Blind loop syndrome

Introduction to blind sputum syndrome The blind sputum syndrome, ie intestinal bacterial overgrowth (EBOS), is mainly due to small intestinal stagnation, bacteria in the small intestine overgrowth and cause malabsorption, also known as intestinal collapse syndrome, intestinal infection syndrome or blind sputum syndrome. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: anemia, digestive tract bleeding, iron deficiency anemia, malnutrition, edema

Causes of blind sputum syndrome

Bacterial hyperplasia in the stomach (30%):

Low acid or no acid, gastric mucosal atrophy, gastric postoperative movement or anatomical abnormalities (such as residual stomach after partial gastrectomy), almost no parietal glandular parenchyma and no acid, in addition, Sachs research proves Ogilvy Latrazole can inhibit the inactivation of H-K-ATPase in parietal cells, and the binding of this proton pump inhibitor to the enzyme is irreversible until the new enzyme in the cell is synthesized and transported to the apical membrane, and the enzyme activity is restored. This update process takes 48 hours, so taking 1 omeprazole can cause low acid for 48 hours.

Small intestinal deposition (30%):

(1) Anatomical reasons: input sputum of Billroth II surgery or gastrectomy, duodenal jejunum diverticulum, surgery-induced blind paralysis, recirculation surgery, intestinal stenosis, adhesions, inflammation and lymphoma obstruction.

(2) intestinal dyskinesia: scleroderma, idiopathic small intestine pseudo-obstruction, transitional complex motor absence or disorder, diabetic autonomic disease.

(3) Abnormal intestinal passage: gastric-colon or jejunum-colon fistula, ileocecal valve resection.

Immunodeficiency syndrome (30%):

Overgrowth of small intestinal bacteria can directly or indirectly affect the structure and function of the intestine, causing malabsorption. When the intestinal bacteria grows excessively, the bacteria can compete with the host for vitamin B12 in the diet. Although the internal factors can inhibit the competition of vitamin B12 by aerobic bacteria, They can slow down the intake of vitamin B12, but intestinal deposition can provide time for their intake. In addition, the internal factors can not inhibit the intake of vitamin B12 by Bacteroides, while the intestinal bacteria itself can synthesize vitamin B12, but it firmly binds. In the body, it can not be used by the host, so vitamin B12 deficiency can occur, and can not be corrected by oral factors. However, since folic acid synthesized by intestinal bacteria can be released into the intestinal lumen and can be utilized by the host, folic acid does not occur. lack of.

Overgrowth of intestinal bacteria can interfere with the metabolism of bile salts, and the combined bile salts are decomposed into free bile salts, which are rapidly reabsorbed by the small intestine. The combination of bile salts reduces the formation of microcapsules and causes fat malabsorption, leading to diarrhea. In addition, when the free bile acid in the intestinal lumen reaches a certain concentration, it can also damage the submicrostructure of the epithelial cells and affect the absorption of sugar and protein.

In patients with blind sputum syndrome, the xylose tolerance test is abnormal, which may be caused by bacterial decomposition and utilization of xylose. The use of 14C xylose for feeding blind mites can measure the decrease of xylose content in animal urine and increase the content of 14CO2 in exhalation. Clinically, according to this principle, the 14C xylose breath test is used for diagnosis.

Intestinal bacterial overgrowth, common protein loss, increased nitrogen content in patients' feces and urine. Hypoproteinemia is caused by intestinal bacteria affecting amino acid absorption and protein-losing enteropathy.

Blindness syndrome prevention

1. Adjust daily life and workload, and regularly carry out activities and exercise to avoid fatigue.

2. Maintain emotional stability and avoid emotional excitement and tension.

3. Keep the stool smooth, avoid using stools, eat more fruits and high-fiber foods.

Blind syndrome complications Complications anemia gastrointestinal bleeding iron deficiency anemia malnutrition edema

1. Typical cases of anemia and gastrointestinal hemorrhage are large cell hyperchromic anemia, caused by vitamin B12 deficiency, sometimes due to mucosal damage caused by ulcer formation or vitamin K deficiency, skin mucosal bleeding, small cell hypopigment due to blood loss Iron deficiency anemia or mixed anemia, occasional massive bleeding in the digestive tract.

2. Hypoproteinemia 70% to 90% of patients with hypoproteinemia, which is the main manifestation of this disease, mainly due to intestinal absorption of amino acid absorption and protein loss, dystrophic edema may occur.

3. Weight loss is caused by malnutrition caused by long-term digestion and absorption of nutrients such as fat, protein, and sugar.

Symptoms of blind sputum syndrome Common symptoms Diarrhea Abdominal discomfort convulsions Bloating Skin mucosal bleeding Weight loss Night blind small bowel bacteria Overgrowth Malnutrition edema Vitamin K deficiency

Clinical manifestations vary greatly depending on the cause, and generally include symptoms of malabsorption and primary disease. Mild people have mild anaesthesia with mild anemia and weight loss. In severe cases, watery diarrhea, steatorrhea, bloating, and anemia are common. , weight loss, severe fat malabsorption may occur rickets, night blindness or even low calcium convulsions, vitamin K deficiency can occur skin mucosal bleeding.

Anemia is mostly due to vitamin B12 deficiency, is a large cell anemia, sometimes caused by ulceration in the intestinal fistula, can cause small cell anemia or mixed anemia due to blood loss.

