What does intestinal dysbiosis mean. Dysbacteriosis is a myth of Russian medicine. Measures to prevent dysbacteriosis

Intestinal dysbacteriosis, due to the predominance of staphylococcus, is a consequence of the adverse effects of drugs. It develops against the background of a change in the body's reactions to external factors and a decrease in the barrier function of the intestine. With this form of dysbacteriosis, symptoms associated with intoxication and an inflammatory process developing in the intestine are noted: fever (up to 39 ° C) with chills and sweating, headache, weakness, poor appetite, sleep disturbance, constant or cramping abdominal pain, liquid copious stools with blood, mucus and pus. Stool frequency - up to 7-10 times a day. Objectively recorded bloating, prolonged pain along the large intestine, spasm. Blood changes are characterized by an increase in the number of leukocytes, and in severe cases, a decrease in the content of total protein.

Types and degrees of dysbacteriosis

Depending on the cause (etiology) in modern medicine, the following types of dysbacteriosis are distinguished.

Dysbacteriosis in practically healthy individuals:

• age;
• seasonal;
• nutritional (due to internal causes);
• professional.

Dysbacteriosis accompanying various diseases of the digestive system:

• diseases of the stomach, occurring with a decrease in acidity;
• diseases of the pancreas;
• diseases of the liver and biliary tract;
• bowel disease;
• malabsorption syndrome (decrease in enzyme activity and impaired digestion of food) of any origin.

Dysbacteriosis in infectious, allergic diseases, immunodeficiency states, hypovitaminosis, hypoxia, that is, insufficient supply of tissues with oxygen, and hypoxemia - a low oxygen content in the blood, intoxications caused by both external and internal causes, exposure to radionuclides.

Drug dysbiosis as a result of taking antibiotics, sulfonamides, tuberculostatics, immunosuppressants, antacids, antisecretory, laxatives, etc.

Stress dysbacteriosis occurs with prolonged emotional or physical stress.

Depending on the severity of microflora disturbance, 3 degrees of dysbacteriosis are distinguished:

1. the first degree - a decrease in the number and decrease in the activity of beneficial microflora;
2. the second degree - the appearance of conditionally pathogenic microorganisms;
3. the third degree - the presence in the intestine of a large number of pathogenic microorganisms.

There is another classification of dysbacteriosis - depending on the quantitative ratio of E. coli and opportunistic microbes:

• mild bacteriosis (opportunistic microflora is 25%);
• moderate bacteriosis (opportunistic microflora is 50%);
• pronounced dysbacteriosis (conditionally pathogenic microflora is 75%);
• pronounced dysbacteriosis (opportunistic microflora is almost 100%, E. coli is absent).

Symptoms in children

1. Violation of body weight:

lack of weight gain;

weight loss;

body weight deficiency.

2. Changes in the skin, mucous membranes, subcutaneous tissue:

pallor, grayish skin tone;

dryness, peeling;

decrease in skin elasticity;

erosion in the corners of the mouth;

allergic dermatitis;

thrush;

brightness, "varnished" mucous membranes;

changes in the mucous membrane and skin in the anus.

3. Symptoms from the digestive system:

decreased and lack of appetite;

regurgitation;

putrid smell from the mouth;

metallic taste in the mouth;

increased salivation;

flatulence, bloating;

rumbling on palpation of the abdomen;

dry skin and mucous membranes.

3. Allergic syndrome:

itching of the skin and mucous membranes;

allergic skin rashes.

4. General symptoms:

fatigue;

weakness;

headaches;

So-called dysbacterial (dysbacteriosis, dysbiotic) reactions should be distinguished from intestinal dysbacteriosis - short-term changes in the intestinal microflora. These changes occur with a short exposure to adverse factors and spontaneously disappear after the elimination of the cause after 3-5 (less often - after 10 or more) days without any special therapeutic measures.

There are many symptoms of the manifestation of dysbacteriosis itself - from subtle (if a person has a huge reserve of compensatory capabilities) to severe metabolic disorders. It is especially important to note that with dysbacteriosis, completely different clinical pictures are possible: this is irritable bowel syndrome, and spastic hyper- or hypomotor dyskinesia (a disorder of coordinated movements of the colon), and chronic non-ulcerative colitis.

