Overview
Disruption of the balance between the microflora of the intestinal tract under the influence of certain factors
Typical manifestations are diarrhea and abdominal pain
The main causes are the use of antibiotics and other drugs, abnormal gastrointestinal function and chronic wasting disease.
The main treatments include medication and fecal flora transplantation.
What is intestinal dysbiosis?
Definition
Under normal circumstances, there are about 1014 bacteria in the gastrointestinal tract of a healthy adult. The intestinal flora maintains a dynamic balance and plays an important role in human health.
When the balance is disturbed due to certain reasons, the intestinal flora changes in terms of species, number, ratio and location, which may cause a variety of diseases.
Classification
Dysbiosis of intestinal flora includes disproportion, localization and self-infection.
Disproportion
The intestinal flora only shows changes in quantity and species, which can be categorized into 3 degrees according to the severity.
Mild: only quantitative changes in bacteria, usually no clinical discomfort or slight bowel abnormality, the normal intestinal flora such as Escherichia coli and enterococci may be reduced, but this is temporary and reversible, and can be recovered naturally once the cause of the dysbiosis is removed.
Moderate: The normal intestinal flora is significantly reduced, causing symptoms of dysbiosis, which usually cannot be recovered naturally. Even if the cause is eliminated, the original dysbiosis is still maintained, and treatment is needed to correct it.
Severe: Most of the normal intestinal flora are inhibited, and the abnormal flora overpopulate, causing symptoms of infection.
Localized transfer
Bacteria and/or endotoxin originally present in the intestinal lumen, through some way to enter other locations resulting in intestinal dysbiosis.
There are two types of transfer: horizontal transfer and vertical transfer.
Lateral transfer refers to the transfer of normal intestinal flora from its original location to the surrounding area.
Longitudinal transfer refers to the transfer of normal flora from the original location to the depth of the intestinal mucosa. Such as bacteria through the lymph, blood to lymph nodes, liver and spleen, peritoneal and systemic infection.
Autoinfection
When the body resistance is low, the normal flora of the intestinal tract can be transformed into conditionally pathogenic bacteria causing infection.
Autoinfections are often seen in patients with impaired immune function or critical illnesses, and are usually the result of a combination of intestinal flora imbalance and localized metastasis.
Pathogenesis
There are no morbidity statistics associated with intestinal dysbiosis.
The time of onset of drug-associated intestinal dysbiosis is well defined, with most occurring during drug use and a few occurring after drug discontinuation.
Questions you may be concerned about
What are the symptoms of intestinal dysbiosis?
The main symptoms of intestinal dysbiosis include abdominal pain, diarrhea, and abdominal discomfort.
Mild patients show loose stools, while severe patients tend to have watery diarrhea or stools with mucus. A few patients may have fever, nausea and vomiting.
Severe cases can lead to dehydration, which is characterized by sunken eye sockets, dry skin, thirst, and oliguria. Shock and coma may also occur.
Will intestinal dysbiosis be cured?
Intestinal dysbiosis can be cured, and the prognosis is usually good by actively treating the primary disease, correcting the predisposing factors, and adjusting the body’s immune function and malnutrition.
Intestinal dysbiosis can be treated with probiotics, prebiotics, synbiotics and other medications, such as Bifidobacterium bifidum and Bacillus licheniformis; it can also be rebuilt through fecal colony transplantation therapy to rebuild the micro-ecology of intestinal flora.
What is the treatment for intestinal dysbiosis?
The main treatment for intestinal dysbiosis is to actively treat the primary disease, stop antibiotics, and give probiotics and fecal flora transplantation.
While discontinuing the original antibiotics, oral probiotics, such as Bifidobacterium bifidum and Bacillus licheniformis, can help regulate the intestinal flora.
As an effective means to rebuild intestinal flora, fecal flora transplantation therapy involves processing feces from healthy individuals and delivering it to the patient’s digestive tract via oral capsules or endoscopic infusion to rebuild the microecology of intestinal flora.
Causes
Causes
Many factors can lead to changes in the normal intestinal flora in terms of species and number, thus causing intestinal flora dysbiosis.
