Recommended antibiotics can include amoxicillin-clavulanic acid, chlortetracycline, ciprofloxacin, doxycycline, metronidazole, neomycin, norfloxacin, rifaximin, tetracycline, and trimethoprim-sulfamethoxazole. When diagnosed, the cornerstone of treatment consists of a course of antibiotic therapy directed at aerobic and anaerobic enteric pathogens as SIBO is frequently due to a polymicrobial overgrowth. The most recent guidelines have considered > 10 3 CFU/mL to be diagnostic for SIBO. Breath testing using carbohydrate substrates such as glucose or lactulose provides an accepted alternative non-invasive testing for SIBO. The currently accepted standard for diagnosing SIBO is quantitative microbial investigation of duodenal or jejunal aspirates. Physical barriers such as the ileocecal valve and physiologic mechanisms such as small bowel motility, gastric acid, pancreaticobiliary secretions, and systemic and local immunity help to prevent SIBO. Due to the nonspecific nature of its clinical manifestations, the true prevalence of SIBO is unknown. Malabsorption can be seen in severe cases. The commonly described symptoms of SIBO include bloating, flatulence, nausea, abdominal distension, diarrhea or constipation, and abdominal pain/discomfort.
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Small intestinal bacterial overgrowth (SIBO) is a syndrome in which an excessive amount of bacteria is found within the small bowel. Early recognition and diagnosis of SIBO is critical in minimizing patient morbidity and mortality. Presentation of severe SIBO in the setting of intestinal stasis secondary to gastric outlet after initiation of enteral feeds is a rare phenomenon. Histologic findings were consistent with SIBO. Surgical exploration confirmed segmental bowel necrosis requiring resection. Imaging revealed diffuse pneumatosis and portal venous gas. Case presentationĪ 55-year-old Hispanic female with gastric outlet obstruction secondary to a newly diagnosed gastric adenocarcinoma, receiving neoadjuvant chemotherapy, developed bloody gastrostomy output and rapidly progressing nausea and abdominal distention 3 days after jejunostomy tube placement and initiation of jejunal enteral nutrition.
![bacterial overgrowth syndrome bacterial overgrowth syndrome](http://img.medscape.com/fullsize/migrated/436/543/chap12.fig5.jpg)
Here we describe a severe case of SIBO leading to small bowel necrosis requiring surgical intervention. Small intestinal bacterial overgrowth (SIBO) is a condition of unknown prevalence characterized by an excessive amount of bacteria in the small bowel, typically resulting in vague gastrointestinal symptoms with bloating being most commonly reported.