The term "Dysbacteriosis", comes from the Greek "dys", which means "negation" and the words "bacteria", "bacteria or microorganism". Intestinal dysbacteriosis is a quantitative and qualitative violation of the normal intestinal flora. The human intestine is inhabited by bacteria, about 2/3 of the contents of the large and small intestines are represented by microorganisms. A certain quantity and quality of such microorganisms constitute the normal intestinal microflora. Normal intestinal flora is a biomass of obligate (mandatory) microbes involved in the development of immunity. With intestinal dysbacteriosis, there is a violation of the production of immunity, the colonization of foreign microorganisms, and the development of putrefactive flora, instead of normal. As a result, the putrefactive flora causes chronic inflammation of the intestine, with characteristic clinical manifestations. An imbalance between microorganisms is the background for the development of various intestinal diseases (the most dangerous is intestinal cancer).

Anatomy and physiology of the intestine

In order to understand in which anatomical formations dysbacteriosis occurs, for this we will talk a little about the anatomy of the intestine.

The intestine is the longest section of the digestive tract, located in the abdominal cavity, originates from the pylorus and ends with the anus. The length of the entire intestine is about 4 meters. It is divided into the small intestine and the large intestine, each of which has its own anatomical features.

1. Small intestine, is the initial section of the intestine, consists of loops, longer than the thick one (from 2.2 to 4.4 m) and smaller in diameter (from 5 to 3 cm). Processes of digestion of proteins, fats and carbohydrates take place in it. The small intestine begins at the pylorus and ends at the ileocecal angle. The small intestine is divided into 3 sections:

• The initial section - the duodenum, starts from the pylorus of the stomach, has the shape of a horseshoe, goes around the pancreas;
• The jejunum is a continuation of the duodenum, making up approximately the initial 6-7 loops of the small intestine, the border between them is not expressed;
• The ileum is a continuation of the jejunum, represented by the following 7-8 loops. It ends with a confluence at a right angle into the initial part of the large intestine (caecum).

1. Colon, represents the final section of the digestive tract, it absorbs water and forms formed feces. It is located so that it borders (surrounds) the loops of the small intestine. Its wall forms protrusions (gaustra), which is one of the differences from the wall of the small intestine. The length of the large intestine is about 150 cm and the diameter is from 8 to 4 cm, depending on the department. The large intestine consists of the following sections:

• The caecum with the appendicular process is the initial section of the large intestine, located below the ileocecal angle, its length is from 3 to 8 cm;
• The ascending part of the colon is a continuation of the caecum, occupies the extreme right lateral position of the abdominal cavity, rises from the level of the ilium to the level of the lower edge of the right lobe of the liver, and ends with the right bend of the colon;
• The transverse colon, starts from the right colic flexure (the level of the right hypochondrium), runs in the transverse direction and ends with the left flexure of the colon (the level of the left hypochondrium);
• The descending part of the colon occupies the extreme left lateral position of the abdominal cavity. It starts from the left bend of the colon, goes down to the level of the left ilium;
• The sigmoid colon, 55 cm long, is a continuation of the previous section of the intestine, and at the level of the 3rd sacral vertebra passes into the next section (rectum). The diameter of the sigmoid colon, compared with the diameter of the other parts of the large intestine, is the smallest about 4 cm;
• The rectum, is the final section of the large intestine, has a length of about 18 cm. It starts from the level of the 3rd sacral vertebra (the end of the sigmoid colon) and ends with the anus.

What is normal intestinal flora?

Microbes that live in the human intestine are vital to the human body. The approximate amount of normal intestinal flora is about 10 14 microbes, which corresponds to 2 kilograms and includes about 500 types of bacteria. The concentration of microbes in different parts of the intestine is not the same: in the duodenum and jejunum about 10 5 microorganisms per 1 ml of intestinal contents, in the ileum about 10 7 - 10 8 , in the large intestine about 10 11 microorganisms per 1 g of feces.
Normally, the intestinal flora is represented by 2 groups of bacteria:

• Obligatory bacteria bifidobacteria (make up about 85-95% of the flora), lactobacilli (1-5% of the flora), E. coli (Escherichia), enterococci, peptostreptococci), are always part of the normal flora;
• Facultative bacteria (peptococci, staphylococci, yeast-like fungi, clostridia and others), they are optional and non-permanent representatives. They enter the intestines with insufficiently thermally processed food. This group of bacteria is often present in healthy people without causing any problems, but with a decrease in immunity, they multiply and develop various infectious diseases of the intestine.

Normal composition of bacteria in the intestine

• bifidobacteria - 10 9 - 10 10 CFU / g;
• lactobacilli - 10 7 - 10 8 CFU / g;
• bacteroids - 10 7 - 10 9 CFU / g;
• Escherichia - 10 6 - 10 8 CFU / g;
• peptococci and peptostreptococci - 10 5 - 10 6 CFU / g;
• eubacteria - 10 3 - 10 5 CFU/g;
• staphylococci - 103 CFU/g;
• streptococci - 10 4 - 10 5 CFU / g;
• clostridia - 10 5 - 10 7 CFU / g;
• yeast-like mushrooms - 10 9 - 10 10 CFU / g;
• conditionally pathogenic enterobacteria - 10 3 CFU / g.

Functions of normal intestinal microflora

1. protective function, is to prevent the colonization of foreign microorganisms in the intestine, which can cause various infectious diseases of the intestine. Microbes (bifidobacteria) of the normal intestinal flora produce special substances (lactic and acetic acid) that inhibit the development of foreign microbes. In order for foreign bacteria to gain a foothold on the intestinal mucosa, they need to displace the normal flora, but the latter interfere with this process, since the place is already “occupied”.
2. Stimulation of immunity, due to bifidobacteria, is to stimulate the formation of antibodies and other substances (cytokines, interferons) involved in the development of immunity.
3. Removal of toxins (detoxification function), consists in the absorption of various toxins (phenols, heavy metal compounds, and others), by bifidobacteria of the intestinal flora.
4. digestive function, bacteria of the intestinal flora are involved in the breakdown of proteins, fats, carbohydrates, to amino acids, fatty acids and monosaccharides. They also increase intestinal motility, preventing the development of constipation.
5. synthesizing function, bacteria of the normal intestinal flora are involved in the formation of vitamins (B, K, C), some acids, enzymes.
6. regulatory function, those. flora bacteria, regulate the gas composition of the intestine, water-salt metabolism, cholesterol and others.
7. Anticarcinogenic (anticancer) action, consists in the absorption by bifidobacteria of the precursors of cancer cells.
8. Antiallergic action, occurs with the help of lactobacilli.

Symptoms of intestinal dysbiosis

The 1st degree and most often the 2nd degree of intestinal dysbacteriosis are not clinically manifested.
Symptoms characteristic of the 3rd and 4th degree of intestinal dysbacteriosis:

1. Stool disorder:

• Most often it manifests itself in the form of loose stools (diarrhea), which develops as a result of increased formation of bile acids and increased intestinal motility, inhibiting the absorption of water. Later the stool becomes foul-smelling, tainted with blood or mucus;
• With age-related (in the elderly) dysbacteriosis, constipation most often develops, which is caused by a decrease in intestinal motility (due to a lack of normal flora).

