Small Bowel Bacterial Overgrowth (SBBO)

Table 4. Medications Metabolized by Intestinal Bacteria

    • Digoxin
    • L-dopa
    • Colchicine
    • Morphine
    • Conjugated Estrogens
    • Chloramphenicol
    • Rifampin
    • Sulfasalazine
Table 5. Clinical Conditions Associated with SBBO
Feature
Associated Clinical Condition
Gastric Proliferation
  • Hypochlorhydria or achlorhydria, especially when combined with motor or anatomic disturbances
  • Sustained hypochlorhydria induced by proton pump inhibitor
Small intestinal stagnation
Anatomic
  • Afferent loop of Billroth II partial gastrectomy
  • Duodenal-jejunal diverticulosis
  • Surgical bind loop (end-to-side anastomosis)
  • Surgical recirculating loop (end-to-side anastomosis)
  • Ileal anal pouch
  • Obstruction (stricture, adhesion, inflammation, neoplasm)
Motor
  • Scleroderma
  • Idiopathic intestinal pseudo-obstruction
  • Absent or disordered migrating motor complex (MMC)
  • Diabetic autonomic neuropathy
Abnormal communication between proximal and distal gastrointestional tract
  • Gastrocolic or jejunocolic fistula
  • Resection of diseased ileocecal valve
Miscellaneous
  • Chronic pancreatitis
  • Immunodeficiency syndromes
  • Cirrhosis
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