Download PDF
Z Gastroenterol 2007; 45(7): 620-628
DOI: 10.1055/s-2007-963045
Übersicht

© Karl Demeter Verlag im Georg Thieme Verlag KG Stuttgart · New York

Bakterielle Fehlbesiedlung des Dünndarms

Bacterial Overgrowth SyndromeJ. M. Stein1 , A. R. Schneider1
  • 1Medizinische Klinik I-ZAFES (Direktor: Prof. Dr. S. Zeuzem), J. W. Goethe-Universität Frankfurt
Further Information

Publication History

Manuskript eingetroffen: 21.9.2006

Manuskript akzeptiert: 25.2.2007

Publication Date:
10 July 2007 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die bakterielle Fehlbesiedlung des Dünndarms ist durch eine pathologisch erhöhte Anzahl luminaler Bakterien im Bereich des Dünndarms bedingt. Prädisponierend sind vornehmlich Veränderungen der intestinalen Motilität, der physiologischen Darmanatomie durch chirurgische Eingriffe und eine verminderte gastrale Sekretionsleistung. Die bakterielle intestinale Fehlbesiedlung steht im Zusammenhang mit einer Vielzahl von Symptomen, die von oligosymptomatischen Verläufen bis zu Anämie, Steatorrhö oder einer Proteinverlust-Enteropathie reichen können. Therapeutisch steht - soweit möglich - die Beseitigung der ursächlichen Erkrankung im Vordergrund. Gleichzeitig erfolgen die antibiotische Eradikation der Keime und die Substitution nutritiver Mangelerscheinungen.

Abstract

Small bowel bacterial overgrowth is a syndrome caused by an abnormal number of bacteria in the upper part of the small bowel and associated with a complex array of clinical symptoms, i. e., chronic diarrhoea, steatorrhoea, macrocytic anaemia, weight loss, and less commonly, protein-losing enteropathy. The most common underlying factors are small intestinal stagnation or dysmotility, intestinal obstruction, blind or afferent loops, and decreased gastric secretion. The treatment usually consists in the eradication of bacterial overgrowth with repeated courses of antimicrobials, correction of associated nutritional deficiencies and, when possible, correction of the underlying predisposing conditions.