1. Bloating, due to the increased formation of gases in the large intestine. The accumulation of gases develops as a result of impaired absorption and removal of gases by an altered intestinal wall. Swollen intestines can be accompanied by rumbling, and cause unpleasant sensations in the abdominal cavity in the form of pain.
2. Cramping pain associated with an increase in pressure in the intestines, after the discharge of gases or stools, it decreases. With dysbacteriosis of the small intestine, pain occurs around the navel, if the large intestine suffers, the pain is localized in the iliac region (lower abdomen on the right);
3. Dyspeptic disorders: nausea, vomiting, belching, loss of appetite, are the result of impaired digestion;
4. allergic reactions, in the form of skin itching and rashes, develop after eating foods that usually did not cause allergies, is the result of an insufficient anti-allergic effect, disturbed intestinal flora.
5. Symptoms of intoxication: there may be a slight increase in temperature up to 38 0 C, headaches, general fatigue, sleep disturbance, are the result of the accumulation of metabolic products (metabolism) in the body;
6. Symptoms that characterize a lack of vitamins: dry skin, seizures around the mouth, pale skin, stomatitis, changes in hair and nails, and others.

Complications and consequences of intestinal dysbacteriosis

• Chronic enterocolitis, is a chronic inflammation of the small and large intestines, which develops as a result of long-term action of the pathogenic intestinal flora.

• Deficiency of vitamins and microelements in the body, leads to the development of iron deficiency anemia, hypovitaminosis of B vitamins and others. This group of complications develops as a result of impaired digestion and absorption in the intestine.
• Sepsis(blood infection), develops as a result of pathogenic flora from the intestines entering the patient's blood. Most often, such a complication develops when the patient does not seek medical help in time.
• Peritonitis, develops as a result of the aggressive action of pathogenic flora on the intestinal wall, with the destruction of all its layers and the release of intestinal contents into the abdominal cavity.
• Accession of other diseases as a result of reduced immunity.
• Gastroduodenitis, pancreatitis, develop as a result of the spread of pathogenic intestinal flora along the digestive tract.
• Decreased patient weight, develops as a result of impaired digestion.

Diagnosis of intestinal dysbacteriosis

The diagnosis of intestinal dysbacteriosis is made on the basis of the patient's complaints, an objective examination and the results of a microbiological study of feces.

1. With the help of an objective examination, which includes palpation of the abdomen, pain is determined along the course of the small and / or large intestine.
2. Microbiological examination of feces: performed to confirm the diagnosis, intestinal dysbacteriosis.

Indications for microbiological examination of feces:

• Intestinal disorders are long-term, in cases where it is not possible to isolate a pathogenic microorganism;
• Long recovery period after acute intestinal infections;
• The presence of purulent-inflammatory foci that are not amenable to antibiotic therapy;
• Impaired bowel function in individuals undergoing radiotherapy or exposure to radiation;
• Immunodeficiency states (AIDS, cancer and others);
• The lag of the infant in physical development and others.

Rules for taking feces for microbiological research: before taking feces, for 3 days, it is necessary, it is necessary to be on a special diet, which excludes products that increase fermentation in the intestines (alcohol, lactic acid products), as well as any antibacterial drugs. Feces are collected in a special sterile container, equipped with a lid, with a screwed-in spoon. In order to correctly evaluate the results, it is recommended to conduct a study 2-3 times, with an interval of 1-2 days.

Degrees of intestinal dysbacteriosis
There are 4 degrees of intestinal dysbacteriosis:

• 1 degree: characterized by a quantitative change in the ischerichia in the intestine, bifidoflora and lactoflora are not changed, most often they are not clinically manifested;
• Grade 2: quantitative and qualitative changes in ischerichia, i.e. a decrease in the amount of bifidoflora and an increase in opportunistic bacteria (fungi and others), accompanied by local inflammation of the intestines;
• Grade 3: change (decrease) in bifidus and lactoflora and the development of opportunistic flora, accompanied by intestinal dysfunction;
• Grade 4: the absence of bifidoflora, a sharp decrease in lactoflora and the growth of conditionally pathogenic flora, can lead to destructive changes in the intestine, followed by the development of sepsis.

Treatment of intestinal dysbacteriosis

Medical treatment

Treatment of intestinal dysbacteriosis is carried out with the help of drugs that restore the normal flora of the intestine and correct other disorders in the body (with the help of enzymes, sorbents, vitamins). The dosage, duration of treatment and a group of drugs are prescribed by the attending physician, depending on the degree of dysbacteriosis. The dosages of drugs for adults are indicated below, for children the dosage depends on the weight and age of the child.
Groups of drugs used in intestinal dysbacteriosis:

1. Prebiotics- have a bifidogenic property, i.e. contribute to the stimulation and growth and reproduction of microbes that are part of the normal intestinal flora. Representatives of this group include: Khilak-forte, Dufalac. Hilak-forte is prescribed 40-60 drops 3 times a day.
2. Probiotics (eubiotics), these are preparations containing live microorganisms (i.e. bacteria of the normal intestinal flora), they are used to treat dysbacteriosis of 2-4 degrees.

• 1st generation drugs: Bifidumbacterin, Lifepack probiotics. They are liquid concentrates of lactobacilli and bifidobacteria, they are not stored for a long time (about 3 months). This group of drugs is unstable under the influence of gastric juice or enzymes of the gastrointestinal tract, which leads to their rapid destruction and insufficient concentration of them, the main disadvantage of 1st generation probiotics. Bifidumbacterin is administered orally, 5 doses of the drug 2-3 times a day, 20 minutes before meals;
• 2nd generation drugs: Baktisubtil, Flonivin, Enterol. They contain spores of bacteria of the normal intestinal flora, which in the patient's intestines secrete enzymes for the digestion of proteins, fats and carbohydrates, stimulate the growth of bacteria of the normal intestinal flora, and also suppress the growth of putrefactive flora. Subtil is prescribed 1 capsule 3 times a day, 1 hour before meals;
• 3rd generation drugs: Bifikol, Lineks. They consist of several types of bacteria of the normal intestinal flora, therefore they are highly effective compared to the previous 2 generations of probiotics. Linex is prescribed 2 capsules 3 times a day;
• 4th generation drugs: Bifidumbacterin forte, Biosorb-Bifidum. This group of drugs is bacteria of the normal intestinal flora in combination with an enterosorbent (with activated charcoal or others). Enterosorbent, necessary to protect microorganisms, when passing through the stomach, it actively protects them from inactivation by gastric juice or enzymes of the gastrointestinal tract. Bifidumbacterin forte is prescribed 5 doses 2-3 times a day, before meals.

