Medicine for dysbiosis – how to choose the best drug?

We are told about dysbacteriosis from the TV screen, in advertising banners, and in pharmacies. We already know for sure that after poor nutrition, stress or a course of antibiotics, we need some kind of medicine that ensures a carefree life for our bacteria in the intestines, and disbacteriosis gets into trouble and ends its disruptive activity. But what is dysbiosis, and how does it occur?

Dysbacteriosis (or dysbiosis) is not an independent disease, but a complex of symptoms. That is, it is secondary and accompanies a number of clinical situations. A distinctive feature of dysbiosis is an imbalance of microflora, when there are more pathogenic microorganisms both qualitatively and quantitatively than beneficial bacteria. I must say that our microflora is rich. Microbes surround us, and in the intestine itself, according to various estimates, there are up to 3 kg of microbes. A healthy intestine contains well-studied bifidobacteria, lactobacilli, etc. They are involved in the work of the stomach, protect us and are involved in the synthesis of vitamins and amino acids. When food ends up in the intestines, it is first broken down by bacteria, and only after that the beneficial elements enter the systemic bloodstream.

There are several types of bacteria in the intestines, all of them are in balance and form microflora. Moreover, it consists not only of bacteria (microbiotes) that are friendly to us, which provide important functions for the body, but also contains opportunistic flora. When streptococci, Proteus, yeast-like fungi or staphylococci enter, an imbalance of healthy and pathogenic microflora occurs. Normally, microbiota inhibit the development of pathogenic flora, but sometimes the latter actively develops. Most of the beneficial bacteria die and cannot contain the onslaught of pathogenic microorganisms. This is how dysbiosis occurs. With dysbacteriosis, the digestive process is the first to be affected. The functioning of the stomach and digestive system is disrupted. Without the assistance of beneficial microbes, a person is not able to absorb the necessary microelements. Signs of stomach upset appear: nausea and vomiting, diarrhea, abdominal pain, etc.

It happens that with dysbiosis, the intestinal microflora is restored by the body, but often the doctor prescribes a diet and medicine for dysbiosis. They should be selected by a doctor, because... Self-medication or ignoring can lead to deterioration of the gastrointestinal tract and the body.

What is dysbiosis

A child is born sterile; there are normally no bacteria in his body. The intestines and skin are colonized gradually, starting from the first attachment of the baby to the breast. The older the child gets and the more varied his food, the more different bacteria enter the intestines and form its microflora. In adults, the composition of microorganisms stabilizes, but becomes diverse. It can be compared to a fingerprint; despite the similarities, it is not repeated in any person.

Among intestinal bacteria, there are hundreds of types of good microorganisms, but normally there are also bad ones, the growth of which the body can restrain. There are three types of microbes:

• dominant - present in all healthy people, these include eubacteria, bacteroides, bifidobacteria, lactobacilli;
• non-permanent species - not found in everyone or under certain conditions, these are streptococci, Escherichia coli, Proteus, Cytobacter;
• transient species - sometimes enter the intestines, but do not stay there for a long time; these are types such as yeast fungi, clostridia, and Pseudomonas aeruginosa.

Good microorganisms are the dominant bacteria, they should be the majority. Thanks to the presence of normal microflora, food is digested. Bacteria help ferment some indigestible foods and participate in the absorption of vitamins, amino acids, and sugars. They themselves also synthesize vitamins B, K, and fatty acids. Therefore, with dysbacteriosis, signs of hypovitaminosis appear.

Good bacteria act as human shields. They form a protective layer on the intestinal wall, which does not allow pathogenic microorganisms to attach and limits their supply of nutrients. The immune function is to train immune cells and regulate its response to the penetration of foreign microorganisms or proteins.

But with a change in the ratio of bacteria, an increase in the number of transient species, and the appearance of yeast fungi, dysbacteriosis develops. It cannot be called a disease, but a person’s well-being is impaired. With dysbacteriosis, there are no pathogenic microorganisms in the intestines (Salmonella, Vibrio cholerae, Yersinia, pathogenic Escherichia, as well as viruses). Changes in composition occur due to an imbalance of normal flora and an increase in the concentration of opportunistic bacteria and the appearance of fungi.

