From the Guidelines
Fecalization of the ileum is a significant problem that requires prompt medical attention, as it can lead to bacterial overgrowth, malabsorption, and nutritional deficiencies. Fecalization of the ileum occurs when colonic bacteria abnormally colonize the small intestine, particularly the ileum, resulting in small intestinal bacterial overgrowth (SIBO) 1. This condition can be caused by resection of the ileocecal valve, allowing colonic bacteria to populate the small intestine 1.
Key Considerations
- Bacterial overgrowth can negatively impact digestion and nutrient assimilation, as bacteria compete for nutrients with the enterocytes 1.
- Diagnosis of bacterial overgrowth may be more difficult using breath tests due to rapid intestinal transit in short bowel syndrome (SBS) 1.
- Treatment can be undertaken with oral antibiotics such as metronidazole, tetracycline, or other antibiotics 1.
Management and Treatment
- Oral rehydration solutions (ORS) with 90-120 mEq/L sodium can help decrease dehydration and total parenteral nutrition (TPN) fluid requirements 1.
- Magnesium deficiency may occur despite a normal serum concentration, and oral calcium supplementation is recommended routinely 1.
- High-dose H2 antagonists and proton pump inhibitors can reduce gastric fluid secretion, and fluid losses can be controlled with anti-motility agents such as loperamide hydrochloride or diphenoxylate 1.
Potential Complications
- If left untreated, fecalization of the ileum can cause significant nutritional deficiencies, particularly of fat-soluble vitamins and vitamin B12, and contribute to chronic gastrointestinal symptoms and overall health deterioration 1.
- The abnormal bacterial presence disrupts normal digestive processes, interferes with nutrient absorption, and produces excessive gas and toxic byproducts 1.
From the Research
Fecalization of the Ileum
- Fecalization of the ileum can lead to several problems, including malabsorption of nutrients, diarrhea, and vitamin deficiencies 2.
- The ileum plays a crucial role in the absorption of bile salts, and its resection can lead to fat malabsorption and steatorrhea 2.
- The loss of the ileocecal valve and ileum segment can accelerate intestinal transit time, resulting in incomplete digestion and absorption of food, leading to osmotic diarrhea 2.
- Fecalization of the ileum can also lead to vitamin B12 deficiency, as the terminal ileum is the primary site for vitamin B12 absorption 2, 3.
- Additionally, derangements in bile salt metabolism can occur, increasing the risk of gallstones and urolithiasis 2.
Small Intestinal Bacterial Overgrowth (SIBO)
- SIBO is a condition characterized by an excessive number of microorganisms in the small intestine, which can lead to symptoms such as abdominal pain, bloating, diarrhea, and weight loss 4, 5, 6.
- SIBO can be caused by various factors, including anatomical alterations, motility disorders, and certain medications 4, 5, 6.
- Diagnosis of SIBO is typically made using breath testing or small bowel aspirate/culture, and treatment usually involves oral antibiotics 4, 5, 6.