1. Symbiotics(Bifidobak, Maltodofilus) , are combined preparations (prebiotic + probiotic), i.e. at the same time stimulate the growth of normal flora and replace the missing amount of microbes in the intestine. Bifidobak is prescribed 1 capsule 3 times a day, with meals.
2. Antibacterial drugs, are used for the 4th degree of intestinal dysbacteriosis, to destroy the pathogenic flora. The most commonly used antibiotics are: groups of tetracyclines (Doxycycline), cephalosporins (Cefuroxime, Ceftriaxone), penicillins (Ampioks), nitroimidazoles: Metronidazole is prescribed 500 mg 3 times a day, after meals.
3. Antifungal drugs(Levorin) , are prescribed if there are yeast-like fungi such as Candida in the feces. Levorin is prescribed for 500 thousand units 2-4 times a day.
4. Enzymes, are prescribed in case of severe digestive disorders. Tablets Mezim 1 tablet 3 times a day, before meals.
5. Sorbents, are prescribed for severe signs of intoxication. Activated charcoal is prescribed 5-7 tablets at a time, for 5 days.
6. Multivitamins: Duovit, 1 tablet 1 time per day.

Diet for intestinal dysbacteriosis

Diet therapy is an important point in the correction of the intestinal flora. In case of intestinal dysbacteriosis, it is first necessary to exclude the use of alcoholic beverages, spicy, fatty foods, smoked meats and foods that enhance fermentation processes in the intestines: sweets (cakes, sweets, and others), homemade pickles, sauerkraut. Secondly, you need to eat fractionally, at least 4 times a day. While eating, try not to drink water, because it dilutes the gastric juice and the food is not digested enough. Exclude from the diet products that increase flatulence (formation of gases) and intestinal motility: legumes (beans, peas, soybeans and others), bran bread, carbonated drinks. It is necessary to increase the amount of protein in the diet due to meat (lean), cooked in boiled or stewed form. Try not to eat fresh bread, dry it a little before eating.

Try to cook all food with herbs (parsley, dill and others), as it enhances the action of normal intestinal flora against pathogenic ones. Foods that enhance the restoration of intestinal microflora include: wheat, rice, buckwheat, oats, fresh vegetables or salads, non-acidic fruits. Indispensable products for restoring normal intestinal microflora are all lactic acid products: kefir, fermented baked milk, curdled milk and others. You can also use special products that are enriched with biocultures: yoghurts, biokefirs and others. Applesauce has excellent prebiotic properties, and it also has an astringent effect and is recommended for diarrhea. Before going to bed, it is recommended to drink a glass of kefir.

Prevention of intestinal dysbacteriosis

In the first place in the prevention of intestinal dysbacteriosis, is the correct use of antibiotics, which are one of the main causes of disruption of the normal flora. Antibiotics should be used strictly according to the indications, after the results of a bacteriological study with an antibiogram. In order to choose the dose of an antibiotic for a particular patient, the attending physician must take into account the age and weight of the patient. In no case should you self-medicate by taking antibiotics for mild illnesses (for example: runny nose). In cases where you have been prescribed long-term antibiotic therapy, it is necessary to take them, in parallel with prebiotics, with periodic monitoring of the state of the intestinal flora (microbiological examination of feces).
In second place in the prevention of intestinal dysbacteriosis is a balanced diet and a rational regimen.

In third place, there are all acute and chronic diseases that lead to intestinal dysbacteriosis, primarily diseases of the gastrointestinal tract. Restorative therapy for patients with chronic diseases. Timely treatment of such diseases can reduce the number of patients with intestinal dysbacteriosis.

Persons who are exposed to occupational hazards (radiation) should include fermented milk products in their diet.

Is there intestinal dysbacteriosis in general? Does such a disease exist?

Officially, there is no such diagnosis. Dysbacteriosis is not an independent disease, but always a consequence of any other diseases. By itself, the change in the composition of the intestinal microflora is not the main problem. Usually, as soon as the underlying disease is cured, dysbacteriosis goes away by itself. If the symptoms continue to bother, the person is not cured. In such a situation, it is pointless to continue the fight against dysbiosis - you need to look for the root cause.
Western doctors never give their patients such a diagnosis. In Russian health care, dysbacteriosis is mentioned in a document called "Standards (protocols) for the diagnosis and treatment of diseases of the digestive system", approved by order of the Ministry of Health of the Russian Federation No. other bowel diseases.
Surely, when you took a blood test, you heard such terms as “increased leukocytosis”, “increased ESR”, “anemia”. Dysbacteriosis is something similar. This is a microbiological concept, one of the manifestations of the disease, but not the disease itself.

How is intestinal dysbacteriosis indicated in the ICD?

International Classification of Diseases(ICD) - a document that lists all possible human diseases, each has its own code. In the ICD, there is no such thing as dysbacteriosis. A doctor who establishes such a diagnosis for a patient finds himself in a difficult situation - after all, he must indicate the code in the medical documentation.
Most often, such doctors use two codes: .
Sometimes dysbacteriosis is a temporary condition, for example, in travelers, especially if they have poor personal hygiene. A “foreign” microflora enters the intestines, which a person does not encounter at home.

Which doctor treats intestinal dysbacteriosis?

Since dysbacteriosis is not an independent disease, it is necessary to look for the initial cause, and then begin treatment with an appropriate specialist.
Most often, diseases that lead to a violation of the composition of the intestinal microflora should be treated by an infectious disease specialist or a gastroenterologist. A general practitioner treats a number of diseases in adults, and a pediatrician in children.

What is the best treatment for intestinal dysbiosis?

Since such a diagnosis does not exist, then “treatment of dysbacteriosis” is a term, in principle, meaningless.
Although, the relevant recommendations still exist - they are spelled out in the standard OST 91500.11.0004-2003. It was put into effect by the Order of the Ministry of Health of the Russian Federation of June 9, 2003 N 231. This document proposes to treat dysbacteriosis with the help of prebiotics and eubiotics, antibacterial and antifungal drugs.
But the effectiveness of these drugs in dysbacteriosis has not been proven. In the same OST there is such a phrase: “the degree of persuasiveness of evidence is C”. This means that sufficient evidence is missing. There is no evidence to recommend treatment of dysbacteriosis with these drugs.
Here it is once again appropriate to recall that doctors who work in clinics outside the CIS never make such a diagnosis to their patients, and even more so they do not prescribe treatment against dysbacteriosis.

Is there a link between intestinal dysbacteriosis and thrush?

Thrush, or candidiasis- a disease that causes yeast-like fungi kind Candida.
The infection can develop in any organ. In this regard, candidiasis of the skin and nails, the oral mucosa (just this form is called thrush), intestines, and genital organs are isolated. The most severe form of the disease is generalized candidiasis, or candidal sepsis when the fungus affects the skin, mucous membranes, internal organs.
candida - fungus conditionally pathogenic. They are not always able to cause infection, but only under certain conditions. One of these conditions is a decrease in immunity. Thrush may well be combined with intestinal damage, which leads to dysbacteriosis. In fact, there is a connection between these two states.
In this case, the same reasons lead to the development of thrush and intestinal dysbacteriosis - a decrease in immunity and a fungal infection. They need to be treated.

Is it possible to use folk remedies for the treatment of intestinal dysbacteriosis?

Traditional medicine, if proven remedies are used correctly, can improve the condition and alleviate the symptoms of the disease. But it can only be used as an addition to the main treatment prescribed by the doctor.
Due to the fact that the topic is inflated and very popular, "anti-dysbacteriosis remedies" are offered by all kinds of traditional healers, healers, manufacturers of dietary supplements, MLM companies. Food producers did not stand aside either.
As already mentioned above, dysbacteriosis as a disease does not exist, it does not have its own specific symptoms, and it cannot be cured without eliminating the root cause. Therefore, first of all, you need to visit a doctor, undergo an examination, establish the correct diagnosis and begin treatment.