Consider the most common symptoms of dysbacteriosis.

Gastrointestinal dyspepsia syndrome

The most common clinical manifestation of dysbacteriosis is the syndrome of gastrointestinal dyspepsia. This is understandable: with dysbacteriosis, the digestive function is disturbed in the first place. How does this syndrome manifest itself? First of all - violations of the chair. As a rule, this is diarrhea (6-8 times a day, yellowish-green feces, with a sharp unpleasant odor), but there may also be constipation, and sometimes alternating diarrhea with constipation. Due to frequent bowel movements, patients experience a dull pain in the anus. Belching, nausea, heartburn appear. Many people have flatulence due to increased gas formation, impaired absorption and removal of gases. Flatulence in these cases is more pronounced in the afternoon and at night. Patients constantly complain of rumbling in the stomach, its swelling, an unpleasant taste in the mouth. Please note: intestinal infections, including dysentery, can occur with the same manifestations!

Pain syndrome

Pain in the abdomen of a different nature:

• distension (associated with an increase in pressure in the intestine) with damage to the small intestine, more often localized in the umbilical region; with dysbacteriosis of the large intestine - in the iliac regions, decrease after defecation and gas discharge;
• spasmodic, cramping, decrease after defecation;
• due to inflammation of the lymph node (regional lymphadenitis), permanent, localized to the left above the navel, increase after exercise and sometimes after defecation.

allergic syndrome

It manifests itself in almost all children with dysbacteriosis (93-98%) and in most adults (80%). It is expressed, as a rule, in the fact that a person cannot tolerate some products (it is sometimes very difficult to identify this). A few minutes (or a few hours) after eating such foods, patients develop nausea, loose stools, the stomach swells and starts to hurt, often these phenomena are supplemented by general allergic reactions: urticaria, skin itching, swelling, bronchospasm.

Malabsorption Syndrome

It is characterized, firstly, by persistent diarrhea, and secondly, there are signs of a deficiency of certain substances in the body. If the violation of intestinal absorption is prolonged, then the general signs of a person’s ill health are clearly manifested: immunity falls, against this background, frequent diseases of the nasopharynx, bronchi, lungs, skin, and joints begin.

For example, with insufficient absorption of proteins in patients, protein-energy deficiency is observed. A person begins to quickly lose weight, he develops edema, hypoproteinemia, that is, a low protein content in the blood, and dystrophic processes begin in the liver.

In violation of the absorption of carbohydrates in patients, hypoglycemia is observed, that is, a low content of glucose in the blood, which cannot be eliminated even by taking a concentrated sugar solution.

If, due to dysbacteriosis, the full absorption of calcium is disturbed, then hypocalcemia begins - the calcium content in the blood decreases: the bones weaken and thin (osteoporosis appears - the scourge of our time), fingers and toes become numb, anemia, depression, apathy develop.

Reduced absorption of phosphorus leads to skull deformity, limb curvature, growth retardation in children.

Water and electrolyte disorders are characterized by:

• hypokalemia (loss of potassium: muscle weakness appears, intestinal atony, extrasystole - a violation of heart contractions);
• hyponatremia (sodium loss: blood pressure decreases, thirst appears, dry skin, tachycardia);
• iron deficiency (iron deficiency anemia).

vitamin deficiency syndrome

The syndrome of vitamin deficiency is directly related to impaired intestinal absorption. With dysbacteriosis, the lack of vitamins of group B is most pronounced. Its very first sign is a violation of the motor function of the digestive tract.

But the lack of each specific vitamin has its own characteristics. With a deficiency of vitamin B 12 (cyanocobalamin, which is of great importance for hematopoiesis), a person develops anemia. Often, with a deficiency of vitamin B 12, the production of vitamin K and folic acid is disrupted, which leads to a variety of bleeding.

With a lack of vitamin B 2 (riboflavin), stomatitis, cheilitis are often observed - inflammation of the skin of the lips, jams appear, dermatitis of the wings of the nose and nasolabial folds, nails fall out, become thinner and hurt.