Combating constipation due to dysbacteriosis

To instantly eliminate constipation associated with intestinal dysbiosis, it is not always enough to take probiotics and prebiotics. Firstly, improvements become noticeable only a few days, and more often, weeks after the start of correction. Secondly, a prolonged delay in emptying requires immediate assistance to avoid increased symptoms of intoxication and worsening of the condition. Therefore, it is important to follow the doctor’s instructions and strictly follow the recommended diet, enrich your diet with dietary fiber, and drink enough water.

If such measures are ineffective and rapid bowel movements are necessary, you can resort to taking special medications.

The choice of laxative for dysbacteriosis should be entrusted to a doctor. This is due to the fact that some drugs for liquefying stool are themselves a risk factor for the development of dysbiosis. Abusing them or exceeding recommended dosages can worsen the condition. If dysbiosis is associated specifically with uncontrolled use of laxatives, it is important to consult a specialist.

Among the means to combat constipation due to dysbacteriosis, there are drugs that are not addictive. Herbal remedies based on natural dietary fiber can delicately solve the problem and improve intestinal motility. One of these laxatives is the British drug Fitomucil Norm. It contains the shell of plantain seeds and the pulp of plum fruits.

The soluble fibers of the drug absorb water, turn into a mucous gel and help soften and remove stool. Insoluble fiber stimulates intestinal motility, accelerating the excretion of feces. The product acts gently and predictably and helps normalize stool. In addition, psyllium creates favorable conditions for the proliferation of beneficial microflora in the intestines and is a natural sorbent, helping to reduce the symptoms of intoxication. Plum pectin enhances the prebiotic effect and stimulates the growth of beneficial bacteria.

Causes

The intestinal microflora in adults is in a state of dynamic equilibrium. It contains certain bacteria, which make up the majority, and about 3% of microorganisms that change their composition. Normally, fluctuations occur under the influence of food and eating habits. The microflora is affected by the predominance of sweets and fatty foods in the diet or predominantly plant foods.

Research shows that fatty foods inhibit bifidobacteria and enterococci, but under these conditions bacteroides multiply. A predominantly carbohydrate diet stimulates the proliferation of bifidobacteria and the total number of microorganisms. But these changes are temporary and do not lead to the appearance of symptoms of dysbiosis. They disappear on their own after a change in diet.

Intestinal dysbiosis in adults appears as a result of other diseases. The main causes of microflora disturbance are:

• long-term treatment with antibiotics;
• pathologies of the overlying parts of the digestive tract;
• long-term mono-diets and constant poor nutrition;
• intestinal infections.

Broad-spectrum antibiotics act nonselectively. They inhibit the growth or cause the death of all microorganisms. The longer the course of treatment, the higher the likelihood that dysbiosis will develop after it. Tetracycline antibiotics are especially dangerous. They significantly inhibit the proliferation of intestinal microflora, which leads to hypovitaminosis B, K, and an increased risk of bleeding.

Gastritis, cholecystitis, pancreatitis, hepatitis or biliary dyskinesia can lead to the development of dysbiosis. Cirrhosis of the liver, tumor processes in the stomach or ulcers are dangerous. These pathologies are accompanied by impaired digestion of food and enzyme production. Therefore, food enters the intestines insufficiently processed and cannot serve as a breeding ground for bacteria. Some of them die, and a seemingly pathogenic flora takes their place.

A fasting day, when the diet is based on the consumption of one food product, does not harm the body. But a mono-diet that lasts several weeks or becomes a way of life can lead to dysbiosis. Constant consumption of food containing simple carbohydrates and animal fats is dangerous. These are sweet, flour, fast food dishes. Such a diet inhibits the reproduction of normal flora, fermentation processes are activated in the intestines, and a large number of yeast fungi appear.

Food infections cause double damage to the intestines. They damage the mucous membrane, and antibiotic treatment kills beneficial bacteria. Therefore, recovery from illness is especially difficult.

Smoking has a negative effect on the condition of the intestines. It creates conditions for the proliferation of yeast, so smokers often suffer from unpleasant symptoms.