What can an analysis for dysbacteriosis show?

The majority of reputable doctors and scientists deeply doubt the information content of the microbiological analysis of feces for dysbacteriosis. There are certain reasons for this:

• The concept of "normal microflora" is very vague. Nobody knows the exact rules. Therefore, if you force any healthy person to take an analysis, many will have dysbacteriosis "revealed".
• The content of bacteria in feces is different from their content in the intestines.
• While the stool is delivered to the laboratory, the composition of the bacteria that are present in it may change. Especially if it is incorrectly assembled into a non-sterile container.
• The composition of the microflora in the human intestine can vary depending on different conditions. Even if you take the analysis at different times from the same healthy person, the results can vary greatly.

To maintain normal health, it is important to maintain an optimal balance of bacteria that inhabit the human intestine.

According to a review of recent research published in Integrative Medicine: A Clinician's Journal, the digestive tract not only processes breakfast, lunch, and dinner. The intestinal microflora controls many processes in the body, prevents many diseases, and greatly affects people's well-being.

The creation of a unique composition of the human intestinal microflora begins at birth, when the infant is exposed to bacteria living in the mother's birth canal. "Primary colonization of the gut plays an important role in shaping the composition of the adult microbiome," the researchers report. However, in the subsequent life of each person, there are internal and external factors that can affect the composition of the intestinal microflora, including:

• foods that make up the daily diet;
• intestinal pH;
• exposure to toxic substances.

“Every day, we put pounds of foreign matter (food, drink, drugs, nutritional supplements) in our mouths, hoping that the body will be able to tell friend from foe,” says renowned American nutritional expert Elizabeth Lipsky. "The digestive system is the center of our immune system, controls our metabolism, vitamin synthesis and communicates with other body systems."

Bacteria that live in the digestive tract play an important role in the digestion of food. Scientists have found that they are able to process what the human body cannot absorb without their participation.

For example, it is bacteria that digest fiber, separating the necessary vitamins and amino acids and converting them into forms available to the human body. Foods rich in dietary fiber, such as whole grains, vegetables, nuts, edible algae, fruits, seeds, leafy greens, are considered to be prebiotics. They must be present in the human diet in order to create optimal conditions for the existence of friendly microorganisms in the microbiome.

In addition, you can enrich the intestinal microflora with healthy bacterial cultures by eating kefir, sauerkraut, natural yogurt and other products that are probiotic.

Maintenance of metabolic processes

In different people, the composition of the microbiome has significant differences. Studies have shown that there is a big difference in the ratio between "bad" and "good" bacteria in individuals. It is known that diseases such as obesity, type 2 diabetes, have a negative impact on the composition of the intestinal microflora. And if a person loses excess weight, the composition of his intestinal microflora changes for the better.

But the relationship between metabolic disorders and the state of the human microbiome is two-way: if the composition of the intestinal microflora improves, metabolic processes are optimized, the risks of metabolic syndrome, diabetes and other diseases are reduced, excess weight is lost. Therefore, for those who want to part with extra pounds, it is also important to change their usual diet, enriching it with probiotic and prebiotic products.

Healthy bacterial cultures that inhabit the intestines protect a person from "bad" bacteria and other aggressive microorganisms in three ways.

The intestinal microflora plays the role of a kind of barrier. Numerous studies explain that the cells of the internal mucous membrane of the digestive tract are the main link in the human immune system and guard his health. Friendly bacteria effectively block the entry of pathogens into the intestinal tissues.

In the human intestine there is a constant competition for resources. Healthy bacteria break down proteins and other nutrients, depriving harmful pathogens of food. As a result, the intestine becomes an inhospitable environment for invaders.

In addition, "good" bacteria actively fight other, "bad" microbes. They generate bacteriocins, antimicrobial proteins that inhibit the growth of aggressive competitors.

Prevention and treatment of inflammatory bowel disease

Although the exact cause of irritable bowel syndrome is still unknown, an imbalance of intestinal bacteria is considered one of the factors in the development of chronic inflammation of the digestive system.

Modern scientists believe that this may be due to the fact that friendly intestinal bacteria effectively prevent pathogens from multiplying on the intestinal walls.

Other inflammatory bowel diseases such as Crohn's disease and ulcerative colitis have been linked to microbiome imbalances. It is he who leads to the development of chronic inflammation.

A healthy gut microflora is also important to protect against allergies. The microbiome stimulates the immune system and trains it to respond adequately to all antigens. Negative changes in the composition of intestinal bacteria in early life can lead to immune errors. As a result, the immune system will overreact to antigens.

The state when a healthy microbiome is damaged is what scientists today call the “atopic march.” It proceeds like an allergy, causing non-specific reactions of the immune system, which also appear in those parts of the body that are not directly exposed to the allergen.

Allergy in this case begins as atopic eczema, then allergic rhinitis and asthma can join. So the whole body reacts to what is happening in the intestines.

The hygiene hypothesis says that living in an environment that is too sterile can also lead to bacterial imbalances.

Communication with the brain

Over the past decade, significant progress has been made in studying the influence of the microbiome on brain function, and the existence of such a connection is recognized. For example, stress (as an experience) can change the bacterial composition of the gut. Conversely, bacteria living in the intestines can interact with the central nervous system, influencing the host's emotional responses.

Knowing the impact that the inhabitants of the digestive system have on health, it is important to learn how to create a favorable environment for them by eating healthy foods and reducing the impact of negative factors, including toxic effects.

Catad_tema Dysbacteriosis - articles

Intestinal bacteria, probiotics and prospects for their use in the treatment of diseases of the gastrointestinal tract

Yu.O. Shulpekova
Department of Propaedeutics of Internal Diseases, Faculty of Medicine, MMA named after THEM. Sechenov, Moscow Peculiarities of the composition and the role of intestinal symbiont bacteria in the maintenance of health are considered. The correctness of the use of the term “dysbacteriosis” in clinical practice is discussed; diseases and conditions are indicated, which are often mistakenly interpreted as dysbacteriosis. A brief review of diseases in which the effectiveness of some probiotics is confirmed by the results of comparative studies is given. Indications for the use of the modern combined probiotic preparation Linex, its advantages and dosing regimens are presented.

The history of studying the role of intestinal microflora in maintaining human health dates back to the end of the 19th century, when ideas about the disease as a consequence of intestinal “autointoxication” were developed.

But even today we have to admit that we still know little about the interaction of our body and the bacteria inhabiting it, and it is very difficult to assess the composition of the microflora that inhabits the gastrointestinal tract (GIT) from the positions of “norm” and “pathology”.

The composition and physiological significance of the intestinal microflora

More than 400 species of microorganisms live in the human gastrointestinal tract. The content of colony-forming units (CFU) in 1 ml of intraluminal contents increases from 10 2-3 to 10 11-12 as you move from the stomach to the colon. At the same time, the proportion of anaerobic microorganisms increases and their oxidative potential decreases.

Intestinal bacteria are represented by the main (dominant or resident), concomitant and residual populations.

The dominant population consists mainly of bacteria of the families Lactobacillus, Bifidobacteria and bacteroids.