Lack of vitamin B 1 (thiamine, or, as it is also called, anti-neuritic vitamin), causes typical neurological disorders: headaches, irritability, general weakness, insomnia, intestinal atony.

The same thing happens with a lack of vitamin B 6 (pyridoxine). With a deficiency of both vitamins (B 1 and B 6), the usual disorders of the peripheral nervous system can develop into neuritis, dystrophic processes of the myocardium begin.

Serious neurological failures also occur in the case of a decrease in the amount of nicotinic acid required by the body. At the same time, patients experience irritability, imbalance, the phenomenon of glossitis - inflammation of the mucous membrane of the tongue (characterized by a bright red color of the mucous membrane of the tongue, pharynx, mouth, increased salivation).

Often with dysbacteriosis, the ability to absorb fat-soluble vitamins, in particular vitamin D, is impaired, which can lead to rickets or aggravate its course in children.

anorectal syndrome

Anorectal syndrome most often develops with prolonged antibiotic treatment. It is characterized by general poor health: weakness, headache, lack of appetite. Then the temperature may rise, diarrhea begins, a dull pain appears in the anorectal region (near the anus).

In conclusion, it is necessary to mention a widespread mistake: dysbacteriosis is often confused with various acute intestinal diseases, and not only by patients, but in some cases by doctors. Therefore, I want to draw the attention of readers - both patients and doctors - to the signs characteristic of such diseases.

Acute intestinal infections (AII) are characterized by:

• acute onset of the disease;
• the presence of a source of infection in identifying the ways of transmission of the infection (contact with a patient with AII, the use of poor-quality food products, an epidemiologically confirmed outbreak of an intestinal infection among relatives or in a team);
• isolation of the pathogen (pathogenic or conditionally pathogenic microbe) in the highest concentration in the first days of the disease, followed by a decrease and disappearance during treatment;
• identification of a pathogen, more often a pathogenic or conditionally pathogenic microorganism, mainly of the genus Proteus, Citrobacter, Klebsiella;
• a 2-4 times increase in the peripheral blood titer of antibodies to the pathogen (this is shown by an analysis of the antibody titer) in the first weeks of the disease;
• decrease in antibody titer from the 3rd week, after the elimination (disappearance) of the pathogen from the body.

Acute food poisoning is characterized by:

• identification of the food product that served as a source of infection;
• clinical signs of acute gastritis, enteritis, colitis in combination with symptoms of general intoxication and dehydration (weakness, diarrhea, thirst, nausea, dry mucous membranes, abdominal pain, vomiting, fever, chills, headache, muscle aches, convulsions);
• typical rapid development and short-term course of the disease;
• isolation from the product and feces of identical pathogens of food poisoning;
• a sharp (2-3 times) increase in the blood titer of antibodies to the isolated strain.

The main symptoms of severe dysbacteriosis:

• unstable stool, that is, a change of constipation and diarrhea;
• flatulence and abdominal pain;
• regurgitation in young children and changes in taste in adults;
• decreased appetite and fatigue (especially in children);
• irritability.

In addition, pronounced dysbacteriosis is characterized by manifestations of polyhypovitaminosis (vitamin deficiency) and mineral deficiency, increased allergic processes while reducing immunity. You should pay attention to the language: it often becomes “geographical” - striated, raids appear on it (whitish, yellowish, etc.; you should especially be wary if the plaque is black - this may be a sign of the development of fungi in the intestines).

Diagnostics

As you can see, there are a lot of symptoms of dysbacteriosis, and often they are very similar to the symptoms of other diseases. Therefore, it is very important for a doctor (of any profile) to have laboratory tests that provide information about the state of the patient's microflora. To do this, there are a variety of methods.

The most common method is stool culture for dysbacteriosis. With its help, it is possible to identify not only the presence of conditionally pathogenic microorganisms, but also a deficiency of bifidus and lactobacilli. True, this method is not accurate enough, since it reflects the microbial composition of only the distal sections of the intestine (rectum and part of the sigmoid colon). With this analysis, only about 20 species of bacteria can be isolated, although there are about 500 of them in the intestine. Nevertheless, the analysis provides quite reliable information for assessing the condition of the most important bacteria that inhabit the large intestine, and the doctor has the opportunity to prescribe the necessary treatment.

