Bacterial overgrowth of the small intestine can be a hidden, unsuspected cause of chronic bowel problems such as indigestion, bloating, abdominal pain, gas, and irregularity.

Normally, far fewer bacteria inhabit the small intestine than the ample growth found in the colon. The secretion of gastric acids and the rapid movement of digested foodstuffs through the intestine (called "intestinal motility") normally keep the small intestine relatively free of bacteria.

A wide range of abnormalities and malfunctions, however, can encourage bacteria to multiply in the small intestine. There, the bacteria ferment carbohydrate, producing gases such as hydrogen and methane. These gases cause the gas and bloating seen in individuals with carbohydrate intolerances and, over time, can lead to irritations of the intestinal lining.

The most common causes of bacterial overgrowth of the small intestine usually relate to a decrease in gastric acidity or digestive enzymes, which create an unsterile environment for the small intestine. Other possible causes of bacterial overgrowth of the small intestine include intestinal obstructions caused by CrohnÕs disease, adhesions, radiation damage and lymphoma.1

Treating bacterial overgrowth of the small intestine has been shown to significantly alleviate chronic symptoms, such as diarrhea and abdominal pain, in patients with Irritable Bowel Syndrome.2 For this reason, healthcare experts recommend that a laboratory evaluation for small bowel bacterial overgrowth be performed in patients with IBS, when indicated by their history.3

The Bacterial Overgrowth of the Small Intestine Breath Test measures breath hydrogen and methane gases in response to a lactulose challenge. Because both gases may be produced in the intestine, testing for both hydrogen and methane is considered more sensitive for detecting small bowel bacterial overgrowth than testing for hydrogen only.4

Without proper detection and treatment, bacterial overgrowth of the small intestine can eventually go on to cause health problems more serious than chronic indigestion. By inhibiting proper nutrient absorption, bacterial overgrowth of the small intestine can lead to systemic disorders such as altered permeability, anemia and weight loss, osteomalacia and vitamin deficiency.5

The incidence of bacterial overgrowth of the small intestine increases with age, particularly in people aged 80 and older.6 Elderly patients may develop malabsorption secondary to bacterial overgrowth. It has been suggested as the major cause of clinically significant malabsorption in the elderly and linked to the "failure to thrive syndrome" seen in older patients.5

References:
1 Toskes PP. Bacterial overgrowth of the gastrointestinal tract. Adv Int Med 1993;38:387-407.
2 Pimental M, Chow EJ, Lin HC. Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol 2000;95(12):3503-3506.
3 Schuster MM. Defining and diagnosing irritable bowel syndrome. Am J Manag Care 2001;7(8):S246-S251.
4 Hamilton LH. Breath tests and gastroenterology. Milwaukee, Wis.: QuinTron Instruments Company, 1998.
5 Keusch, Solomons. Nutritional consequences of bacterial overgrowth syndromes. Effects of microorganisms on GI tract. 182-5.
6 Riordan SM, McIver CJ, Duncombe VM, Bolin TD. The association between small intestinal bacterial overgrowth and ageing. Gastroenterol 1994;106(4):A266.

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