The associated population is represented by Escherichia coli, eubacteria, fusobacteria, enterococci and peptococci.

The residual population includes yeast-like fungi, bacilli, clostridia, Proteus, and others. Some of these microorganisms have more or less pronounced pathogenic properties. It is generally accepted that no more than 15% of intestinal microbes have the characteristics of pathogenic or opportunistic pathogens in a healthy person.

In the upper gastrointestinal tract, the composition of the microflora is similar to that of the oropharynx; a significant proportion of it is represented by streptococci. In the distal direction, the content of lactobacilli gradually increases, and bifidobacteria predominate in the colon.

According to modern concepts, the main role in maintaining the normal physiological state of the microflora of the gastrointestinal tract is played by bacteria of the Lactobacillus and Bifidobacteria families, which are Gram-positive non-spore-forming anaerobes that do not have pathogenic properties. An important characteristic of these microorganisms is the saccharolytic type of metabolism. In the process of fermentation of carbohydrates under the action of enzymes of lactobacilli and bifidobacteria, short-chain fatty acids are formed - lactic, acetic, butyric, propionic. In the presence of these acids, the development of conditionally pathogenic strains, which for the most part have a proteolytic type of metabolism, is inhibited. The suppression of proteolytic strains is accompanied by the suppression of putrefactive processes and the suppression of the formation of ammonia, aromatic amines, sulfides, and endogenous carcinogens. Thanks to the production of fatty acids, the pH of the intestinal contents is regulated.

Short chain fatty acids play an important role in the regulation of metabolism. Entering the systemic circulation, they provide up to 20% of the body's daily energy needs, and also serve as the main energy supplier for the intestinal wall epithelium.

Butyric and propionic acids increase mitotic activity and regulate epithelial differentiation. Lactic and propionic acids regulate calcium absorption. Of great interest is their role in the regulation of cholesterol metabolism and glucose metabolism in the liver.

Lactobacilli and bifidobacteria synthesize amino acids, proteins, vitamins B1, B2, B6, B12, K, nicotinic and folic acids, substances with antioxidant activity.

Bacteria of the main population play an important role in the digestion of milk components. Lactobacilli and Enterococcus are able to break down lactose and milk proteins. The phosphoprotein phosphatase secreted by bifidobacteria is involved in the metabolism of casein. All these processes take place in the small intestine.

Species of lactobacilli that inhabit the intestines include: L. acidophilus, L. casei, L. bulgaricus, L. plantarum, L. salivarius, L. rhamnosus, L. reuteri. Among bifidobacteria, B. bifidum, B. longum, B. infantis are distinguished.

Of the aerobic microorganisms belonging to the concomitant population, a serious role in the microbial biocenosis of the intestine belongs to the non-hemolytic Escherichia coli, which produces vitamins (B1, B2, B6, B12, K, nicotinic, folic, pantothenic acids), participates in cholesterol metabolism, bilirubin, choline, bile and fatty acids, indirectly affects the absorption of iron and calcium.

With the expansion of knowledge about the characteristics of the vital activity of the intestinal microflora, the idea of ​​its important role in maintaining the tension of local and systemic immunity becomes more and more clear.

In the intestines, there are protective mechanisms that prevent excessive reproduction and the introduction of microflora. These include the integrity of the epithelium and the brush border (the distance between the microvilli of which is smaller than the size of the bacteria), the production of immunoglobulin A, the presence of bile, the presence of Peyer's patches, etc.

Due to the production of substances with antibacterial activity (bacteriocins, short-chain fatty acids, lactoferrin, lysozyme), the normal microflora provides local protection against excessive reproduction of opportunistic pathogens and the introduction of pathogenic microorganisms. The presence of a constant microbial stimulus and contact with macrophages and lymphocytes in the area of ​​Peyer's patches provide sufficient local immunity, the production of immunoglobulin A and high phagocytic activity. At the same time, constant contact with immune cells underlies immunological tolerance.

Components of intestinal bacteria penetrate into the systemic circulation, thus maintaining the necessary degree of tension of systemic immunity and ensuring its "acquaintance" with the microflora of the environment.

However, even those intestinal bacteria that are considered non-pathogenic, lacking a distinct ability to adhere, invade, and produce toxins, are theoretically capable of causing damage to the intestinal wall, and possibly also a systemic infection, if local defense mechanisms fail. Therefore, the appointment of drugs based on intestinal bacteria (probiotics) should always be justified.

Causes of violations of the composition of the intestinal microflora

The composition of the intestinal microbial population, even in a healthy person, is subject to variability and, apparently, reflects the body's ability to adapt to the characteristics of nutrition and lifestyle, and climatic factors.

It should be recognized that the general concept of “dysbacteriosis”, which until recently was widely used to refer to violations of the composition of the intestinal microflora, does not fully reflect the essence of such changes, does not allow a clear diagnosis and determine the tactics of treatment.

So, it is possible to distinguish individual diseases and syndromes, which are often mistakenly interpreted as dysbacteriosis:

• bacterial overgrowth syndrome;
• antibiotic-associated diarrhea;
• Clostridium difficile infection (pseudomembranous colitis);
• irritable bowel syndrome;
• "traveler's diarrhea";
• disaccharidase deficiency;
• intestinal candidiasis against the background of immunodeficiency states;
• staphylococcal enteritis, etc.

Each of these diseases has its own cause, certain risk factors, clinical presentation, diagnostic criteria and treatment tactics. Of course, against the background of these diseases, secondary disorders of the microbial composition of the intestine can develop.

Perhaps the most common bacterial overgrowth syndrome in clinical practice is characterized by a decrease in the number of anaerobes (especially bifidobacteria), an increase in the total number of functionally defective forms of E. coli (“lactose-”, “mannitol-”, “indolo-negative”), the content of hemolytic forms E. coli and creating conditions for the reproduction of Candida spp.

The syndrome of excessive bacterial growth develops against the background of disorders of the luminal or parietal digestion (congenital enzyme deficiency, pancreatitis, celiac enteropathy, enteritis), the passage of intestinal contents (interintestinal fistulas, “blind loops” of the intestine, diverticula, peristalsis disorders, intestinal obstruction); decrease in the protective properties of the mucous membrane (anacid conditions, immunodeficiencies); iatrogenic effects on the intestinal microflora (the use of corticosteroids, cytostatics, especially in debilitated and elderly patients).

Excessive reproduction of bacteria is observed mainly in the small intestine, since the most favorable nutrient medium is created here. Manifestations of bacterial overgrowth syndrome, such as flatulence, rumbling, transfusion in the abdomen, loose stools, hypovitaminosis, weight loss, often come to the fore in the clinical picture of the main diseases listed above.

Tests confirming the presence of pathological disorders of the composition of the microflora

As in the diagnosis of other diseases, adequate methods must be used to assess changes in the intestinal microflora.

Sowing feces for dysbacteriosis, common in Russia, cannot be considered an informative test, especially since pathological changes in the microflora mainly affect the small intestine. This method is valuable in terms of ruling out intestinal infections as well as C. difficile infection.

The microbiological examination of the aspirate culture of the contents of the small intestine has a very high accuracy.