To diagnose dysbacteriosis, a coprological study (coprogram) is also carried out - a biological study of intestinal contents.

Another method is gas-liquid chromatography of faeces, based on the separation and subsequent analysis of the various components of the intestinal contents. This method makes it possible to detect volatile fatty acids: acetic, valeric, caproic, isobutyric, etc. The deviation of their content from the physiological norm characterizes the state of the intestinal flora and the relationships within it.

Sigmoidoscopy - bacteriological examination of scrapings from the mucous membrane of the rectum - visual examination of the rectum and sigmoid colon; colonoscopy - examination of the inner surface of the large intestine using a flexible optical device - a colonoscope, as well as the study of intestinal contents and bile.

A method such as the determination of indole and skatol in the urine is also used.

For express diagnosis of the small intestine, a 4C-xylose breath test is used, but its results are not always accurate, the probability of error is 10%.

Using the analysis of chloroform-methanol extract of the liquid of the small intestine, free bile salts are detected in the small intestine. However, this method is rarely used.

To find out the reasons for the development of dysbacteriosis, X-ray, endoscopic and ultrasound examinations of the organs of the gastrointestinal tract, as well as computed tomography of the abdominal cavity, are carried out.

Do not hesitate to visit a doctor if:

• you have any chronic diseases, especially from the immune system and the gastrointestinal tract, as well as allergies, eczema, bronchial asthma;
• disturbed by constant violations of the stool: constipation or diarrhea, or unstable stool - alternating constipation and diarrhea;
• severe flatulence and abdominal pain appeared;
• there is no appetite or, conversely, there is a constant feeling of hunger;
• taste has changed (in adults), regurgitation has appeared (in children);
• worried about bad breath, which is impossible to "interrupt";
• hair began to fall out intensively;
• nail deformities have formed;
• cracks appear on the lips and mucous membranes;
• raids appear on the tongue, pay special attention to black plaque;
• skin rashes of an allergic nature appeared;
• loss of healthy color and elasticity of the skin;
• constantly feel weak, get tired quickly;
• sleep disturbed.

In addition, there are a number of psychological moments that signal that not everything is in order with health (in particular, with microflora):

• you have impaired concentration, it is difficult to "gather your thoughts";
• often experience anxiety, mental discomfort, apathy - up to depression;
• constantly irritated.

If dysbacteriosis is caused by enterobacteria, Pseudomonas aeruginosa, enterococci, the following phenomena are noted: poor appetite, dull pain in the abdomen, unstable mushy stools with a lot of mucus, flatulence, spasm and soreness of the sigmoid colon. Due to the low severity of the above symptoms, the situation is often underestimated, and the developed disease supports the inflammatory (mostly local) process in the intestine.

Dysbacteriosis, caused by associations of opportunistic microorganisms (usually staphylococci, yeast-like fungi, enterococci, less often hemolytic and Pseudomonas aeruginosa), is much more severe than in the case of a single pathogen.

With the predominance of fungal flora, the picture of symptoms is often unclear or erased. The body temperature is normal, there is a slight pain in the abdomen, the stool is liquid or mushy up to 3-5 times a day, sometimes with mucus and the presence of whitish-gray mycotic lumps.

Dysbacteriosis caused by fungi of the genus Candida and Aspergilla is more severe. With candidomycosis, patients complain of abdominal pain of a different nature or localized in the navel, bloating and a feeling of heaviness in the abdomen. The stool is liquid or mushy with mucus, sometimes with blood or frothy, with the presence of whitish-gray or grayish-green mycotic lumps or films up to 6 times or more per day.

Patients have low-grade fever, poor appetite, general weakness, and weight loss. On examination, they have a crimson tongue and stomatitis.

