-specific abdominal discomfort and nutrient malabsorption. Currently, rifaximin is widely applied in SIBO based on its antibacterial and non-absorbable nature. Berberine is a natural component of many popular medicine plants that ameliorates intestinal inflammation in humans through its modification of the gut microbiota. Potential effect of berberine to the gut may provide therapeutic target for SIBO. We aimed to evaluate the effect of berberine compared with rifaximin on SIBO patients. Methods: This is an investigator-initiated, single-center, open-label, double-arm randomized controlled trial, termed BRIEF-SIBO (Berberine and rifaximin effects for small intestinal bacterial overgrowth). In total, 180 patients will be recruited and allocated to an intervention group (berberine) and a control group (rifaximin). Each participant will receive one 400 mg drug twice a day (800 mg daily) for 2 weeks. The total follow-up period is 6 weeks from the start of medication. The primary outcome is a negative breath test. The secondary outcomes include abdominal symptom relief and alteration in gut microbiota. Efficacy assessment will be performed every 2 weeks, as well as safety assessment during the treatment. The primary hypothesis is that berberine is not inferior to rifaximin for SIBO. Discussion: The BRIEF-SIBO study is the first clinical trial assessing the eradication effects of 2 weeks of berberine treatment in SIBO patients. The effect of berberine will be fully verified by using rifaximin as the positive control. The findings of this study may have implications for the management of SIBO, especially increasing the awareness of both physicians and patients who are suffering from long-term abdominal discomfort and avoiding excessive examination.
... Many authors [14,15,16] admit the fact of ascending retrograde infection of the small intestinal mucosa at NBD. A pathological condition in which the titer of microorganisms in the mucous membrane of the small intestine exceeds 105 CFU / ml, or colonization of the colonic flora occurs, has been called Small Bacterial Overgrowth Syndrome (SIBO). ...
... Direct evidence of the occurrence of SIBR in case of the failure of the Bauhinia Damper (NBZ) is the experience of Larry S Miller (2012) [16]. In a clinical experiment, the author modeled the ileocecal valve insufficiency by placing a 4-lumen probe behind the lips of the bauhinia valve in the direction of the ileum of 19 healthy volunteers during a colonoscopy. ...
... We have not met domestic studies on the etiotropic effect on the syndrome of excessive bacterial growth in patients with proven deficiency of the bauhinia valve. The few foreign works [14,16] are devoted only to the statement of the fact that there is a SIBR at the NBZ. ...
... The overload will be absolute after right colectomy, especially if extended, or relative in cases with ileocecal resections: the cecum, right colon, and transverse colon are in fact the colonic sections where water reabsorption is highest when compared to the other colonic sections. Ileocecal valve removal also allows easy passage of colonic bacteria into the ileum: this phenomenon may induce small intestinal bacterial overgrowth (SIBO) syndrome that is characterized by diarrhea and weight loss [41]. Fast transit time, liquid overload, and bacterial overgrowth, all together, explain the possible high frequency of bowel movements that may appear after ileocecal resections or right colectomies. ...
The colon is the part of large bowel employed for storing, transporting, and expelling feces. This complex activity is due to the interaction between motor activity of the muscular wall, the absorption/secretion activity of the mucosa, and the microbiota activity which modifies the endoluminal content. The form and structure of the stool are the results of the influence of these different activities on the enteric material that arrives as liquid at the level of the ileocecal valve and that is discharged in solid state. Colonic surgery can obviously modify these activities resulting in altered motility, absorption/secretion, and microbiota composition, causing changes in the bowel stool, bowel transit, and defecation.
... Colon has a dense population of anaerobic bacteria. An incompetent ileocecal valve can permit translocation of bacteria from colon to small intestine, causing SIBO [7]. ...
Globus sensation is a common clinical condition affecting both gender, more prevalent from 25 to 45 years old. Its pathogenesis remains unclear. The majority causes are related to gastrointestinal issues. However, unusual conditions as autoimmune diseases and alimentary allergies have been reported. In this case, we evaluate SIBO as a possible cause of globus sensation. It is a misdiagnosis condition that can lead to other diseases, like irritable bowel syndrome, nonalcoholic fatty liver disease and celiac disease. In this case, even after a surgical procedure, patient continues to complain about globus sensation, and only relieved of his the symptoms after an appropriate SIBO treatment.
... Removing the ileocaecal valve leads to faster transportation of bowel contents into the colon and may lead to a reduced capacity for water absorption. Removal of the terminal ileum can lead to reduced absorption of bile acids 15 , along with bacterial growth in the ileum as a result of loss of the ileocaecal valve 12,13 . During the past 15 years, the concept of surgery with complete mesocolic excision (CME) has evolved for colonic cancer. ...
Background
This population‐based cohort study aimed to evaluate occurrence of low anterior resection syndrome (LARS) and correlate this to health‐related quality of life in patients who had undergone segmental colonic resection for colonic cancer in the Stockholm–Gotland region. The hypothesis was that there is a difference in occurrence of LARS depending on whether a right‐ or a left‐sided resection was performed.