The breath test with 14C-xylose, hydrogen tests with lactulose and glucose can detect the presence of excessive bacterial growth in the intestine, but do not give an idea of ​​the composition of the microflora.

Determination of the spectrum of fatty acids in feces by gas-liquid chromatographic analysis makes it possible to approximately estimate the quantitative ratio of various types of intestinal bacteria.

The use of probiotics

At the beginning of the 20th century, the great Russian scientist Mechnikov I.I. put forward a hypothesis that a high content of lactobacilli in the intestinal biocenosis is a necessary condition for human health and longevity. Mechnikov I.I. conducted experiments on the use of a living culture of bifidobacteria for medicinal purposes.

In subsequent years, the development of drugs based on microorganisms with beneficial properties, the so-called probiotics, continued.

As a potential therapeutic agent, lactobacilli initially attracted the most attention as the bacteria with the most well-studied beneficial properties. Since the 1920s culture L. acidophilus began to be used in the form of acidophilus milk for the treatment of diseases of the gastrointestinal tract, accompanied by constipation. Since the 1950s experience is accumulating in the use of L. acidophilus and other crops to prevent antibiotic-associated diarrhea.

With the development of microbiology, new information was obtained about the positive properties of bifidobacteria, E. coli, non-toxigenic lactic streptococcus - Streptococcus (or Enterococcus) faecium. Certain strains of these microorganisms and their combinations began to be included in probiotic preparations.

When studying the ability of microbes to adhere to epithelial cells of the small intestine, it was shown that the use of microorganisms in combination increases their ability to be fixed in the brush border zone.

The mechanisms of the therapeutic action of probiotics include: inhibition of the growth of pathogenic microorganisms, restoration of the integrity of the epithelium, stimulation of the secretion of immunoglobulin A, suppression of the production of pro-inflammatory cytokines, and normalization of metabolic processes.

The modern approach to the development of such preparations implies, firstly, the use of microorganisms in combinations and, secondly, their release in encapsulated form, which allows long-term storage at normal temperature. Clinical and experimental studies have shown that under the influence of gastric juice and bile, probiotics lose up to 90% of their activity before entering the intestine. Methods are being developed to increase the survival of bacteria - due to their immobilization on porous microcarriers, the inclusion of nutrient medium components in the preparation.

Despite the “theoretically” competent development of probiotic preparations, not all of them are effective in practice. To date, data from many open and blind controlled studies have been accumulated, according to the results of which some conclusions have been drawn about the prospects for the use of certain types of microorganisms in various intestinal diseases.

It has been shown that L. rhamnosus strain GG has the greatest effect in the treatment of infectious gastroenteritis in children, and E. faecium SF68 in adults.

According to some reports, during the recovery period after viral gastroenteritis, it is advisable to prescribe drugs containing lactobacilli or their combinations with bifidobacteria and enterococcus; subspecies of bifidobacteria contribute to the speedy resolution after bacterial intestinal infections.

The ability to reduce the incidence of antibiotic-associated diarrhea has been established for the following bacteria in probiotics:

• L. rhamnosus strain GG;
• a combination of L. acidophilus and L. bulgaricus;
• E. faecium SF68;
• B. longum;
• a combination of Lactobacillus and B. longum;
• medicinal yeast Saccharomyces boulardii.

To reduce the frequency of side effects of anti-Helicobacter therapy, it is recommended to take probiotics containing L. rhamnosus and S. Boulardii at the same time, or a combination of L. acidophilus with Bifidobacterium lactis.

A combination of L. acidophilus, L. bulgaricus, and Streptococcus thermophilus proved to be effective in preventing traveler's diarrhea.

According to a meta-analysis, in the treatment of recurrent C. difficile infection (pseudomembranous colitis), a probiotic containing S. boulardii is most effective.

In irritable bowel syndrome, the effect of probiotics on the severity of symptoms such as bloating, pain, as well as the total number of manifestations was investigated. Efficiency of microorganisms E. faecium, L. plantarum, as well as mixture VSL#3 (combination of Bifidobacterium breve, B. longum, B. infantis, L. acidophilus, L. plantarum, L. casei, L. bulgaricus, S. thermophilus) has been demonstrated , mixtures of L. acidophilus, L. plantarum and B. breve and mixtures of L. Salivarius and B. infantis. However, these data were obtained on relatively small groups of patients, so they have not yet been reflected in international recommendations for the treatment of patients with irritable bowel syndrome.

There is an acute question about the possibility of using probiotics for the treatment and prevention of exacerbations in chronic inflammatory bowel diseases - ulcerative colitis and Crohn's disease. Given the undoubted role of endogenous microflora in maintaining epithelial integrity and controlling inflammation, as well as the potential toxicity of currently used immunosuppressants, high hopes are placed on probiotics as the “drugs of the future” in the treatment of inflammatory bowel diseases. Due to insufficiently large statistical material, the results of the conducted studies do not yet allow us to develop generally accepted recommendations for the inclusion of probiotics in standard treatment regimens. However, very encouraging data have been obtained regarding the ability of the complex probiotic VSL#3 to reduce the incidence of relapses of Crohn's disease. In ulcerative colitis, E. coli Nissle 1917 and Lactobacillus GG showed an effect in terms of maintaining remission; in terms of remission induction, very high doses of VSL#3 probiotic.

It should be understood that the appointment of probiotics is rarely effective in the absence of etiotropic and pathogenetic treatment of the underlying disease. Depending on the specific situation, surgical treatment may be required (for example, with afferent loop syndrome, inter-intestinal fistulas), the appointment of anti-inflammatory and antibacterial drugs, regulators of gastrointestinal motility (for example, with irritable bowel syndrome).

Many probiotic preparations are registered in Russia. However, the vast majority of them are not sufficiently up-to-date and do not contain species and strains of microorganisms for which evidence has been obtained from comparative studies. With the accumulation of experience, there has been a trend towards the use of combined probiotics.

Characteristics and application of Linex

In recent years, in the practice of Russian gastroenterologists, Linex, a combined preparation containing bacteria - representatives of the natural intestinal microflora: Bifidobacterium infantis v. liberorum, Lactobacillus acidophilus and non-toxigenic group D lactic streptococcus Streptococcus (Enterococcus) faecium. As noted above, these bacterial species have demonstrated clinical efficacy in the treatment of a number of intestinal diseases and are among the microorganisms with which special “hopes” are associated for inclusion in future treatment regimens for chronic inflammatory bowel diseases. The cultures of microorganisms that are part of Linex are obtained by growing on media with the addition of antibiotics, therefore they are resistant to most antibacterial agents and are able to multiply even under conditions of antibiotic therapy. The resistance of the resulting strains to antibiotics is so high that it persists with repeated inoculations of 30 generations, as well as in vivo. At the same time, no transfer of genes of antibacterial resistance to other types of microorganisms was noted. This is very important from the point of view of the consequences of the use of Linex: both on the background of taking and after discontinuation of the drug, there is no danger of developing resistance to antibiotics from pathogenic bacteria and one's own microflora.

The therapeutic effect of Linex consists in the temporary replacement of the functions of the patient's own intestinal microflora in conditions of its suppression, in particular against the background of the use of antibiotics. The inclusion of lactobacilli, S. Faecium and bifidobacteria in Linex ensures the supply of “therapeutic” microflora to different sections of the intestine in quantitatively and qualitatively balanced ratios.