Symptoms of dysbiosis

There are no strict symptoms that most likely indicate dysbiosis. Manifestations of pathology often do not correspond to the severity of the disorders. The most common symptom is indigestion such as intestinal dyspepsia. It manifests itself with the following symptoms:

• rumbling in the stomach;
• flatulence, increased gas formation;
• bloating;
• stool disorders;
• the appearance of pathological impurities in the stool.

Increased gas formation at the initial stage occurs after a nutritional disorder. If on a certain day the diet included milk, legumes, a large amount of flour and sweets, the symptoms appear clearly.

Stool disorders are variable. Most often, dysbiosis manifests itself as diarrhea. It may be accompanied by cramps and abdominal pain. Sometimes unformed stool appears only once a day, so it does not meet the criterion of diarrhea.

Diarrhea may alternate with constipation. This process is observed in people who limit the amount of fiber and dietary fiber in their diet. This deprives the bacteria of essential nutrients and prevents them from retaining water in the intestinal lumen. Mucous pathological impurities in the stool and abdominal pain appear with advanced forms of dysbacteriosis.

Violation of the microflora composition leads to vitamin deficiency. If it is not compensated by nutrition or taking multivitamin preparations, symptoms of hypovitaminosis appear:

• the condition of hair and nails worsens;
• rashes appear on the skin;
• allergic reactions or food intolerance appear;
• fatigue increases, performance decreases;
• sleep is disturbed.

Intestinal microorganisms synthesize vitamin K, which is involved in blood clotting. With hypovitaminosis, the appearance of bruises and hematomas under the skin from slight mechanical impact becomes more frequent. With a stomach ulcer or minor injuries, the risk of prolonged bleeding increases.

In severe cases, dysbiosis, which is accompanied by diarrhea, leads to dehydration. Many patients experience weight loss.

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The human body is home to up to 1016 microorganisms. This is more than 10 times the number of his own cells.

About 60% of microflora is found in the gastrointestinal tract. Any failure in the coordinated work of the microcosm can cause problems in many systems and functions.

1. What is dysbiosis? You can often find other designations - dysbiosis and enhanced microbial growth syndrome.

The term “dysbacteriosis” was proposed in 1916 by the German scientist Alfred Nissle, using this word to designate a quantitative change in E. coli. In 1972, the Soviet physiologist Alexander Ugolev described dysbiosis as a change in the qualitative and quantitative composition of the intestinal bacterial flora, which occurs under the influence of poor nutrition, physical and mental stress, serious illnesses, taking antibacterial drugs, surgical interventions, immunodeficiency, environmental pollution, etc. In our country, the term “dysbacteriosis” was introduced into medical use by academician Alexander Bilibin (1897–1976) to name qualitative and quantitative changes in the microbiocenosis of the intestine, especially the large intestine, disturbances in the species and quantitative composition of microbial populations in a certain biotope. Russian scientist Professor Yakov Zimmerman proposed the term “dysbiosis”: it reflects changes not only in the bacterial flora, but also in fungi, as well as metabolic, trophic and other disorders of the macroorganism associated with disturbances in the intestinal microecology. Today, the terms “dysbacteriosis” and “dysbiosis” are disputed and even denied by representatives of Western medicine and their supporters in our country. Instead of the concept of “dysbiosis”, “bacterial overgrowth syndrome” (SIBO) is popularized in the specialized literature (in English literature - bacterial overgrowth syndrome). However, it reflects a different pathophysiological and clinical situation - the spread of microbial growth into the small intestine (more than 105 microorganisms per 1 ml of intestinal contents in adults and more than 104 per 1 ml in children), i.e., not a qualitative, but a quantitative shift in the microcenosis. ICD-10 does not contain the terms “dysbacteriosis”, “dysbiosis” and “SIBO”. But in clinical practice they are actively used.

2. Can dysbiosis and SIBO be called independent diseases? Do they require treatment?

SIBO and dysbiosis are secondary syndromes that accompany many pathological processes. An imbalance of intestinal microflora is observed in irritable bowel syndrome, traveler's diarrhea, antibiotic-associated diarrhea, inflammatory bowel disease and other pathologies. However, this does not mean that SIBO and dysbiosis should not be diagnosed and treated. Disorders of intestinal microbiocenosis and an increase in the number of opportunistic and pathogenic intestinal microflora (Staphylococcus aureus, enteropathogenic Escherichia coli, Enterobacter, Proteus, Klebsiella, Pseudomonas aeruginosa, Shigella, Campylobacter, Clostridia, Candida, etc.) require therapy, because they cause and support local inflammation, are accompanied by intoxication and can lead to the development of sepsis. For subcompensated and decompensated intestinal dysbiosis, treatment is mandatory.

