eMedicine Specialties > Infectious Diseases > Gastrointestinal Tract and Intra-abdominal Infections

Bacterial Overgrowth Syndrome: Follow-up

Author: Pedro A Manibusan Jr, DO, Intern, Department of Internal Medicine, Tripler Army Medical Center
Coauthor(s): Joshua S Hawley, MD, Assistant Chief, Consulting Staff, Departments of Infectious Disease and Internal Medicine, Tripler Army Medical Center; Richard E Frye, MD, PhD, Assistant Professor, Departments of Pediatrics and Neurology, University of Texas Health Science Center at Houston; M Akram Tamer, MD, Program Director, Professor, Department of Pediatrics, University of Miami; Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Contributor Information and Disclosures

Updated: May 21, 2009

Follow-up

Further Inpatient Care

Admission criteria for bacterial overgrowth syndrome (BOS) should be based on severity of clinical manifestations at presentation, especially in high-risk individuals.

Further Outpatient Care

No specific guidelines for bacterial overgrowth syndrome exist; however, close interval follow-up is recommended to ensure that therapy is improving symptoms. It is also not clearly defined whether serial testing for increased bacteria burden is warranted.

Complications

Complications of bacterial overgrowth syndrome are possible in patients with prolonged and untreated symptoms, potentially leading to increased morbidity and mortality in higher-risk patients (eg, the very young and elderly).

  • Malabsorption of iron, vitamin B-12, and folate can lead to anemia
  • Persistent diarrhea can lead to volume loss and electrolyte disturbances.
  • Decreased fat absorption can lead to further diarrhea

Prognosis

If bacterial overgrowth syndrome is the result of an underlying medical problem that cannot be controlled, relapse will occur, with symptom-free periods.

Patient Education

  • Patients with chronic diarrhea should be educated on avoidance of food products that may exacerbate symptoms. Patients with bacterial overgrowth syndrome should document which foods cause their diarrhea, as this can vary among patients. Some examples of such foods are those high in carbohydrates such as fruits and fruit juices, spicy food, milk-containing products, fried food, and high-fat foods.
  • Patients should also be educated on early detection of symptoms such as diarrhea to avoid malabsorption.
  • In high-risk patients (eg, neonates and elderly patients), early recognition is challenging. Education should be extended to the primary care givers in this situation.

Miscellaneous

Medicolegal Pitfalls

  • Because reoccurrence of bacterial overgrowth syndrome after several asymptomatic months is common, close follow-up is preferable for several months after treatment.
  • Neonates must be hospitalized until a standard formula is well tolerated; for example, a neonate may require a lactose-free formula upon discharge, but the physician must ensure that the neonate has tolerated the formula for several days before discharging the patient. Rapid decompensation can occur if nutrient malabsorption reoccurs.
 


More on Bacterial Overgrowth Syndrome

Overview: Bacterial Overgrowth Syndrome
Differential Diagnoses & Workup: Bacterial Overgrowth Syndrome
Treatment & Medication: Bacterial Overgrowth Syndrome
Follow-up: Bacterial Overgrowth Syndrome
References
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References

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Further Reading

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Keywords

bacterial overgrowth syndrome, BOS, acquired monosaccharide intolerance of infancy, blind-loop syndrome, blind loop syndrome, contaminated small bowel syndrome, small intestinal stasis syndrome, stagnant loop syndrome, fat malabsorption, protein malabsorption, carbohydrate malabsorption, vitamin malabsorption, malabsorption, neonatal chronic diarrhea, neonatal diarrhea

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Contributor Information and Disclosures

Author

Pedro A Manibusan Jr, DO, Intern, Department of Internal Medicine, Tripler Army Medical Center
Pedro A Manibusan Jr, DO is a member of the following medical societies: American College of Physicians, American Osteopathic Association, and Association of Military Osteopathic Physicians and Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Joshua S Hawley, MD, Assistant Chief, Consulting Staff, Departments of Infectious Disease and Internal Medicine, Tripler Army Medical Center
Joshua S Hawley, MD is a member of the following medical societies: American College of Physicians, Armed Forces Infectious Diseases Society, Infectious Diseases Society of America, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Richard E Frye, MD, PhD, Assistant Professor, Departments of Pediatrics and Neurology, University of Texas Health Science Center at Houston
Richard E Frye, MD, PhD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, Child Neurology Society, and International Neuropsychological Society
Disclosure: Nothing to disclose.

M Akram Tamer, MD, Program Director, Professor, Department of Pediatrics, University of Miami
M Akram Tamer, MD is a member of the following medical societies: American Medical Association and Florida Medical Association
Disclosure: Nothing to disclose.

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

Mark Raymond Wallace, MD, Infectious Disease Fellowship Director, Orlando Regional Healthcare; Clinical Professor of Medicine, Florida State University
Mark Raymond Wallace, MD is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Tropical Medicine and Hygiene, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Joseph F John Jr, MD, FACP, FIDSA, FSHEA, Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center
Disclosure: BioMerieux Honoraria Review panel membership; Cubist Honoraria Review panel membership; Pfizer Honoraria Speaking and teaching; Merck Stock dividends stock holdings

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD, Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center
Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Association of Professors of Medicine, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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