Methods
Patients who underwent segmental colonic resection for colonic cancer stages I–III in the Stockholm–Gotland region in 2013–2015 received EORTC QLQ‐C30, QLQ‐CR29 and LARS score questionnaires 1 year after surgery. Clinical patient and tumour data were collected from the Swedish ColoRectal Cancer Registry. Patient‐reported outcome measures were analysed in relation to type of colonic resection.
Results
Questionnaires were sent to 866 patients and complete responses were provided by 517 (59·7 per cent). After right‐sided resection 20·6 per cent reported major LARS. After left‐sided resection the proportion with major LARS was 15·6 per cent. The odds ratio (OR) for major LARS after right‐sided resection was 1·45 (95 per cent c.i. 1·02 to 2·06; P = 0·037) compared with left‐sided resection. After adjustment for age and sex, an increase in the risk of major LARS after right‐ versus left‐sided resection remained (OR 1·48, 1·03 to 2·13; P = 0·035). Major LARS correlated with impaired quality of life.
Conclusion
Major LARS was more frequent after right‐sided than following left‐sided colonic resection. Major LARS reflected impaired quality of life.
... Studies have found that patients with SIBO diagnosed by the breath test were more likely to have an incompetent ileocecal valve. 8 Normal motility in the small bowel may be the single most important protective factor against the development of SIBO. Intestinal motility is facilitated by migrating motor complexes (MMCs), waves of electrical activity that trigger peristaltic waves and transport contents through the intestine. ...
Small intestinal bacterial overgrowth (SIBO) is defined by increased density and/or abnormal composition of microbiota in the small bowel. SIBO is often encountered in patients with cirrhosis as a result of impaired intestinal motility and delayed transit time, both of which are exacerbated by more severe liver disease. Additional risk factors for SIBO commonly encountered in cirrhotic patients include coexisting diabetes, autonomic neuropathy, and/or alcoholic use. Diagnosis of SIBO is performed by breath testing or jejunal aspiration, the gold standard. In cirrhotic patients, the presence of SIBO can lead to profound clinical consequences. Increased intestinal permeability in these patients predisposes to bacterial translocation into the systemic circulation. As a result, SIBO is implicated as a significant risk factor in the pathogenesis of both spontaneous bacterial peritonitis and hepatic encephalopathy in cirrhotics. Antibiotics, especially rifaximin, are the best studied and most effective treatment options for SIBO. However, prokinetics, probiotics, nonselective beta-blockers, and treatment of underlying liver-related pathophysiology with transjugular intrahepatic portosystemic shunt placement or liver transplantation are also being investigated. This review will discuss the risk factors, diagnosis, manifestations in cirrhosis, and treatment options of SIBO.
... The ileocecal valve serves as an important barrier and gatekeeper that prevents reflux of colonic contents into the small bowel. In contrast, conditions that favor low ileocecal valve pressure or loss of the ileocecal barrier, such as following colectomy and construction of an ileocolonic anastomosis, may allow transmigration of bacteria from the colon and predispose patients to the development of SIBO 32,33 . ...
Objectives:
After subtotal colectomy, 40% of patients report chronic gastrointestinal symptoms and poor quality of life. Its etiology is unknown. We determined whether small intestinal bacterial overgrowth (SIBO) or small intestinal fungal overgrowth (SIFO) cause gastrointestinal symptoms after colectomy.
Methods:
Consecutive patients with unexplained abdominal pain, gas, bloating and diarrhea (>1 year), and without colectomy (controls), and with colectomy were evaluated with symptom questionnaires, glucose breath test (GBT) and/or duodenal aspiration/culture. Baseline symptoms, prevalence of SIBO/SIFO, and response to treatment were compared between groups.
Results:
Fifty patients with colectomy and 50 controls were evaluated. A significantly higher (p = 0.005) proportion of patients with colectomy, 31/50 (62%) had SIBO compared to controls 16/50 (32%). Patients with colectomy had significantly higher (p = 0.017) prevalence of mixed SIBO/SIFO 12/50 (24%) compared to controls 4/50 (8%). SIFO prevalence was higher in colectomy but not significant (p = 0.08). There was higher prevalence of aerobic organisms together with decreased anaerobic and mixed organisms in the colectomy group compared to controls (p = 0.008). Patients with colectomy reported significantly greater severity of diarrhea (p = 0.029), vomiting (p < 0.001), and abdominal pain (p = 0.05) compared to controls, at baseline. After antibiotics, 74% of patients with SIBO/SIFO in the colectomy and 69% in the control group improved (p = 0.69).
Conclusion:
Patients with colectomy demonstrate significantly higher prevalence of SIBO/SIFO and greater severity of gastrointestinal symptoms. Colectomy is a risk factor for SIBO/SIFO.