3. What are the causes of problems with intestinal microflora?

Dysbiosis develops as a result of infectious diseases and post-infectious conditions; after antibiotic, hormonal and polychemotherapy, the use of laxatives and sorbents; surgical removal of part of the intestine. Excessive, unbalanced and disordered nutrition play a role; deficiency of dietary fiber in the diet; consumption of products with an abundance of preservatives, dyes, xenobiotics; radiation damage to the intestines; Colon hydrotherapy. SIBO appears in hypo- and anacid conditions of the stomach; lactase and disaccharidase deficiency, celiac disease; chronic pancreatitis and cholecystitis, inflammatory diseases of the small intestine (Crohn's disease, Whipple's disease, vasculitis); neuropathies and myopathies; intestinal tumors and chronic constipation.

4. How to diagnose microbiocenosis disorders?

Since more than 500 species of bacteria live in the intestines (their total mass can reach 2.5 kg), it is not easy to determine violations of the quantitative and qualitative composition of microflora. The following methods are used: classical bacteriological analysis of feces (culture for dysbiosis) with determination of the main types of microorganisms; culture of intestinal contents obtained endoscopically on bacterial media (to determine SIBO); breath test with lactulose, xylose, labeled with the 14C carbon isotope; bacteriological examination of feces by PCR, FISH method, study of microbial metabolites (indican, phenol, paracresol, ammonia, etc.); gas chromatography-mass spectrometry of the generic composition of microorganisms, which allows you to detect living and dead microorganisms and find out their concentrations.+

5. How does dysbiosis manifest itself?

Symptoms are nonspecific; can be observed in diseases of the gastrointestinal tract that are not accompanied by a violation of microbiocenosis. The main symptoms are dyspeptic syndrome (belching, unpleasant taste in the mouth, increased gas formation, bloating, rumbling, diarrhea, pain and itching in the anus), maldigestion syndrome (impaired digestion and absorption of fats, meat, carbohydrates), abdominal pain, allergic reactions (bloating, loose foamy stools, itching, urticaria, Quincke's edema, bronchospasm, polyarthralgia). The presence of internal intoxication is very typical: weakness, fatigue, lack of appetite, headaches, fever. With a long course, malabsorption syndrome develops, manifested by multivitamin deficiency, weight loss, and anemia. During the day, several liters of gas are formed in the digestive tract, which is mainly absorbed by the intestinal wall. About 600 ml is excreted daily through the rectum, and with excessive bacterial growth, its amount increases to 2 liters or more.+

6. What treatment is needed for SIBO and dysbiosis?

Indications for the destruction of microbial contamination (decontamination) are SIBO and the presence of high titers of opportunistic microflora, which pose a threat of transfer of microbes to the small intestine. For this purpose, several groups of drugs are used: +

• antibacterial drugs;
• non-pathogenic fungi;
• preparations of spore-forming transient flora;
• microbial metabolites.

Antibiotics should not be absorbed from the intestines and suppress the growth of normal microflora. Rifaximin, a local intestinal antiseptic that is well tolerated and does not cause bacterial resistance, meets these requirements. The drug has a wide spectrum of action against opportunistic and pathogenic gram-positive (streptococci, staphylococci, enterococcus, tuberculosis bacillus), gram-negative (shigella, salmonella, yersinia, proteus, E. coli, peptostreptococcus, vibrio cholerae), aerobic bacteria, as well as anaerobic gram-positive ( clostridia, peptococcus) and gram-negative (bacteroides, Helicobacter pylorus). This drug is successfully used for the treatment of acute intestinal infections, correction of SIBO, sanitation of the colon in case of dysbacteriosis and hepatic encephalopathy. Rifaximin is used for a week at 400 mg 3 times a day. At the same time, the level of exhaled hydrogen decreases by 3–5 times already by the third day of therapy, which indicates rapid sanitation of the small intestine.