Intestinal dysbacteriosis caused by aspergillus (15 of the known 300 species are pathogenic) more often develops in patients with previous diseases of the stomach or intestines, especially with gastritis with high acidity. Manifestations of the presence of aspergillus are observed in sharply weakened, malnourished patients against the background of a general, most often chronic lung disease (tuberculosis, pneumonia, bronchitis, etc.), blood diseases, in the process of prolonged use of antibiotics (especially tetracycline). The disease begins with dyspeptic phenomena: nausea, vomiting, pain in the epigastric region, a bitter moldy taste in the mouth, rashes on the mucous membrane of the mouth, throat and pharynx, as well as frothy stools with a lot of mucus and a moldy smell, sometimes with an admixture of blood. Intestinal dysbiosis caused by aspergillus can occur with severe intoxication, called mycotoxicosis, since these microorganisms, being biochemically active, form enzymes and thus can produce toxic substances. In this case, symptoms similar to intoxication occur, especially after eating a large amount of carbohydrates.

As a rule, fungal lesions of the intestine are accompanied by manifestations of severe somatic diseases, which makes their treatment difficult.

Since in some cases dysbacteriosis does not manifest itself with any symptoms, or the existing symptoms may also relate to other diseases, microbiological analysis data are crucial in making a diagnosis.

The indications for analysis are as follows:

long-term intestinal disorders in which it is not possible to isolate pathogenic microorganisms;

prolonged recovery period after dysentery and other acute intestinal diseases;

intestinal dysfunction in persons who are exposed to radiation for a long time, chemicals, as well as with intensive antibiotic and (or) immunosuppressive therapy, long-term chemotherapy, hormone therapy;

the presence of purulent-inflammatory foci that are difficult to treat (pyelitis, cholecystitis, ulcerative colitis, enterocolitis, sluggish pneumonia);

allergic diseases (atonic dermatitis, bronchial asthma, etc.), which are difficult to treat.

Microbiological diagnostic criteria are:

an increase in the number of conditionally pathogenic microorganisms of one or more species in the intestine with a normal amount of bifidobacteria;

an increase in the number of one or more types of conditionally pathogenic microorganisms with a moderate decrease in the concentration of bifidobacteria (by 1-2 orders of magnitude);

moderate or significant decrease in the content of bifidobacteria, combined with pronounced changes in the microflora - a decrease in the number of lactobacilli, the appearance of altered forms of Escherichia coli, the detection of one or more opportunistic microorganisms in an increased amount.

The most common consequence of intestinal dysbiosis, in addition to all the unpleasant symptomatic phenomena discussed above, there is a lack of vitamins. The most pronounced lack of B vitamins, the earliest sign of which is a violation of the motor function of the digestive tract. riboflavin deficiency is evidenced by stomatitis, dermatitis of the wings of the nose and nasolabial folds, changes in nails, hair loss. With a deficiency of thiamine, neurological disorders in the form of sleep disorders are possible. Vitamin B12 deficiency due to intestinal dysbacteriosis is especially dangerous, which leads to the development of B12-deficiency anemia. It is also possible malabsorption of fat-soluble vitamins, in particular vitamin D, which can aggravate the course of rickets.

So, you found some of the listed symptoms in yourself, visited a doctor, underwent an examination, passed tests and are sure that you have dysbacteriosis - what should you do in this case? You will read about this in this book. Furthermore! Even if you don't have any of the mentioned signs, you feel normal - this book will still be useful to you: to maintain and increase your health and vigor. Yes, yes, we mean nothing more than prevention. Since the given methods of treatment are non-drug, unpleasant consequences are not expected from them, although, of course, you should not overdo it with them. Follow the recipe and the rules of application - and everything will turn out exactly as intended.

In severe cases, as you can understand from the above, the treatment should be carried out under the strict supervision of a specialist doctor. If you do not have a severe, ordinary disorder, you can try to cope with it on your own. However, for severe cases, the treatment methods described below are quite applicable, of course, subject to prior consultation with the doctor and his approval.

Syndrome "Intestinal dysbacteriosis"

Parallelism of clinical manifestations and the severity of dysbiotic changes is not always present. In some cases, with severe disorders in the intestinal microflora, there are no clinical manifestations, and vice versa - pronounced clinical manifestations are accompanied by minor changes in the microflora.