Schlüsselwörter

bakterielle Fehlbesiedlung - Malassimilation - Colon irritabile

Key words

bacterial overgrowth - malassimilation - irritable colon

Literatur

  • 1 Abrahamsson H. Gastrointestinal motility in patients with the irritable bowel syndrome.  Scand J Gastroenterol Suppl. 1987;  130 21-26
    Google Scholar
  • 2 Almeida J, Galhenage S, Yu J. et al . Gut flora and bacterial translocation in chronic liver disease.  World J Gastroenterol. 2006;  12 1493-1502
    Google Scholar
  • 3 Attar A, Flourie B, Rambaud J C. et al . Antibiotic efficacy in small intestinal bacterial overgrowth-related chronic diarrhea: A crossover, randomized trial.  Gastroenterology. 1999;  117 794-799
    Google Scholar
  • 4 Bardham F K, Gyr K, Beglinger C. et al . Diagnosis of bacterial overgrowth after culturing small bowel aspirate obtained during routine upper gastrointestinal endoscopy.  Scand J Gastroenterol. 1992;  27 253-258
    Google Scholar
  • 5 Bauer T M, Steinbruckner B, Brinkmann F E. et al . Small intestinal bacterial overgrowth and bacterial translocation in patients with cirrhosis: prevalence and relation with spontaneous bacterial peritonitis.  Am J Gastroenterol. 2001;  97 2364-2370
    Google Scholar
  • 6 Biancone L, Vernia P, Agostini D. et al . Effect of rifaximin on intestinal bacterial overgrowth in Crohn’s disease as assessed by the H2-Glucose Breath Test.  Curr Med Res Opin. 2000;  16 14-20
    Google Scholar
  • 7 Blaut M. Ökologie des Darms. Caspary WF, Kist M, Stein J. Infektiologie des Gastrointestinaltraktes Springer Verlag Berlin, Heidelberg, New York; 2006: 31-44
    Google Scholar
  • 8 Bjorneklett A, Fausa O, Midtvedt T. Small bowel bacterial overgrowth in the postgastrectomy syndrome.  Scand J Gastroenterol. 1983;  18 277-287
    Google Scholar
  • 9 Bjorneklett A, Fausa O, Midtvedt T. Bacterial overgrowth in jejunal and ileal disease.  Scand J Gastroenterol. 1983;  18 289-298
    Google Scholar
  • 10 Bouhnik Y, Alain S, Attar A. Bacterial populations contaminating the upper gut in patients with small intestinal bacterial overgrowth syndrome.  Am J Gastroenterol. 1999;  94 1327-1331
    Google Scholar
  • 11 Brandt L J, Bernstein L H, Wagle A. Production of vitamin B12 analogues in patients with small-bowel bacterial overgrowth.  Ann Intern Med. 1977;  87 546-551
    Google Scholar
  • 12 Brummer R J, Armbrecht U, Bosaeus I. et al . The hydrogen (H2) breath test. Sampling methods and the influence of dietary fibre on fasting level.  Scand J Gastroenterol. 1985;  20 1007-1013
    Google Scholar
  • 13 Caspary W F, Reimold W V. Klinische Bedeutung des 14C-Glykocholat-Atemtests in der gastroenterologischen Diagnostik bei Erkrankungen mit gesteigerter Dekonjugation von Gallensäuren.  Dtsch Med Wschr. 1976;  101 353-360
    Google Scholar
  • 14 Castiglione F, Rispo A, Di Girolamo E. et al . Antibiotic treatment of small bowel bacterial overgrowth in patients with Crohn’s disease.  Aliment Pharmacol Ther. 2003;  18 1107-1112
    Google Scholar
  • 15 Chang C S, Chen G H, Lien H C. et al . Small intestine dysmotility and bacterial overgrowth in cirrhotic patients with spontaneous bacterial peritonitis.  Hepatology. 1998;  28 1187-1190
    Google Scholar
  • 16 Chang J, Defilippi C, Defilippi C. Small intestine dysmotility and bacterial overgrowth in cirrhotic patients with spontaneous bacterial peritonitis.  Hepatology. 1998;  28 1187-1190
    Google Scholar
  • 17 Corazza G R, Menozzi M G, Strocchi A. et al . The diagnosis of small bowel bacterial overgrowth. Reliability of jejunal culture and inadequacy of breath hydrogen testing.  Gastroenterology. 1990;  98 302-309