In a placebo-controlled study involving 60 adult patients suffering from antibiotic-associated diarrhea or diarrhea of ​​\u200b\u200bunidentified etiology, taking Linex for 3-5 days was accompanied by normalization of the stool. In children, Linex has been shown to be highly effective in preventing and treating antibiotic-associated diarrhea that has already developed.

The use of Linex against the background of eradication anti-Helicobacter therapy improves the tolerance of antibiotics: it reduces the incidence of flatulence and diarrhea.

In the intestine, the microbial components of Linex not only have a eubiotic effect, but also perform all the functions of normal intestinal microflora: they are involved in the synthesis of vitamins B1, B2, B3, B6, B12, H (biotin), PP, K, E, folic and ascorbic acids. By lowering the pH of the intestinal contents, they create favorable conditions for the absorption of iron, calcium, and vitamin D.

Lactobacilli and lactic acid streptococcus carry out enzymatic cleavage of proteins, fats and complex carbohydrates, including have a substitution effect in lactase deficiency, which in most cases accompanies intestinal diseases.

Linex is available in capsules containing at least 1.2×10 7 live lyophilized bacteria.

The pharmacokinetics of the drug has been little studied due to the fact that at present there are no pharmacokinetic models for the study of complex biological substances in humans, consisting of components with different molecular weights.

Infants and children under 2 years of age are prescribed Linex 1 capsule 3 times a day, children 2-12 years old - 1-2 capsules 3 times a day, children over 12 years old and adults - 2 capsules 3 times a day. The drug is taken after meals with a small amount of liquid. Do not drink hot drinks to avoid the death of living microflora.

Linex can be prescribed during pregnancy and breastfeeding. There are no reports of cases of Linex overdose.

Conclusion

Thus, probiotics, especially their combined preparations, are gradually taking an increasingly strong place in gastroenterology.

As the evidence base accumulates, they may provide doctors with a way to treat the patient, skillfully influencing his symbiosis with the bacterial world and minimal risk to the human body.

Literature

1. Belmer S.V. Antibiotic-associated intestinal dysbacteriosis // BC. 2004. V. 12. No. 3. S. 148–151.
2. Zhikhareva N.S., Khavkin A.I. Therapy of antibiotic-associated dysbacteriosis // BC. 2006. V. 14. No. 19. S. 1384–1385.
3. Ushkalova E.A. The role of probiotics in gastroenterology // Farmateka. 2007. No. 6. S. 16–23.
4. Shenwald S., Tsar V. Results of a single placebo-controlled clinical trial of Linex. INDOK, Lek, 1984.
5. Arunachalam K, Gill HS, Chandra RK. Enhancement of natural immune function by dietary consumption of Bifidobacterium lactis (HN019). Eur J Clin Nutr 2000;54(3):263–67.
6. Bassetti S, Frei R, Zimmerli W. Fungemia with Saccharomyces cerevisiae after treatment with Saccharomyces boulardii. Am J Med 1998; 105:71-72.
7. Bengmark S. Colonic food: pre- and probiotics. Am J Gastroenterol 2000;95(Suppl. 1):S5–7.
8. Cremonini F, Di Caro S, Covino M, et al. Effect of different probiotic preparations on anti-Helicobacter pylori therapy-related side effects: a parallel group, triple blind, placebo-controlled study. Am J Gastroenterol 2002;97:2744–49.
9. Elmer GW, Surawicz CM, McFarland LV. biotherapeutic agents. JAMA 1996;275:870–76.
10. Hilton E, Isenberg HD, Alperstein P, et al. Ingestion of yogurt containing Lactobacillus acidophilus as prophylaxis for candidal vaginitis. Ann Intern Med 1992;116:353–57.
11. Loizeau E. Can antibiotic-associated diarrhea be prevented? Ann Gastroenterol Hepatol 1993; 29:15–18.
12. Perapoch J, Planes AM, Querol A, et al. Fungemia with Saccharomyces cerevisiae in two newborns, only one of whom had been treated with Ultra-Levura. Eur J Clin Microbiol Infect Dis 2000;19:468–70.
13. Perdigon G, Alvarez S, Rachid M, et al. Immune system stimulation by probiotics. J Dairy Sci 1995;78:1597–606.
14. Scarpignato C, Rampal P. Prevention and treatment of traveler's diarrhea: a clinical pharmacological approach. Chemotherapy 1995;41:48–81.

There are several varieties of intestinal bacteria that live in the human body. However, some gut bacteria aid the digestion process, while others are potentially harmful, especially when present in large amounts.

Any individual questions regarding intestinal bacteria should be directed to a physician or other medical professional.

Dangerous intestinal bacteria

Diseases or bad eating habits can upset the balance between good and bad bacteria in the intestinal tract. For this reason, probiotic supplements are becoming an increasingly popular remedy for restoring the natural balance of gut bacteria. These supplements are available from most pharmacies and are available over-the-counter, although it's always best to check with your doctor before you start taking any dietary supplement.

is a type of harmful intestinal bacteria that usually enters the body as a result of food poisoning. Common signs of salmonella infection are abdominal pain, fever, and diarrhea. In most cases, these symptoms disappear on their own within a few days, although sometimes medical attention may be needed.

Serious cases of salmonellosis can be very severe and even fatal, so if you have any symptoms of this disease, you should consult a doctor for further medical examination.

E. coli– Some strains of E. coli are actually good for maintaining a healthy digestive tract, while others can cause moderate to severe illness. Sources of this type of harmful gut bacteria include undercooked meat and foods that have been in contact with contaminated feces. Some of the most common symptoms of E. coli infection include painful intestinal cramps, bloody diarrhea, and fever. Most often, the symptoms disappear within a couple of weeks without any medical intervention, although there is a possibility of potentially fatal complications.

Listeria are harmful intestinal bacteria that are sometimes present in water or soil and can contaminate almost any type of food.

At first, a Listeria infection usually causes flu-like symptoms such as fever and fatigue. Enlargement of the heart, liver, and spleen may occur. In this case, the patient's condition most often worsens and requires hospitalization. Pregnant women are particularly susceptible to infection with this type of bacteria, particularly when they consume undercooked meat, milk, or other foods.

Every person in his life suffered at least one intestinal infection, although, according to statistics, everyone had a lot of so-called poisonings. Indeed, the gastrointestinal tract is often exposed to infection by various microorganisms, and, in general, diseases are caused by intestinal bacterial infection.

There are many types of bacteria that, getting into the digestive tract, calmly tolerate gastric juice, begin to actively multiply, release toxins that irritate the intestinal mucosa. As a result, a person experiences all the symptoms of inflammation of the gastrointestinal tract: diarrhea, nausea, vomiting, deterioration of health, fever.

Some infections can be called not too serious, but among the diseases there are those that, without competent and timely treatment, can even lead to death. Especially intestinal infections in children whose body is not yet strong enough.

All pathogens of bacterial intestinal infections enter the body through the alimentary route, that is, with water and food. It is worth considering the most serious of them.