You can also use other antibacterial drugs: derivatives of hydroxyquinols (Intetrix), nitrofurans (nifuroxazide, or stopdiar), nitroimidazoles (metronidazole, tinidazole), enterofuril. Metronidazole and tinidazole are indicated for contamination with anaerobic microorganisms. Intetrix and nifuroxazide have an antimicrobial effect against Shigella, Salmonella, Yersinia, Campylobacter, Proteus, Klebsiella, pathogenic cocci, and Intetrix also inhibits the growth of fungi and amoebae. The duration of therapy for SIBO is 12–14 days.

An effective treatment for SIBO is enterol, which is a non-pathogenic yeast fungus of the genus Saccharomyces boulardii, obtained from tropical plants and fruits and possessing genetically determined resistance to almost all groups of antimicrobial drugs. The antimicrobial effect of enterol has been established in relation to a wide range of opportunistic microorganisms and protozoa. At the same time, enterol does not suppress the growth of obligate microorganisms in the intestinal cavity. These mushrooms have an antiviral and trophic effect (synthesize polyamines) and 2–5 days after the end of administration they are completely eliminated from the body without side effects. Enterol is used as an antidiarrheal and antiseptic for acute intestinal infections (as an alternative to antibiotics when their use is impossible), antibiotic-associated diarrhea, pseudomembranous colitis, parasitic diarrhea, dysbiosis, SIBO.

In case of grade IV colonic dysbiosis and the ineffectiveness of intestinal antiseptics, general resorptive antibiotics are needed, preferably fluoroquinolones (ofloxacin, ciprofloxacin, norfloxacin, pefloxacin); for pseudomembranous colitis - vancomycin, metronidazole, enterol, bacitracin.

Indications for antibiotics: microbial contamination of the small intestine; generalized form of dysbacteriosis; severe intoxication syndrome; persistent diarrhea syndrome; severe immunodeficiency.

The use of bacteriophages for intestinal dysbiosis has not lived up to the hopes placed on them: it provokes bacterial mutations.

To relieve symptoms of dysbiosis, regulators of intestinal motility (debridat, meteospasmil, motilium, dicetel, mucofalk, imodium), enterosorbents (smecta, enterosgel, enterodes) are used.

7. What biological drugs are used to treat dysbiosis?

There are several groups of biological agents for the correction of intestinal microflora disorders. Eubiotics, or probiotics, contain living obligate microorganisms; symbiotics - a combination of several types of living organisms; prebiotics - growth stimulators of normal microorganisms; synbiotics - live bacteria; prebiotic complexes - a rational combination of probiotics, prebiotics, sorbents, vitamins, microelements.

8. How do probiotics work?

In the broad sense of the word, these are living microorganisms and substances of microbial and other origin that have a beneficial effect on the physiological functions, biochemical and behavioral reactions of the body through the optimization of its microecological status. There are 4 generations of probiotics. The 1st includes single-component (colibacterin, bifidumbacterin, lactobacterin), i.e. containing 1 strain of bacteria. 2nd generation drugs (bactisubtil, biosporin, sporobacterin, etc.), based on the use of microorganisms non-specific for humans, are self-eliminating antagonists of pathogenic microflora. 3rd generation drugs include multicomponent probiotics, which contain several symbiotic strains of bacteria of the same type (acylact, acipol, etc.) or different types (linex, bifiform) with a mutually reinforcing effect. The 4th generation includes bifid-containing drugs immobilized on a sorbent (bifidumbacterin forte, probifor). Sorbed bifidobacteria effectively colonize the intestinal mucosa, providing a more pronounced protective effect than unsorbed analogues. The effects of these drugs on the human body: synthesis of nutrients and antioxidants (vitamins C, K, group B, folic acid, short-chain fatty acids, butyrate, nitric oxide); protective function (colonization of the colon mucosa, production of lysozyme, bacteriocins, decreased production of endotoxins, decreased mutagenicity); immunomodulatory (stimulation of macrophages, IgA synthesis, suppression of IgE synthesis, modulation of cytokine response); digestive (breakdown of carbohydrates, fiber, fats, proteins, deconjugation of bile acids); cytoprotective (neutralization of toxic substrates and metabolites, stimulation of regeneration and differentiation of the intestinal epithelium, anticarcinogenic effect of butyrate through the regulation of apoptosis).