Clinical manifestations of dysbiosis depend on disturbances in the microflora of the macroorganism (in particular, on the variant of the leading opportunistic agents or their associations) and on its compensatory capabilities. The causes of the onset of symptoms of the disease are a decrease in the colonization resistance of the intestinal mucosa, the detoxification and digestive functions of the intestinal microflora, and a violation of the body's immune status.

The main clinical manifestations of intestinal dysbacteriosis are: violation of the general condition (intoxication, dehydration); weight loss; symptoms of damage to the mucous membranes of the gastrointestinal tract; digestive disorders in various parts of the gastrointestinal tract; protein and micronutrient deficiency; decreased function of the immune system.

Clinical manifestations of intestinal dysbacteriosis in children.

1. Lack of gain, loss or deficiency of body weight, malnutrition I, II, III degree.

2. Changes in the skin, mucous membranes, subcutaneous tissue: pallor, grayish skin tone, dryness, peeling, decreased skin elasticity, excoriation, erosion in the corners of the mouth, lichenification, allergic dermatitis, thrush, cheilitis (hyperemia, thickening of the lips, dry scales), brightness, hyperemia, "lacquering" of mucous membranes, aphthae, enanthema on the mucous membrane of the gums, oral cavity and pharynx, changes in the mucous membrane and skin in the anus.

3. Symptoms of the digestive system: decrease and lack of appetite; nausea; regurgitation; vomit; aerophagia; putrid smell from the mouth; metallic taste in the mouth; increased salivation; flatulence; bloating; on palpation of the abdomen - rumbling and splashing noise, spastic contraction of the colon; pain in the abdomen - independent and on palpation; increased gas emission; itching and burning in the anus; violations of the sphincter of the rectum (sphincteritis); diarrhea; change in the nature of the stool (copious, mushy with undigested lumps of mucus, liquid, watery, thin, scanty with pathological impurities, sheep stool, constipation).

Clinical manifestations of intestinal dysbacteriosis in adults.

1. Symptoms of the gastrointestinal tract: decrease or lack of appetite; nausea; vomit; metallic taste in the mouth; pain in the abdomen (dull or cramping) - independent and on palpation; belching; aerophagia; flatulence; rumbling in the stomach, its swelling; feeling of incomplete bowel movement; imperative urge to defecate; constipation; diarrhea; alternating constipation and diarrhea; fecal masses in the form of a corky stool (mushy or liquid feces with a solid first portion of it, sometimes with an admixture of mucus); sheep feces (for constipation) mixed with mucus; putrid or sour smell of feces.

2. Signs of hypovitaminosis: seizures, dry skin and mucous membranes.

3. Allergic syndrome: itching of the skin and mucous membranes, allergic skin rashes.

4. General symptoms: fatigue, weakness, headaches, sleep disturbance.

Intestinal dysbacteriosis, caused by the prevalence of hemolytic or epidermal staphylococcus (but at its level not higher than 10 7 CFU per 1 g of feces), is a consequence of the adverse effects of drugs. It develops against the background of an altered reactivity of the body and a decrease in the barrier function of the endothelial-macrophage system of the intestine.

In the clinical picture of intestinal dysbacteriosis caused by staphylococcus, there are symptoms associated with intoxication and an inflammatory process that develops in the intestine: fever (up to 39 ° C) with chills and sweating, headache, weakness, poor appetite, sleep disturbance, constant or cramping pain in the abdomen, loose copious stools with blood and mucus, with the presence of pus. Stool frequency - up to 7-10 times a day. Objectively recorded bloating, prolonged pain along the colon, spasm. Blood changes are characterized by an increase in the number of leukocytes, a shift of the leukocyte formula to the left and an increase in ESR, a decrease in albumin and an increase in globulin fractions, and in severe cases, a decrease in the content of total protein (up to 6.1 g / l). Sigmoidoscopy reveals a catarrhal, catarrhal-hemorrhagic and / or erosive-ulcerative inflammatory process.