Typhoid fever

It should be noted right away that this disease is no longer common, but once upon a time a lot of people died from typhus, and even today epidemics are recorded in the poor regions of our planet. This is a really serious and severe disease that is caused by the bacterium Salmonella typh. It is released into the environment along with the urine and feces of a sick person, which explains the outbreaks of typhus in countries where the level of hygiene is extremely low.

The carriers of the disease can be insects that transport particles of infected excrement on their paws, leaving them on food. If the excrement has got into the source of drinking water, infection is inevitable when people drink raw water, without its treatment.

When it enters the body, the bacterium affects not only the mucous membrane, but also the lymphatic system of the intestine, causing severe intoxication. The first symptoms of infection may appear after 3 weeks. As a rule, the onset of the disease is acute.

Symptoms of typhoid fever:

• an increase in body temperature up to 40 degrees;
• Strong headache;
• weakness;
• insomnia;
• anorexia;
• constipation or loose stools;
• flatulence;
• soreness of the abdomen;
• enlargement, hardening of the liver and spleen;
• a characteristic rash (roseola) on the chest and abdomen - appears on the 8-9th day of the disease;
• apathy, confusion, delirium - in severe cases.

Typhoid fever is dangerous in itself, but, in addition, it causes serious complications. As a result of the activity of bacteria, ulcers form on the walls of the intestine, which is fraught with bleeding, perforation of the intestine. Also, infectious-toxic shock is possible, which leads to coma and death.

salmonellosis

A fairly common bacterial infection caused by salmonella. In total, there are about 700 species of these bacteria. The source of microorganisms are birds, animals and humans (carrier or patient).

As a rule, a person becomes infected from food - salmonella can live for a long time in meat, dairy products, they tolerate freezing and smoking well.

Especially often infection occurs after eating raw chicken eggs. The only thing that has a detrimental effect on the bacterium is prolonged heat treatment of products.

In addition, it is possible to get infected from a sick person through contact and household contact. Salmonellosis in this regard is especially dangerous because it often does not manifest itself, that is, a person does not get sick, but is a carrier of infection and can infect others.

When infected, Salmonella enters the small intestine and actively multiplies there, releasing toxins. The first symptoms appear at different intervals, the incubation period can be from 6 to 72 hours.

What symptoms can the infection cause? Typical for intestinal diseases:

• weakness;
• heat;
• nausea and vomiting;
• abdominal pain;
• diarrhea.

The stool caused by salmonellosis is frequent, profuse, watery, with a characteristic green tint. The disease is most dangerous due to intoxication and severe dehydration of the body, as well as complications - renal failure, peritonitis, polyarthritis, infectious toxic shock. However, hospitalization for salmonellosis is carried out only for children, the elderly, employees of medical or food institutions.

Dysentery

The causative agent of this disease are bacteria of the genus Shigella. The source of the infection is a sick person, the infection occurs through household contact - dysentery is also called the disease of dirty hands. In addition, water, unwashed or undercooked food can be a source of infection.

The bacterium infects the large intestine. The incubation period can last from several hours to several days.

Symptoms of dysentery:

• diarrhea;
• tenesmus;
• false urge to defecate;
• nausea and vomiting;
• fever and high temperature;
• weakness and feeling unwell;
• loss of appetite;
• headache.

The main and most characteristic symptom of dysentery is called stool - frequent, liquid, but not too plentiful. The stool has a dark green color, inclusions of mucus, pus and blood are found.

As with most intestinal infections, the patient develops severe intoxication and dehydration. As for complications, it is possible to rupture the intestine.

coli infection

This disease is also called coli-enteritis or escherichiosis. It can be caused by E. coli, or rather, its pathogenic strains. Mostly, if the infection affects children under 2 years of age and newborns. Particularly susceptible to infection are premature, formula-fed children, babies with rickets or malnutrition. Among adults, people with immunodeficiency or diseases that reduce the body's resistance are sick.

Sick people become the source of infection, infection occurs through household contact, through food. The most common source is "home-made, fresh" milk that has not been boiled. It is also possible to become infected by contact-household.

The incubation period for coli enteritis ranges from 12 hours to 6 days. The severity of the disease increases gradually.

Infection in children is manifested as follows:

• regurgitation;
• diarrhea;
• bloating;
• anxiety;
• subfebrile temperature;
• weight loss;
• dry skin;
• dehydration.

Feces with coli infection are yellow, liquid, contain undigested food and vitreous mucus. With the development of the disease in the stool, the amount of water increases, to the point that they pour out in a jet.

The danger of this intestinal infection is that the microorganism can colonize other organs, causing pyelonephritis, meningitis, otitis media, and in some cases sepsis develops. In addition, dehydration in children is especially serious, so hospitalization is required in all cases.

Yersiniosis

It refers to zoonotic infections, that is, to those in which the main source of infection are animals and birds. As a rule, these are livestock, dogs and rodents. The disease is caused by the bacteria Yersinia enterocolitica and Yersinia pseudotuberculosis. A feature of these microorganisms is resistance to cold, they can multiply in food, even stored in the refrigerator.

Human infection occurs through the consumption of food of animal origin, if they were obtained from sick livestock (milk, meat, semi-finished products). A factor can also be the faeces of animals that have fallen into the water or on vegetables and fruits. The contact-household route of infection is possible, but such cases are rare.

When infected, the development of three forms of yersiniosis is possible: generalized, intestinal, secondary focal.

Symptoms of the intestinal form (appear after 1-6 days):

• fever up to 40 degrees;
• headache;
• weakness;
• aches in joints and muscles;
• loss of appetite;
• CNS disorders (in severe cases);
• abdominal pain;
• dyspepsia;
• loose stools, sometimes with blood;
• nausea and vomiting;
• joint pain;
• moderate enlargement of the lymph nodes.

In some cases, catarrhal symptoms may appear, a rash on the body, mainly on the palms and feet, which is accompanied by burning and peeling of the skin.

A complication of yersiniosis can be acute appendicitis, terminal ileitis, infectious hepatitis, myocarditis, perforation of the intestinal wall, adhesions, inflammatory diseases of the nervous, genitourinary system, and the musculoskeletal system.

Diagnosis of intestinal infections

In each case, the disease is determined in advance, based on the anamnesis, examination and questioning of the patient. But only a bacteriological examination (bakposev) of feces, vomit or blood can accurately indicate the type of pathogen. To clarify the diagnosis, serotyping is carried out, which allows you to determine a specific strain of bacteria.

Treatment

First of all, it is aimed at the destruction of pathogenic microorganisms, so the basis of therapy are antibiotics or intestinal antiseptics. Nowadays, broad-spectrum drugs are mainly used - their advantage is that treatment can be started even before the pathogen is determined, which is critical, since the results of bakposev are obtained only after a few days.

In all cases, sorbents are prescribed, which provide accelerated removal of toxins from the body. As the condition normalizes, patients are prescribed probiotics.

The third, important component of therapy is rehydration. Together with the feces, the patient loses a lot of fluid and salts, which can lead to serious consequences. If a person is not placed in a hospital, he is prescribed a plentiful drink in small portions. In a hospital setting, droppers are placed.

Otherwise, symptomatic treatment is prescribed - antipyretic, antidiarrheal drugs, and so on. It is imperative that both the child and the adult observe bed rest and adhere to it.