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Jejunal Flora Analysis – Small Intestine Test
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.
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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.
What is Jejunal Flora Analysis?
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.
When is Jejunal Flora Analysis Used?
This analysis is indicated when SIBO is suspected. Common signs include:
- Chronic bloating and abdominal pain
- Diarrhea or unexplained changes in bowel habits
- Unintentional weight loss
- Nutritional deficiencies despite adequate food intake
- Irritable bowel syndrome (IBS) without a clear cause
- Food intolerances
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.
How Does the Analysis Work?
Jejunal Aspiration (Gold Standard)
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.
Breath Tests as an Indirect Method
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.
What Do the Results Indicate?
An elevated bacterial count or the presence of specific bacterial species in the jejunum may indicate:
- SIBO (Small Intestinal Bacterial Overgrowth)
- Impaired intestinal motility
- Intestinal immune deficiencies
- Post-surgical changes or anatomical abnormalities of the gut
Treatment After Diagnosis of Overgrowth
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.
References
- Bures J et al. – Small intestinal bacterial overgrowth syndrome. World Journal of Gastroenterology, 2010. PubMed PMID: 20533598.
- Ghoshal UC et al. – Small intestinal bacterial overgrowth and irritable bowel syndrome: a bridge between functional organic dichotomy. Gut and Liver, 2017.
- Rezaie A et al. – Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders. American Journal of Gastroenterology, 2017.
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