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Small intestinal bacterial overgrowth in the symptomatic elderly
S M Riordan1, C J McIver, D Wakefield
1Department of Gastroenterology, Prince of Wales Hospital, Sydney, Australia.
The American Journal of Gastroenterology
|January 1, 1997
Summary
Small intestinal bacterial overgrowth with colonic flora is common in elderly patients with chronic diarrhea, anorexia, or nausea. This overgrowth is likely due to small intestinal dysmotility, not reduced gastric acidity or immune senescence.
Area of Science:
- Gastroenterology
- Microbiology
- Geriatrics
Background:
- Small intestinal bacterial overgrowth (SIBO) with colonic-type flora is increasingly recognized in symptomatic individuals.
- The prevalence and underlying mechanisms of SIBO in elderly patients, especially those without typical risk factors, require further investigation.
Purpose of the Study:
- To determine the prevalence of SIBO with colonic-type bacteria in symptomatic elderly individuals.
- To explore potential contributing factors, including gastric acidity, small intestinal motility, and luminal immunoglobulin A (IgA).
Main Methods:
- Culture of small intestinal luminal secretions from 52 symptomatic subjects (22 aged ≥75 years).
- Measurement of fasting gastric pH, assessment of small intestinal motility via bacterial origin, and quantification of luminal IgA concentrations.
Main Results:
- SIBO was not observed in dyspeptic patients but was present in 64.3% of elderly patients (≥75 years) with chronic diarrhea, anorexia, or nausea.
- Small intestinal dysmotility was indicated by the presence of non-salivary bacteria.
- Elevated luminal IgA levels were found in elderly patients with SIBO compared to culture-negative subjects.
Conclusions:
- SIBO with colonic-type bacteria should be considered in elderly patients (≥75 years) presenting with chronic diarrhea, anorexia, or nausea, even without apparent predisposing factors.
- Small intestinal dysmotility appears to be the primary driver of SIBO in this population, rather than hypochlorhydria or immunosenescence.