    Google Scholar
  • 18 Corazza G R, Di Stefano M, Scarpignato C. Treatment of functional bowel disorders: is there room for antibiotics?.  Digestion. 2006;  73 (Suppl 1) 38-46
    Google Scholar
  • 19 Cuoco L, Montalto M, Jorizzo R A. et al . Eradication of small intestinal bacterial overgrowth and oro-cecal transit in diabetics.  Hepatogastroenterology. 2002;  49 1582-1586
    Google Scholar
  • 20 Cuoco L, Salvagnini M. Small intestine bacterial overgrowth in irritable bowel syndrome: a retrospective study with rifaximin.  Minerva Gastroenterol Dietol. 2006;  52 89-95
    Google Scholar
  • 21 Dear K L, Elia M, Hunter J O. Do interventions which reduce colonic bacterial fermentation improve symptoms of irritable bowel syndrome?.  Dig Dis Sci. 2005;  50 758-766
    Google Scholar
  • 22 Dellert S F, Nowicki M J, Farrell M K. et al . The 13C-xylose breath test for the diagnosis of small bowel bacterial overgrowth in children.  J Pediatr Gastroenterol Nutr. 1997;  25 153-158
    Google Scholar
  • 23 Dibaise J K, Young R J, Vanderhoof J A. Enteric microbial flora, bacterial overgrowth, and short-bowel sindrome.  Clin Gastroenterol Hepatol. 2006;  4 11-20
    Google Scholar
  • 24 Di Stefano M, Malservisi S, Veneto G. et al . Rifaximin versus chlortetracycline in the short-term treatment of small intestinal bacterial overgrowth.  Aliment Pharmacol Ther. 2000;  14 551-556
    Google Scholar
  • 25 Di Stefano M, Miceli E, Missanelli A. et al . Absorbable vs. non-absorbable antibiotics in the treatment of small intestine bacterial overgrowth in patients with blind-loop syndrome.  Aliment Pharmacol Ther. 2005;  21 985-992
    Google Scholar
  • 26 Draganov P, Toskes P. Is the prevalence of small bowel bacterial overgrowth in patients with irritable bowel syndrome increased? The question remains unanswered.  Dig Dis Sci. 2005;  50 1461
    Google Scholar
  • 27 Elphick D A, Chew T S, Higham S E. Small bowel bacterial overgrowth in symptomatic older people: can it be diagnosed earlier?.  Gerontology. 2005;  51 396-401
    Google Scholar
  • 28 Falk P G, Hooper L V, Midvedt T. et al . Creating and maintaining the gastrointestinal ecosystem: what we know and need to knoe from gnotobiology.  Microbiol Mol Biol Rev. 1998;  62 1157-1170
    Google Scholar
  • 29 Fried M, Siegrist H, Frei R. et al . Duodenal bacterial overgowth during treatment in outpatients with omeprazole.  Gut. 1994;  35 23-26
    Google Scholar
  • 30 Ghoshal U, Ghoshal U C, Ranjan P. et al . Spectrum and antibiotic sensitivity of bacteria contaminating the upper gut in patients with malabsorption syndrome from the tropics.  BMC Gastroenterol. 2003;  3 9
    Google Scholar
  • 31 Gianella R A, Rout W R, Toskes P P. Jejunal brush border injury and impaired sugar and amino acid uptake in the blind loop syndrome.  Gastroenterology. 1974;  80 965-974
    Google Scholar
  • 32 Gorbach S L, Nahas L, Lerner P I. et al . Studies of intestinal microflora. I. Effects of diet, age, and periodic sampling on numbers of fecal microorganisms in man.  Gastroenterology. 1967;  53 845-855
    Google Scholar
  • 33 Gregg C R, Toskes P P. Enteric bacterial flora and small bowel bacterial overgrowth syndrome. Feldman M, Scharschmidt BF, Sleisenger MH Gastrointestinal and liver disease Philadelphia; W.B. Saunders 2002: 1783-1793
    Google Scholar
  • 34 Guarner C, Soriano G. Bacterial translocation and its consequences in patients with cirrhosis.  Eur J Gastroenterol Hepatol. 2005;  17 27-31
