Sobrecrecimiento bacteriano del intestino delgado y sobrecrecimiento metanógeno intestinal: ¿están sobrediagnosticados?
DOI:
https://doi.org/10.52787/agl.v55i4.570Palabras clave:
Sobrecrecimiento bacteriano del intestino delgado, intestino delgado, malabsorción, microbioma, síndrome del intestino irritableResumen
El sobrecrecimiento bacteriano del intestino delgado se describió originalmente como una causa de mala digestión y malabsorción, y su diagnóstico se basaba en el cultivo de aspirados del intestino delgado superior; sin embargo, la aplicación de pruebas de hidrógeno en el aliento para evaluar la sospecha de sobrecrecimiento bacteriano del intestino delgado aumentó drásticamente la frecuencia de este diagnóstico y amplió su contexto clínico desde la mala digestión hasta incluir una serie de molestias gastrointestinales inespecíficas e incluso algunas enfermedades sistémicas. No obstante, una revisión crítica de la literatura reciente sugiere que la dependencia de las pruebas de aliento, en particular aquellas que utilizan lactulosa como sustrato, ha llevado a un sobrediagnóstico del sobrecrecimiento bacteriano del intestino delgado, ya que muchos aspectos del concepto actual de su diagnóstico siguen siendo controvertidos y no resueltos, incluidos los umbrales diagnósticos, la respuesta al tratamiento con antibióticos y el papel del metano, el sulfuro de hidrógeno y otros gases derivados de la fermentación bacteriana en el tracto gastrointestinal. En este contexto, se analizan estos temas prestando especial atención al concepto de sobrecrecimiento de metanógenos intestinales y al papel de los metanógenos y el metano en la homeostasis gastrointestinal, se aboga por un enfoque crítico y cauteloso en el diagnóstico tanto del sobrecrecimiento bacteriano del intestino delgado como del sobrecrecimiento de metanógenos intestinales y por una gran prudencia en la prescripción de antibióticos, y se destaca el interés en la aplicación de la microbiología molecular moderna al estudio del microbioma y el metaboloma del intestino delgado, con el objetivo de lograr una comprensión más completa de la biología del metano.
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