Drug metabolism
Drugs may cause imbalance of intestinal flora. Common drugs with imbalance of flora include antibiotics, lactulose, salicylic acid azidosulfapyridine and so on.
Abnormal intestinal function
Abnormal intestinal peristalsis caused by various diseases may lead to positional changes in the intestinal flora. Long-term abnormal gastrointestinal peristalsis and residual food residues can lead to bacterial overpopulation and intestinal flora dysbiosis.
Chronic wasting disease
Chronic wasting disease such as infectious disease, malignant tumor, metabolic syndrome, connective tissue disease, impaired liver and kidney function, etc., can lead to intestinal flora dysbiosis due to loss of appetite and weakened digestive function.
Others
Post-radiation therapy, malnutrition and other factors may lead to intestinal flora dysbiosis.
Symptoms
Main Symptoms
Clinical symptoms
Abdominal pain, diarrhea, abdominal discomfort.
Mild patients present with loose stools, while severe patients tend to have watery diarrhea or stools with mucus.
A few patients may have fever, nausea and vomiting.
Onset
The onset of drug-associated intestinal dysbiosis is relatively clear, mostly occurring during drug use, with a few occurring after drug discontinuation.
Complications
Dehydration
Nausea, vomiting, diarrhea, and in severe cases, dehydration may result, with patients presenting with sunken eye sockets, dry skin, thirst, and oliguria.
Shock
Severe cases may have water and electrolyte disorders, manifesting as confusion and convulsions, cardiac arrest and coma.
Consultation
Department of Medicine
Gastroenterology
Abdominal pain and diarrhea are recommended to seek medical attention.
Emergency Department
When severe abdominal pain and diarrhea occur and there are symptoms of dehydration such as weakness, extreme thirst, scanty urination, dry skin, sunken eyes, etc., it is recommended to consult a doctor immediately.
Pediatrics
Children can visit the pediatrics department.
Preparation for medical treatment
Preparation for medical consultation: registration, preparation of documents, frequently asked questions
Tips for seeking medical treatment
Try to keep a record of symptoms, duration, etc. for the doctor’s reference before the visit.
Preparation list
Symptom list
Pay particular attention to the time of onset of symptoms, special manifestations, etc.
What is the discomfort? How long has it lasted?
Is there any abdominal pain or discomfort and when does it usually get worse?
Are there any changes in bowel movements or stool patterns from normal?
Is there any bloating and how does it resolve?
Any acid reflux, nausea or vomiting?
Have you eaten any unclean food or drunk any unhygienic water recently?
What medications have you taken recently?
Medical History List
Have you ever suffered from intestinal diseases?
Has any relevant examination been done?
Any history of drug allergy?
Checklist
Test results in the last six months, which can be brought to the doctor’s office
Routine blood test, routine stool test
Stool culture
Colonoscopy
Abdominal ultrasound, abdominal CT
Medication list
Medication used in the last 3 months, if available in boxes or packages, bring with you to the doctor’s office
Antibacterial drugs: cefuroxime, clarithromycin, amoxicillin, levofloxacin
Antidiarrheal drugs: Montelukast, Berberine hydrochloride
Anticholinergics: Racemic scopolamine
Diagnosis
Diagnosis is based on
Medical history
The patient can suffer from intestinal and systemic diseases.
The patient has recently been on antibiotics, hormones, and other medications and exposed to radionuclides.
Clinical manifestations
The patient has diarrhea, abdominal distension, abdominal pain, abdominal discomfort and other symptoms.
Laboratory tests
Stool examination
Stool smear may show a decrease in the number of bacteria, especially gram-negative bacilli, and a decrease in normal physiological flora and an increase in pathogenic bacteria in fecal culture and flora analysis.
There is no need to fast and abstain from food and water before the fecal test, and the specimen needs to be sent for examination in time using a special container, and cannot be mixed with urine and other impurities.
Note: The specimen for fecal bacterial culture should use the special specimen box provided by the hospital laboratory to avoid mixing with other bacteria.
Blood biochemistry test
Blood biochemistry tests measure the levels of ions, sugars, lipids, proteins, as well as various enzymes, hormones and many metabolites of the body in the blood.
Thyroid stimulating hormone and blood calcium concentration tests can help the doctor to rule out diseases related to bowel abnormalities caused by hyperthyroidism and hypercalcemia.