9. What are prebiotics?

These are drugs or dietary supplements of non-microbial origin. They are not digested in the intestines, but have a positive effect on the body, stimulating the growth and/or metabolic activity of normal intestinal microflora. Typical representatives of prebiotics are compounds belonging to the class of low molecular weight carbohydrates: disaccharides, oligosaccharides, which are widespread in nature. Prebiotics should not be hydrolyzed by digestive enzymes and should be absorbed in the upper digestive tract. They selectively stimulate 1 species or a specific group of colon microorganisms. Oligosaccharides (soy oligosaccharide, fructooligosaccharides) are used as prebiotics; monosaccharides (xylose); disaccharides (lactulose); polysaccharides (pectins, dextrin, inulin), dietary fiber from herbs (psyllium), cereals (bran, Rekitsen-RD), fruits; peptides (soy, dairy); enzymes (saccharomyces proteases, etc.); amino acids (valine, arginine, glutamic acid); antioxidants (carotenoids, glutathione, vitamins A, C, E, selenium salts); unsaturated fatty acids; organic acids (acetic, propionic, citric); other substances (lecithin, para-aminobenzoic acid, lactoferrin, lectins, algae extracts, plant and microbial extracts). Prebiotics are best used in the initial stages of dysbiosis, as well as for its prevention.

10. Is herbal medicine prescribed for dysbiosis?

Treatment with medicinal herbs can become a preventive and auxiliary method of correction. The most famous plants that have an antibacterial effect against certain pathogenic microorganisms: apricot - suppresses putrefactive microorganisms, Proteus, Klebsiella, Pseudomonas aeruginosa; barberry (berberine) - hemolytic staphylococci, streptococci, dysentery bacteria, enterobacter; lingonberry (juice) - candida growth; strawberries - Staphylococcus aureus, Enterobacter; cranberries (berries) - putrefactive bacteria of the genus Proteus and Klebsiella; black currant - mushrooms and Staphylococcus aureus, influenza viruses; blueberries - staphylococcus, shigella; rosehip - gram-positive bacteria; apples - pathogenic E. coli, influenza A viruses. Their therapeutic effect is not strong and is observed only after prolonged exposure. Depending on the form and severity of dysbiosis, patients with disorders of the intestinal microflora can be recommended for home treatment for: staphylococcal dysbiosis - eucalyptus, St. John's wort, calamus, calendula, barberry, coltsfoot, Icelandic moss. The diet should include blueberries, rowan berries, strawberries, and raspberries; garlic, horseradish; mycotic candidal dysbacteriosis - linden, thyme, birch buds, eucalyptus, mint, lemon balm, fennel, sage, calamus, Icelandic moss, valerian, speedwell, elecampane, bergenia. You should eat lingonberries, carrots, wild garlic; yeast, potato, pumpkin and rice extracts; putrefactive dysbacteriosis - nettle, lingonberry, caraway, currants, cinquefoil, bergenia, birch buds, celandine, wormwood, maquea, burdock. Apricots, currants, rowan berries, lingonberries are shown; Jerusalem artichoke, red sweet pepper; Proteus dysbacteriosis - eucalyptus, calendula, calamus, plantain, St. John's wort, alder, bergenia, wormwood, cinquefoil erecta. Cranberries, raspberries, currants, peppers, garlic, and onions are useful.

There are 3 degrees of microbiocenosis disturbances.

Easy. The amount of bifid flora is reduced slightly, anaerobes predominate over aerobes, opportunistic flora is represented by no more than 2 species in titers up to 106. Average. The number of aerobes increases. The bifid flora titer decreases. The number of anaerobes and aerobes is approximately the same. Atypical forms of E. coli appear, and the titer of opportunistic microorganisms increases. Heavy. The number of aerobes exceeds the number of anaerobes. The titer of bifidobacteria and lactobacilli is sharply reduced. The number of opportunistic flora has increased - 107 and higher. Patients complain of stool upset, flatulence; there are signs of intoxication: fever, weakness, fatigue.