    Google Scholar
  • 35 Riordan S M, McIver C J, Wakefield D. et al . Small intestinal bacterial overgrowth in the symptomatic elderly.  Am J Gastroenterol. 1997;  92 47-51
    Google Scholar
  • 36 Gunnarsdottir S A, Sadik R, Shev S. et al . Small intestinal motility disturbances and bacterial overgrowth in patients with liver cirrhosis and potal hypertension.  Am J Gastroenterol. 2003;  98 1362-1370
    Google Scholar
  • 37 Hansel S, Lyden E, Gilroy R. et al . Prevalence and risk factors of small intestinal bacterial overgrowth in short bowel syndrome.  Gastroenterology. 2005;  128 A679
    Google Scholar
  • 38 Hoverstad T, Bjoneklet A, Fausa O. et al . Short-chain fatty acids in the small-bowel bacterial overgrowth syndrome.  Scand J Gastroenterol. 1985;  20 492-499
    Google Scholar
  • 39 Husebye E, Skar V, Hoverstad T. et al . Fasting hypochlorhydria with gram positive gastric flora is highly prevalent in healthy old people.  Gut. 1992;  33 1331-1337
    Google Scholar
  • 40 Husebye E. Gastrointestinal motility disorders and bacterial overgrowth.  J Intern Med. 1995;  237 419-427
    Google Scholar
  • 41 Husebye E. The pathogenesis of gastrointestinal bacterial overgrowth.  Chemotherapy. 2005;  51 (Suppl 1) 1-22
    Google Scholar
  • 42 Keller J, Franke A, Storr M. et al . Klinisch relevante Atemtests in der gastroenterogischen Diagnostik - Empfehlungen der Deutschen Gesellschaft für Neurogastroenterologie und Motilität sowie der Deutschen Gesellschaft für Verdauungs- und Stoffwechselerkrankungen.  Z Gastroenterol. 2005;  43 1071-1090
    Google Scholar
  • 43 Kerlin P, Wong L. Breath hydrogen testing in bacterial overgrowth of the small intestine.  Gastroenterology. 1998;  95 982-987
    Google Scholar
  • 44 King C E, Toskes P. Protein-losing enteropathy in the human and experimental rat blind loop syndrome.  Gastroenterology. 1981;  80 504-511
    Google Scholar
  • 45 King T S, Elia M, Hunter J O. Abnormal colonic fermentation in irritable bowel syndrome.  Lancet. 1998;  352 1187-1189
    Google Scholar
  • 46 King C E, Toskes P P, Guilarte T R. et al . Comparison of the one-gram D-[14C]xylose breath test to the [14C]bile acid breath test in patients with small intestinal bacterial overgrowth.  Dig Dis Sci. 1980;  25 53-58
    Google Scholar
  • 47 Kohler H, McCormick B A, Walker B A. Bacterial-enterocyte crosstalk: cellular mechanisms in health and disease.  J Pediatr Gastroenterol Nutr. 2003;  36 175-185
    Google Scholar
  • 48 Lauritano E C, Gabrielli M, Lupascu A. et al . Rifaximin dose-finding study for the treatment of small intestinal bacterial overgrowth.  Aliment Pharmacol Ther. 2005;  22 31-35
    Google Scholar
  • 49 Lewis S J, Franco S, Young G. et al . Altered bowel function and duodenal bacterial overgrowth in patients treated with omeprazole.  Aliment Pharmacol Ther. 1996;  10 557-561
    Google Scholar
  • 50 Li E. Bacterial overgrowth. Yamada T, Alpers DH, Laine L, Owyang C, Powell DW ( Textbook of Gastroenterology Philadelphia; Lippincott Williams & Wilkins 1999: 1697-1703
    Google Scholar
  • 51 Lichtman S N, Keku J, Schwab J H. et al . Hepatic injury associated with small bowel bacterial overgrowth in rats is prevented by metronidazole and tetracycline.  Gastroenterology. 1991;  100 512-519
    Google Scholar
  • 52 Lin H C. Small intestinal bacterial overgrowth: A framework for understanding irritable bowel disease.  JAMA. 2004;  292 852-858
    Google Scholar