With dysbacteriosis caused by enterobacteria, Pseudomonas aeruginosa, enterococci, poor appetite, subfebrile temperature, dull pain in the abdomen, unstable mushy stools with a lot of mucus, flatulence, spasm and soreness of the sigmoid colon are determined. Due to the low severity of the above symptoms, the situation is often underestimated, and the developed dysbacteriosis supports the inflammatory (mostly local) process in the intestine.

Dysbacteriosis caused by associations of opportunistic microorganisms (usually staphylococci, proteus, lactose-negative Escherichia, yeast-like fungi, enterococci, less often hemolytic and Pseudomonas aeruginosa), is much more severe than in the case of a single pathogen, and is characterized by the occurrence of complications such as perforation of ulcers , bacteremia and septicopyemia.

With the predominance of fungal flora, the clinical picture is polymorphic and often erased. Body temperature is normal. There is slight pain in the abdomen. The stool is liquid or mushy, up to 3-5 times a day, sometimes with mucus and the presence of whitish-gray mycotic lumps. In the blood of some patients, an increased ESR is recorded, with sigmoidoscopy - catarrhal changes in the mucosa.

Dysbacteriosis caused by fungi of the genus Candida and Aspergillus is more severe. With candidiasis, patients complain of diffuse abdominal pain or localized in the navel, bloating and a feeling of heaviness in the abdomen. The stool is liquid or mushy, with mucus, sometimes with blood or frothy, with the presence of whitish-gray or grayish-green mycotic lumps or films, up to 6 times or more per day. Patients have low-grade fever, poor appetite, general weakness, and weight loss. On examination, they have a crimson tongue, aphthous stomatitis. Sigmoidoscopy reveals catarrhal or catarrhal-hemorrhagic proctosigmoiditis, sometimes large-ulcer lesions.

If yeast-like fungi of the genus Candida are found in crops up to 10 7 CFU per 1 g of feces, the situation is assessed as intestinal dysbacteriosis. If the number of fungi in crops exceeds 10 7 CFU per 1 g of feces and the clinical picture indicates a generalization of the process (lesion of the skin, mucous membranes and internal organs), such cases are considered as candidiasis or candidiasis sepsis.

Intestinal dysbacteriosis caused by aspergillus (pathogenic are 15 of the described 300 species), more often develops in patients with previous diseases of the stomach or intestines, especially with gastritis with high acidity. Clinical manifestations of such dysbacteriosis are observed in sharply weakened, malnourished patients against the background of a common, most often chronic lung disease (tuberculosis, pneumonia, bronchitis, bronchiectasis, etc.), blood diseases, and prolonged use of antibiotics (especially tetracycline).

The disease begins with dyspeptic phenomena - nausea, vomiting, pain in the epigastric region, a bitter moldy taste in the mouth, aphthous rashes on the mucous membrane of the mouth, pharynx and pharynx, as well as foamy stools with a lot of mucus and a musty smell, sometimes with an admixture of blood.

Intestinal dysbiosis caused by aspergillus can occur with severe intoxication, called mycotoxicosis, since these microorganisms, being biochemically active, form proteolytic, saccharolytic and lipolytic enzymes and thus can produce toxic substances. In this case, a state similar to intoxication occurs, especially after eating a large amount of carbohydrates.

Generalized forms of aspergillosis, including Aspergillus sepsis, are very rare and extremely severe, usually fatal.

Typically, fungal infections of the intestine are accompanied by diseases with severe forms that make their treatment difficult.

With intestinal dysbacteriosis, signs of hypovitaminosis are noted. The most pronounced deficiency of B vitamins, the earliest sign of which is a violation of the motor function of the digestive tract with a tendency to atony. The lack of riboflavin is indicated by stomatitis, cheilitis, dermatitis of the wings of the nose and nasolabial folds, changes in nails, hair loss. With a deficiency of thiamine, neurological disorders are possible in the form of sleep disorders, paresthesias. With intestinal dysbacteriosis, vitamin B 12 deficiency may occur, which leads to the development of B 12 deficiency anemia.

With a deficiency of nicotinic acid, patients experience irritability, imbalance, glossitis, bright red color of the mucous membrane of the tongue, throat, mouth, and increased salivation.