Imaging
Imaging manifestations have no diagnostic significance for intestinal dysbiosis, but can help doctors rule out organic gastrointestinal disorders, such as abdominal CT and ultrasound.
Precautions: Metal objects, such as belts, need to be removed from the abdomen before the examination. Children need to be assisted by their parents during the examination.
Colonoscopy
Colonoscopy is intuitive and clear, and biopsy is performed on suspicious areas to rule out organic intestinal diseases, such as ulcerative colitis and colorectal tumors.
Differential Diagnosis
Colorectal tumor
Similarity: both of them can have symptoms such as abdominal pain, diarrhea and constipation, and people over 50 years old should pay attention to the differentiation.
Differences: endoscopy is needed for differential diagnosis.
Ulcerative colitis
Similarity: Both may present with diarrhea and other symptoms.
Difference: Ulcerative colitis is usually accompanied by mucus, pus and blood in the stool. In addition, the site of pain is usually the left lower abdomen, except around the umbilicus. It can be differentiated by endoscopy, but ulcerative colitis can often be combined with intestinal flora imbalance.
Functional diarrhea
Similarity: both have diarrhea.
Difference: Functional diarrhea is not accompanied by abdominal pain, and there is no intestinal flora imbalance, stool examination can be clear differential diagnosis.
Treatment
Treatment principle: actively treat the primary disease, correct the possible triggering factors, adjust the body’s immune function and malnutrition.
Medication
Micro-ecological preparations
Microecological agents utilize normal microorganisms that are beneficial to the human body or agents that promote the growth of normal microorganisms, and currently there are three main categories: probiotics, prebiotics and synbiotics.
Probiotics
Probiotics refer to a class of live bacterial agents and their metabolites that can improve the ecological level of human gastrointestinal flora.
At present, they mainly include Bifidobacterium, Lactobacillus, Clostridium acetobacter, Bacillus licheniformis and so on.
Probiotics
Substances that can selectively promote the growth and reproduction of beneficial bacteria in the human intestinal tract.
Mainly includes lactulose, sucrose oligosaccharide, cotton seed oligosaccharide, etc.
Probiotics
Preparations in which probiotics and prebiotics coexist and are taken to help regulate intestinal flora.
Fecal Flora Transplantation Therapy
Fecal flora transplantation therapy involves treating feces from healthy individuals and then delivering it to the patient’s digestive tract via oral capsules or endoscopic infusion of extracts to rebuild the microecology of the intestinal flora.
Adverse effects: Abdominal bloating, nausea and vomiting may occur in the short term after transplantation.
Other treatments
For patients with primary diseases, primary diseases should be actively treated to improve immunity.
For patients with severe diarrhea, antidiarrheal agents can be used for relief, such as montelukast.
Patients with severe diarrhea leading to dehydration need rehydration therapy.
Prognosis
Cure
The prognosis of intestinal dysbiosis is usually good after active treatment.
Dangers
Abdominal discomfort, abdominal pain and diarrhea caused by intestinal dysbiosis can adversely affect the patient’s emotional state and quality of life.
In recent years, with the deepening of research, there is a certain link between intestinal flora dysbiosis and the onset of diabetes mellitus, nephropathy, depression and other diseases, and prolonged dysbiosis of intestinal flora may lead to the occurrence of the above diseases.
Daily
Daily Management
Dietary management
Avoid stimulating foods.
Avoid overeating and have regular meals at regular intervals.
Avoid drinking strong tea, coffee, etc.
Prohibit alcohol consumption during treatment.
Lifestyle management
Work and rest on time, don’t stay up late and ensure enough sleep.
Keep in a good mood and avoid bad emotions.
Exercise actively.
Quit smoking.
Prevention
Eat less stimulating food and have balanced nutrition to avoid malnutrition.
Work and rest should be regular, avoid staying up late.
Exercise properly, such as jogging, playing ball games, etc., to improve physical fitness and resistance.
Actively treat primary diseases, such as gastrointestinal diseases.
Take medication as prescribed by the doctor, do not take antibiotics and glucocorticoids.
Avoid contact with radioactive substances, radiation therapy needs to be well protected.