  • 53 Lupascu A, Gabrielli M, Lauritano E C. et al . Hydrogene glucose breath test to detect small intestinal bacterial overgrowth: a prevalence case-control study in irritable bowel syndrome.  Aliment Pharmacol Ther. 2005;  22 1157-1160
    Google Scholar
  • 54 Mackie R I, Sghir A, Gaskins H R. Developmental microbial ecology of the neonatal gastrointestinal tract.  Am J Clin Nutr. 1999;  69 1035S-1045S
    Google Scholar
  • 55 Madrid A M, Hurtado C, Venegas M. et al . Long-Term treatment with cisapride and antibiotics in liver cirrhosis: effect on small intestinal motility, bacterial overgrowth, and liver function.  Am J Gastroenterol. 2001;  96 1251-1255
    Google Scholar
  • 56 McEvoy A, Dutton J, James O FW. Bacterial contamination of the small intestine is an important cause of occult malabsorption in the elderly.  BMJ. 1983;  287 789-793
    Google Scholar
  • 57 Milberg P, Eckardt L, Bruns H J. et al . Divergent Proarrhythmic Potential of Macrolide Antibiotics Despite Similar QT Prolongation: Fast Phase 3 Repolarization Prevents Early Afterdepolarizations and Torsade de Pointes.  J Pharmacol Exp Ther. 2002;  303 218-225
    Google Scholar
  • 58 Morencos F C, de las Heras Castano G, Martin Ramos L. et al . Small bowel bacterial overgrowth in patients with alcoholic cirrhosis.  Dig Dis Sci. 1995;  40 1252-1256
    Google Scholar
  • 59 Morenos F C, De Las Heras Castano G, Meal R. Small bowel bacterial overgrowth in patients with alcoholic cirrhosis.  Dig Dis Sci. 1995;  40 1252-1256
    Google Scholar
  • 60 Mowat C, Williams C, Gillen D. et al . Helicobacter pylori status and alterations in the intragastric milieu facilitating bacterial N-nitrosation.  Gastroenterology. 2000;  119 339-347
    Google Scholar
  • 61 Nayak A K, Karnad D R, Abraham P. et al . Metronidazole relieves symptoms in irritable bowel syndrome: the confusion with so-called „chronic amebiasis”.  Indian J Gastroenterol. 1997;  16 137-139
    Google Scholar
  • 62 Nieuwenhuijs V B, Verheem A, Duijvebode-Beumer van H. et al . The role of interdigestive small bowel motility in the regulation of gut microflora, bacterial overgrowth, and bacterial translocation in rats.  Ann Surg. 1998;  228 188-193
    Google Scholar
  • 63 O’Keefe S J. Bacterial overgrowth and liver complications in short bowel intestinal failure patients.  Gastroenterology. 2006;  130 (Suppl 1) S67-S69
    Google Scholar
  • 64 Pardo A, Bartoli R, Lorenzo-Zuniga V. et al . Effect of cisapride on intestinal bacterial overgrowth and bacterial translocation in cirrhosis.  Hepatology. 2000;  31 858-863
    Google Scholar
  • 65 Pelosini I, Scarpignato C. Rifaximin, a peculiar rifamycin derivative: established and potential clinical use outside the gastrointestinal tract.  Chemotherapy. 2005;  51 122-130
    Google Scholar
  • 66 Pimentel M, Chow E J, Lin H C. Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome.  Am J Gastroenterol. 2000;  95 3503-3506
    Google Scholar
  • 67 Pimentel M, Chow E J, Lin H C. Normalization of lactulose breath testing correlated with symptom improvement in irritable bowel syndrome: a double-blind, randomized, placebo-controlled study.  Am J Gastroenterol. 2003;  98 412-419
    Google Scholar
  • 68 Pimentel M, Soffer E, Chow E J. et al . Lower frequency of MMC is found in IBS subjects with abnormal lactulose breath test, suggesting bacterial overgrowth.  Dig Dis Sci. 2002;  47 2639-2643
    Google Scholar
  • 69 Pimentel M, Park S, Mirocha J. et al . The effect of a nonabsorbed oral antibiotic (rifaximin) on the symptoms of the irritable bowel syndrome: a randomized trial.  Ann Intern Med. 2006;  145 557-563