Hypoproteinemia is common and dystrophic edema can occur.

Primary diseases such as blind or stenosis caused by surgery, abdominal discomfort, bloating, diarrhea accompanied by umbilical hernia and anemia before diarrhea, between the formation of blind sputum and bacterial overgrowth, generally have a longer The interval is as short as several months and as long as several years. Sometimes the primary disease even masks the symptoms of bacterial overgrowth, such as intestinal stenosis or fistula caused by small bowel Crohn's disease, intestinal movement caused by scleroderma or pseudo-intestinal obstruction. Attenuation, some of the primary disease caused by malabsorption and bacterial overgrowth caused by malabsorption is difficult to identify, such as Crohn's disease, radiation enteritis, short bowel syndrome, lymphoma, etc., jejunal diverticulum is more common in the elderly, diverticulum to Bacterial overgrowth has many years of interval, often asymptomatic, and later steatorrhea and anemia.

Examination of blind sputum syndrome

Anemia can be large cell or low hemoglobin small cell anemia, abnormal vitamin B12 absorption test, can not be corrected by internal factors, serum iron, vitamins, folic acid concentration decreased, serum albumin, sodium, potassium, calcium, phosphorus, magnesium, cholesterol Triacylglycerols, etc. are also reduced to varying degrees, prothrombin activity is also reduced, and fecal fat is increased.

1. Collection of small intestine contents The collection of small intestine contents should be based on multiple sites. There are many specific methods. The most accurate method for small intestine puncture in abdominal surgery is small, but the practical value is not large. The method of extracting small intestine fluid through endoscopic cannula or small intestine catheter is relatively reliable, and the contamination rate is low. At least one antibiotic should be stopped for 1 week before the examination, at least 8 hours on the fasting. The specimen should be contaminated or diluted by saliva, and the specimen must be in anaerobic conditions. Obtained, diluted in multiple ratios, inoculated in several media under anaerobic conditions, different numbers of Bacteroides, anaerobic lactobacilli, Escherichia coli and enterococci, the total number of bacteria exceeds 105/ml It is considered to have clinical significance and is often used as a comparison standard for other tests such as breath test. This test operation is complicated and time consuming, and bacterial overgrowth in the sputum may be missed. In addition, it is difficult to extract the contents of the distal small intestine. .

2. Urine blue mother determination Urine blue mother is the product of intestinal bacteria decomposition of tryptophan, discharged from the urine after absorption, normal people are negative or light blue, color deepening indicates excessive bacterial growth, simple operation but sensitivity specificity The average difference is now rarely used.

3. The determination of jejunal fatty acid and jejunal cholic acid has a good diagnostic value, but the acquisition of specimens and measurement techniques is difficult and complicated.

4. Xylose breath test Xylose is mostly intestinal bacteria decomposition, only partially absorbed by the intestine, the absorption site is mainly in the proximal part of the small intestine, rarely affected by the distal small intestine and colon bacteria and malabsorption, the intestinal bacteria overgrowth 14C-labeled xylose decomposition increased, CO2 production increased, 1g14C xylose breath test had better sensitivity and specificity, 85% of patients in the first 60min after the start of the test, exhaled 14CO2 increased The 30-minute breath sample is the most reliable and is often used as the preferred method for various breath tests.

5. The hydrogen breath test substrate has lactulose and glucose, which is decomposed by intestinal bacteria to produce hydrogen. It is also used as a method to understand the time and absorption of intestinal movement. Some people compare 10g lactulose and 80g glucose hydrogen breath test. The sensitivity is 68%, the specificity is 44%; the latter is 62% and 85% respectively. The method is non-radioactive and simple to operate, but there are more conditions, and the individual differences are large, even some bacteria are not metabolized. Hydrogen is produced, and the sensitivity of the domestic mannitol hydrogen breath test is 71% and the specificity is 67%.

6. Glycine breath test Bile salt or 14C glycocholic acid is separated from the bile salt and absorbed in the ileum. After metabolism, it becomes 14CO2. The specificity of this method is not as good as the xylose breath test. The false positive result is as high as 30%~ 40%, because ileal lesions or ileal resection, bile salts into the colon decomposition, it is sometimes difficult to know whether bile acid is in the small intestine, the test is often used for fecal 14C cholic acid analysis.

Diagnosis and diagnosis of blind sputum syndrome

Diagnosis depends mainly on small intestine content culture or breath test. Any slow-onset diarrhea, steatorrhea, weight loss, large cell anemia patients, especially the elderly or patients with a history of abdominal surgery should consider intestinal bacterial hyperplasia in differential diagnosis. Growth, X-ray gastrointestinal angiography shows diverticulum, blind sputum, fistula and other anatomical or functional abnormalities, fiber enteroscopy and biopsy have a certain help for the diagnosis of the cause.

1. A dysbacteriosis caused by antibiotics.

2. Gastrin (gastrin) deficiency after gastric antrum resection.

3. Intra-factor deficiency after subtotal or total gastrectomy.

4. Short bowel syndrome.

5. Primary intestinal malabsorption syndrome.

Any slow-onset diarrhea, steatorrhea, weight loss, large cell anemia, especially in the elderly or patients with a history of abdominal surgery should consider intestinal bacterial overgrowth in the differential diagnosis.

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