Dysbacteriosis is a qualitative and quantitative change in the normal intestinal microflora in the direction of increasing the number of symbiotic microorganisms that are not present in healthy people or are found in small quantities.
Dysbacteriosis is quite common and occurs in 90% of adults. It should be borne in mind that intestinal dysbiosis is not an independent disease, it is just a clinical and laboratory syndrome that develops against the background of the underlying disease.
A huge number of bacteria is present in the human intestine:
- conditionally pathogenic flora (bacteroids, staphylococci, streptococci, peptococci and others).
Conditionally pathogenic microorganisms are found in small numbers and peacefully coexist with the “main contingent” of the intestine. But when any factors occur, they begin to actively proliferate, which leads to the development of dysbiosis.
Normal intestinal microflora performs a number of important functions. The main role is protective (they prevent the growth and reproduction of pathogenic and conditionally pathogenic microorganisms). Lactic, succinic and other acids that produce bifidobacteria and E. coli inhibit the growth of putrefactive and pyogenic microbes. In addition, the normal intestinal microflora promotes digestion and produces vitamins. In addition, the normal microflora contributes to the production of antibodies, that is, it has an immunizing property.
There are several clinical forms of intestinal dysbiosis:
- typical ( enteritic, enterocolitis, colitis);
- medium heavy;
With the flow:
- acute (up to 30 days);
- protracted (up to 4 months): with clinical manifestations (continuous or recurrent) and without clinical manifestations;
- chronic (more than 4 months): with clinical manifestations (continuous or recurrent) and without clinical manifestations.
The development of dysbiosis lead to various adverse factors:
- intensive antibiotic therapy, chemotherapy, hormone therapy;
- acute and chronic intestinal infections;
- abdominal surgery;
- diseases of the digestive tract;
- reduction of the body’s defenses under the influence of adverse factors (radiation sickness, burn disease);
- poor nutrition, fasting, overeating;
- a sharp change in the usual way of life;
- the effect of various allergens on the body;
- helminthiasis ( ascariasis , enterobiosis and others).
Clinical manifestations of intestinal dysbiosis can be very diverse. They depend on the nature of the pathological changes that caused dysbacteriosis, and on individual sensitivity, the degree of specific and non-specific sensitization of the organism. Also play the role of the patient’s age, the nature and duration of the drugs used, which led to this state, the type of microbes and so on.
The clinical picture of intestinal dysbiosis is characterized by the presence of common and local signs.
Common manifestations include:
- loss of appetite
- fast fatiguability,
- weight loss
- signs of hypolivitaminosis,
If there is an increase in the activity of conditionally pathogenic flora, then the symptoms of infectious intoxication join:
- high temperature
- heart palpitations
- leukocytosis and acceleration of ESR in the blood .
Local symptoms of intestinal dysbiosis include:
- copious watery stools without pathological impurities ( enteritis ),
- loose stools with admixture (enterocolitis),
- when pus, mucus and blood streak appear in the stool, they speak of colitis .
A spasm of the large intestine due to its inflammation leads to constipation and increased gas formation ( flatulence ).
Abdominal pain is characteristic of all types of intestinal dysbiosis. The intensity of the pain syndrome varies and depends on the location and depth of the pathological process.
In addition, intestinal dysbiosis is characterized by allergic syndrome, which is manifested by itching of the skin and mucous membranes and an allergic rash.
For mild enteritnogo, enterocolitica and kolitnogo dysbiosis include those cases where the chair is no more than 5 times a day, fever and inflammatory changes in the blood are not available. There is also a decrease in appetite.
Moderate form of dysbiosis
In case of an increase in stool up to 6-10 times a day, lack of appetite, continued weight loss, the development of intoxication syndrome and the manifestation of allergy, they speak of a moderate form.
Symptoms of hypovitaminosis and anemia also increase. In the event of a fever, inflammatory changes in the blood indicate an increase in the activity of conditionally pathogenic flora.
With stool frequency up to 10 times a day or more, fever, intestinal paresis (refuses to peristaltic ), anemia, significant weight loss, hemodynamic changes up to toxic shock should be diagnosed with a severe form of dysbacteriosis.
Differential diagnosis of dysbiosis should be carried out with intestinal infections.
From laboratory methods of diagnosis, microbiological examination of feces provides real assistance, which makes it possible to identify not only the qualitative and quantitative violation of the intestinal microflora, but also to determine the sensitivity of the inoculated pathogenic and conditionally pathogenic microorganisms to antibiotics and bacteriophages.
For the study, 1 gram of feces, diluted in nat. the solution is sown on nutrient medium. A violation of the intestinal biocenosis is evidenced by the absence of growth of bifidobacteria and a sharp decrease in E. coli. In addition, an indicator of dysbiosis is the detection of bacteria such as proteus, staphylococcus, yeast-like fungi, and others.
In addition to the examination, the doctor may prescribe gastroscopy, sigmoidoscopy, barium enema, colonoscopy and Ultrasound examination of the abdominal cavity .
The gastroenterologist, or, in his absence, a general practitioner, is engaged in the treatment of intestinal dysbacteriosis.
Treatment should begin with the elimination of the cause of the condition (if possible) and the appointment of a diet.
Diet for dysbacteriosis
First of all, when dysbacteriosis is imposed a ban on alcohol, fatty, fried, spicy and salty foods, sweets and baked goods, as well as products that enhance gas formation and putrefactive processes.
Rough fiber is also recommended not to use. In the food should be dairy products and fruits, berries and vegetables that are well absorbed in the intestines and inhibit rotting and fermentation (apricots, tomatoes without skin, blueberries, pumpkin, eggplant and others).
Antibacterial therapy is prescribed for moderately severe and severe forms of dysbacteriosis.
Antibiotics are selected taking into account the sensitivity to them of the sown pathogenic microorganisms.
For example, in staphylococcal dysbacteriosis, preference is given to macrolide antibiotics (azithromycin, erythromycin), aminoglycosides (gentamicin), fluoroquinolones ( ciprolet ) and cephalosporins ( cefazolin ).
In dysbacteriosis caused by Klebsiella and citrobacter, gentamicin is indicated.
Treatment of candidal dysbacteriosis requires prescription of antifungal drugs ( flucostat ).
It is possible to replace antibiotics with nitrofuran derivatives ( furazolidone , furadonin ) or bacteriophages (for a mild disease): staphylococcal bacteriophage, proteic bacteriophage, pyobacteriophage and others.
The course of treatment with antibiotics and nitrofurans lasts 7-10 days. Bacteriophages prescribed courses for 5-7 days, at intervals of 3 days. The number of courses depends on the effectiveness of treatment.
The second step in the treatment of dysbiosis is the restoration of normal intestinal microflora.
Bacterial drugs (probiotics) include: bifikol, lactobacterin, colibacterin, bifidumbacterin, baktsibutil and others. The duration of the course of treatment with biological preparations ranges from 3 weeks to 1.5-2 months, depending on the severity of the disease.
Treatment of dysbacteriosis is complex and should include, in addition to the above, enzyme preparations ( festal , pancreatin, abomin ), vitamin complexes and immunostimulants.
Dysbacteriosis leads to secondary immunodeficiency, as a result of which the following diseases can develop (if there is a predisposition and provoking factors):
- bronchial asthma;
- malignant intestinal tumors and so on.
The prognosis for dysbacteriosis depends on the adequacy of therapy and the severity of the process.
In most cases, the prognosis is favorable.