    Google Scholar
  • 70 Pimentel M, Chatterjee S, Chow E J. et al . Neomycin Improves Constipation-Predominant Irritable Bowel Syndrome in a Fashion That Is Dependent on the Presence of Methane Gas: Subanalysis of a Double-Blind Randomized Controlled Study.  Dig Dis Sci. 2006;  51 1297-301
    Google Scholar
  • 71 Posserud I, Stotzer P O, Bjornsson E. et al . Small intestinal bacterial overgrowth in patients with irritable bowel syndrome.  Gut. 2006; [Epub ahead of print]; 
    Google Scholar
  • 72 Riordan S M, McIver C J, Walker B M. et al . The lactulose breath tests and small intestinal overgrowth.  Am J Gastroenterol. 1996;  91 1795-1799
    Google Scholar
  • 73 Riordan S M, McIver C J, Wakefield D. et al . Small intestinal bacterial overgrowth in the symptomatic elderly.  Am J Gastroenterol. 1997;  92 47-51
    Google Scholar
  • 74 Riordan S M, McIver C J, Wakefield D. et al . Small intestinal mucosal immunity and morphometry in luminal overgrowth of indigenous gut flora.  Am J Gastroenterol. 2001;  96 494-500
    Google Scholar
  • 75 Romagnuolo J, Schiller D, Bailey R J. Using breath tests wisely used in a gastroenterology practice: an evidence-based review of indications and pitfalls in interpreatation.  Am J Gastroenterol. 2002;  97 1113-1116
    Google Scholar
  • 76 Rumessen J J, Gudmand-Hoyer E, Bachmann E. et al . Diagnosis of bacterial overgrowth of the small intestine. Comparison of the 14C-D-xylose breath test and jejunal cultures in 60 patients.  Scand J Gastroenterol. 1985;  20 1267-1275
    Google Scholar
  • 77 Sadik R, Abrahamson H, Bjornsson E. et al . Etiology of portal hypertension may influence gastrointestinal transit.  Scand J Gastroenterol. 2003;  38 1039-1044
    Google Scholar
  • 78 Saltzman J R, Kowdley K V, Pedrosa M C. et al . Bacterial overgrowth without clinical malabsorption in elderly hypochlorhydric subjects.  Gastroenterology. 1994;  106 615-623
    Google Scholar
  • 79 Sanduleanu S, Jonkers D, De Bruine A. et al . Non-helicobacter pylori bacterial flora during acid-suppressive therapy: differential fidings in gastric juice and gastric mucosa.  Aliment Pharmacol Ther. 2001;  15 379-388
    Google Scholar
  • 80 Schmidt T, Pfeiffer A, Kaess H. Abnormal intestinal motility in irritable bowel syndrome.  Gastroenterology. 1996;  111 1400-1401
    Google Scholar
  • 81 Scott L D, Cahall D L. Influence of the interdigestive myoelectric complex on enteric flora in the rat.  Gastroenterology. 1982;  82 737-745
    Google Scholar
  • 82 Sharma B K, Santana I A, Wood E C. et al . Intragastric bacterial activity and nitrosation before, during, and after treatment with omeprazole.  Br Med J. 1984;  289 717-719
    Google Scholar
  • 83 Sherman P, Wesley A, Forstner G G. Sequential disacchridase loss in rat intestinal blind loops: impact of malnutrition.  Am J Physiol. 1985;  248 G626-G632
    Google Scholar
  • 84 Shindo K, Machida M, Koide K. et al . Deconjugation ability of bacteria isolated from the jejunal fluid of patients with progressive systemic sclerosis and its gastric pH.  Hepatogastroenterology. 1998;  45 1643-1650
    Google Scholar
  • 85 Simren M, Stotzer P O. Use and abuse of hydrogen breath tests.  Gut. 2006;  55 (3) 297-303
    Google Scholar
  • 86 Strid H, Simren M, Stotzer P O. et al . Patients with chronic renal failure have abnormal small intestinal motility and a high prevalence of small intestinal bacterial overgrowth.  Digestion. 2003;  67 (3) 129-137
    Google Scholar