Anatoly Bliznyuk, Associate Professor of the Department of Polyclinic Therapy of BSMU, Candidate of Medical Sciences Medical Bulletin , June 25, 2014

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What examination is needed

Symptoms of dysbacteriosis are nonspecific. The same symptoms may mask pathology of the digestive system or hypovitaminosis. Therefore, dysbiosis is considered a clinical and laboratory syndrome.

Diagnosis begins with a scatological examination, which allows you to assess digestive function, the state of enzyme systems, peristalsis and the speed of movement of the food bolus.

But a change in the composition of feces does not indicate dysbacteriosis. It is necessary to confirm changes in the composition of bacteria in the intestinal lumen. In Moscow, many clinics use gas-liquid and ion chromatography methods. They make it possible to determine the composition of the microflora based on the resulting metabolites.

Bacteriological testing is often used. To do this, swabs from the intestinal mucosa, feces or scrapings are sown on special nutrient media. This method allows you to obtain colonies of bacteria and determine their type with high accuracy. A special stool test for dysbacteriosis is also used. But a mandatory condition is that the biological material must reach the laboratory no later than an hour after it is received from the patient. Feces must be kept warm so as not to cause the death of bacteria. The method does not justify itself by providing an idea only of the state of the colon flora.

The gold standard for diagnosing dysbacteriosis is intestinoscopy. This is an endoscopic method during which a flexible probe with a video camera is inserted into the cavity of the small intestine through the mouth and stomach or rectum and colon. It is necessary to examine the intestinal mucosa and obtain an aspirate of its contents. The resulting liquid is also inoculated onto a nutrient medium. The disadvantage of this method is the need for general anesthesia, special bacteriological media and a long wait for the result. Sometimes a breath test with labeled H2 is used to diagnose dysbiosis.

Diagnostics

The presence of dysbiosis caused by taking antibacterial drugs can be determined by characteristic clinical signs. Specific methods for diagnosing this pathological condition include bacterial culture of stool and laboratory analysis for dysbacteriosis. In order to determine dysbiosis of the small intestine, an examination of an aspirate or scraping from the jejunum is performed. Indirect signs of microflora imbalance are determined by performing gas-liquid analysis and biochemical examination of feces.

Drugs and their action

The most effective way to restore microflora and get rid of dysbiosis is to use drugs from the group of probiotics. Manufacturers offer medicines in different forms:

• capsules;
• pills;
• powder;
• drops;
• solution.

The dosage form is selected by the doctor depending on the age of the patient. Children and elderly people who have difficulty swallowing tablets are prescribed a solution or powder for its preparation. At the age of 0-3 years, it is easier to give probiotic drops to a child. For everyone else, capsules or tablets are recommended.

Anti-dysbacteriosis medications are medications that can be purchased without a doctor's prescription. But self-medication is not recommended; only a specialist can tell you which type is best to take.

Probiotics usually contain 1-2 types of bacteria that restore mucous membranes well. Usually these are lacto- and bifidobacteria. They are normal inhabitants of the intestines that help improve microbial balance. The mechanism of action of this therapeutic group is associated with suppression of the growth of pathogenic flora. Lactic acid bacteria compete for receptors on the mucosal epithelium and nutrients. They secrete lactic acid and cytokines, which have an inhibitory effect on pathogens.

Preparations from the group of prebiotics help to effectively cure dysbiosis. These are medications that belong to the group of dietary fibers: inulin and lactulose, as well as drugs based on them.

They are not broken down by digestive enzymes and enter unchanged into the large intestine, where they become a nutrient substrate for lacto- and bifidobacteria. Therefore, microbes multiply well, increase the volume of bacterial mass, and restore the intestinal wall. To make the treatment as effective as possible, it is recommended to take prebiotics and probiotics at the same time.

Treatment of dysbiosis is not contraindicated in case of concomitant pathologies of the digestive tract. Probiotics are not harmful to patients with stomach ulcers, liver disease, or gallbladder disease. And in some cases they will speed up recovery.

In advanced cases of intestinal dysbiosis and when the symptoms of dyspepsia are too painful, medications from the group of enzymes can help. They should be selected by a doctor, depending on the type of digestive disorder. These medications must be taken daily before meals.

It’s hard to say how long it will take to treat dysbacteriosis. In some cases, this can last for several weeks, and in advanced cases – several months.