Blind loop syndrome

Definition

• Rare condition manifested by
  • Diarrhoea
  • Steatorrhea
  • Megaloblastic anaemia
  • Weight loss
  • Abdominal pain
  • Deficiencies in fat-soluble vitamins (A, D, E, K)
  • Related to bacterial overgrowth in the small bowel

Aetiology

• SIBO in stagnant areas of the small bowel
  • Strictures
  • Fistulas
  • Diverticula
  • Diverted segments
• Normal small bowel content has minimal bacteria
  • Usually gram +ve aerobes and anaerobes
• Stasis enables proliferation of aerobic and anaerobic bacteria
  • Esp. Bacteroides, anaerobic lactobacilli, coliforms and enterococci
• Bacteria compete for Vit B12
  • Megaloblastic anaemia
• Not improved by intrinsic factor but in fact needs treatment with antibiotics

Diagnosis

• Cultures of intestinal tube
• Carbohydrate breath test
• Schilling test
  • 57-Co-labled Vit B12
  • Reveals reduction in urinary excretion of Vit B12
• Small bowel aspirate

Management

• IV Vit B12 replacement
• Broad-spectrum abx
  • Augmentin or doxycycline or Cef/met
  • 7–10-day course
• Surgical correction of the stagnation is the long-term cure in patients who require multiple antibiotic courses