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Jejunal flora analysis examines the bacterial population in the small intestine to detect overgrowth early. It is a key diagnostic tool for unexplained digestive complaints.
Jejunal flora analysis examines the bacterial population in the small intestine to detect overgrowth early. It is a key diagnostic tool for unexplained digestive complaints.
Jejunal flora analysis is a diagnostic procedure that examines the composition and quantity of microorganisms in the jejunum – the middle section of the small intestine. Under healthy conditions, the jejunum contains relatively few bacteria. An abnormally high bacterial count in this region is referred to as Small Intestinal Bacterial Overgrowth (SIBO), which can cause a wide range of digestive symptoms.
This analysis is indicated when SIBO is suspected. Common signs include:
It may also be recommended in patients with Crohn's disease, coeliac disease, or following gastric surgery or other anatomical changes to the gastrointestinal tract.
The most accurate method involves directly collecting small intestinal fluid via upper endoscopy. A thin, flexible tube (endoscope) is passed through the mouth, oesophagus, and stomach into the jejunum, where a fluid sample is aspirated. This sample is then cultured in a laboratory to identify and quantify the microorganisms present. A bacterial count exceeding 10³ colony-forming units per millilitre (CFU/ml) is generally considered indicative of overgrowth.
A less invasive alternative is the hydrogen breath test. The patient drinks a sugar solution (such as lactulose or glucose), and exhaled air is measured at regular intervals for hydrogen and methane content. Bacteria in the small intestine ferment the sugars and produce these gases, which are absorbed into the bloodstream and exhaled. While simpler to perform, breath tests are slightly less precise than direct aspiration.
An elevated bacterial count or the presence of specific bacterial species in the jejunum may indicate:
If SIBO is confirmed, treatment typically involves antibiotic therapy targeting the overgrown bacteria. Rifaximin is commonly used because it is minimally absorbed into the bloodstream and acts primarily within the gut. Dietary modifications and probiotic supplementation may be used as supportive measures. Treating any underlying condition that contributed to the overgrowth is equally important for long-term management.
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