  • 87 Solomons N W, Schoeller D A, Wagonfeld J B. et al . Application of a stable isotope (13C)-labeled glycocholate breath test to the diagnosis of bacterial overgrowth.  J Lab Clin Med. 1977;  90 431-439
    Google Scholar
  • 88 Soudah H C, Hasler W I, Owyang C. Effect of octreotide on intestinal motility and bacterial overgrowth in scleroderma.  New Engl J Med. 1991;  325 1461-1467
    Google Scholar
  • 89 Stockbruegger R W, Cotton P B. et al . Pernicious anaemia, intragastric bacterial overgrowth, and possible consequences.  Scand J Gastroenterol. 1984;  19 355-364
    Google Scholar
  • 90 Stotzer P O, Blomberg L, Conway P L. et al . Probiotic treatment of small bacterial overgrowth by Lactobacillus fermentus KLD.  Scand J Infect Dis. 1996;  28 615
    Google Scholar
  • 91 Tabaqchali S, Hatzioannou J, Booth C C. Bile-salt deconjugation and steatorrhoea in patients with the stagnant-loop syndrome.  Lancet. 1968;  2 (7558) 12-16
    Google Scholar
  • 92 Theisen J, Nehra D, Citron D. et al . Suppression of gastric acid secretion in patients with gastroesophageal reflux disease results in gastric bacterial overgrowth and deconjugation of bile acids.  J Gastrointest Surg. 2000;  4 50-54
    Google Scholar
  • 93 Thorens J, Froehlich F, Schwizer W. et al . Bacterial overgrowth during treatment with omeprazole compared with cimetidine: a prospective randomised double blind study.  Gut. 1996;  39 54-59
    Google Scholar
  • 94 Trespi E, Ferrieri A. Intestinal bacterial overgrowth during chronic pancreatitis.  Curr Med Res Opin. 1999;  15 47-52
    Google Scholar
  • 95 Tursi A, Brandimarte G, Giorgetti G. High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten with-drawal.  Am J Gastroenterol. 2003;  98 839-843
    Google Scholar
  • 96 Felius I D, Akkermans L M, Bosscha van K. et al . Interdigestive small bowel motility and duodenal bacterial overgrowth in experimental acute pancreatitis.  Neurogastroenterol Motil. 2003;  15 267-276
    Google Scholar
  • 97 Vanderhoof J A, Young R J. Probiotic therapy in children with short bowel syndrome and bacterial overgrowth (abstract).  Gastroenterology. 1997;  112 A916
    Google Scholar
  • 98 Vanderhoof J A, Young R J, Murray N. et al . Treatment strategies for small bowel bacterial overgrowth.  J Pediatr Gastroenterol Nutr. 1998;  27 155-160
    Google Scholar
  • 99 Verdu E F, Fraser R, Armstrong D. et al . Effects of omeprazole and lansoprazole on 24-hour intragastric pH in Helicobacter pylori-positive volunteers.  Scand J Gastroenterol. 1994;  29 1065-1069
    Google Scholar
  • 100 Welkos S L, Toskes P P, Baer H. et al . Importance of anaerobic bacteria in the cobalamin malabsorption of the experimental rat blind loop syndrome.  Gastroenterology. 1981;  80 313-320
    Google Scholar
  • 101 Wigg A J, Roberts-Thomson I C, Dymock R B. et al . The role of small intestinal bacterial overgrowth, intestinal permeability, endotoxaemia, and tumour necrosis factor alpha in the pathogenesis of non-alcoholic steatohepatitis.  Gut. 2001;  48 206-211
    Google Scholar
  • 102 Williams C, McColl K EL. Proton pump inhibitors and bacterial overgrowth.  Aliment Pharmacol Ther. 2005;  23 3-10
    Google Scholar
  • 103 Yang C Y, Chang C S, Chen G H. Small-intestinal bacterial overgrowth in patients with liver cirrhosis, diagnosed with glucose H2 or CH4 breath test.  Scand J Gastroenterol. 1998;  33 867-871
    Google Scholar

Prof. Jürgen M. Stein

Med. Klinik I-ZAFES, Universität Frankfurt

Theodor-Stern-Kai 7

60590 Frankfurt

Phone: ++49/69/63 01 59 17

Fax: ++49/69/6 30 18 31 12

Email: j.stein@em.uni-frankfurt.de

      >