With intestinal dysbacteriosis, the absorption of fat-soluble vitamins, in particular vitamin D, is disrupted, which can aggravate the course of rickets.

With the development of dysbiotic changes, a decrease in the immunological reactivity of the body, the production of lysozyme, as well as an increase in the content of histamine in organs and tissues, sensitization of the body occurs with the development of allergic reactions. In this regard, the clinical manifestations of dysbacteriosis may be accompanied by signs of allergy, but their severity is individual.

Treatment of the syndrome "Intestinal dysbacteriosis. Stage: compensation; phase: latent

Changes in the intestinal microbiocenosis correspond to I-II degree of microbiological disorders. There are no clinical manifestations of dysbacteriosis.

The examination includes a clinical examination of the patient, collection of anamnesis and complaints, which makes it possible to identify the presence (or absence) of the patient's risk factors for the development of dysbacteriosis associated with the premorbid state.

In children under the age of 1 year, the risk factors for the development of intestinal dysbacteriosis are as follows: the presence of intestinal dysbacteriosis in the mother, bacterial vaginosis during pregnancy, complicated pregnancy and childbirth, mastitis; childbirth by caesarean section; low Apgar score and the presence of resuscitation in the newborn; the presence of a purulent infection in a child; artificial feeding.

In relation to children of the 1st year of life, when interviewing parents (or a trustee), they clarify the nature of feeding the child (natural or artificial), the timing of the introduction of supplementary feeding, complementary foods, and features of physical development (weight gain).

In children under the age of 15, when preparing for vaccination, for surgery, sending a child for planned hospital treatment, to sanatorium-improving institutions, the presence of risk factors for dysbacteriosis is clarified, such as: unfavorable course of the neonatal period; early artificial feeding; dyspeptic disorders; frequent acute respiratory viral infections; allergic diseases (for example, atopic dermatitis); rickets; anemia; hypotrophy; being in closed groups; transferred intestinal and other infections; previously diagnosed immunodeficiency states, endocrine, oncological and allergic (dermatitis, rhinitis, asthma, etc.) diseases; as well as the timing and nature of their treatment (courses of antibiotics, hormonal and chemotherapy, etc.); allergic dermatitis, in addition, find out the frequency and nature of the stool.

In patients over the age of 15, the presence of one or more risk factors for the development of intestinal dysbacteriosis is detected: intensive antibiotic treatment, long-term hormonal and chemotherapy, primary and secondary immunodeficiencies, intestinal and other (respiratory, urogenital, etc.) infections suffered during the last year, chronic gastrointestinal diseases (cholecystitis, peptic ulcer of the stomach and duodenum, colitis, including nonspecific ulcerative colitis, etc.). The attention is focused on stool disorders (diarrhea, constipation, their alternation) and nutrition (lack of body weight) in the patient.

During external examination and palpation of the patient, the presence of clinical signs of dysbacteriosis is excluded, for which attention is paid to:

Skin (dryness and peeling, allergic dermatitis);

Oral cavity (jamming, cheilitis, aphthae, glossitis, hyperemia and varnishing of the mucosa, enanthema, etc.);

Abdominal area (soreness and bloating).

Microbiological examination of feces is carried out in order to identify violations of the intestinal microbiocenosis (table). The obtained data on the qualitative and quantitative composition of the main intestinal microflora are compared with normal values.

The degree of microbiological disorders in intestinal dysbacteriosis

A coprological study is carried out to determine the nature of intestinal dysfunction.

The patient (or the child's parents, accompanying person) must be explained the procedure and rules for taking medicines, repeated (control) microbiological examination of feces.

Microbiological examination of feces is carried out 14 days after the end of therapy in order to assess the dynamics of indicators of intestinal microbiocenosis.

Means used for the prevention and correction of intestinal microbiocenosis disorders.

Drug therapy begins with the appointment of one of the means used to prevent and correct violations of intestinal microbiocenosis. These drugs include bifid-containing drugs that restore the intestinal microflora. For children, these drugs are prescribed in preparation for vaccination, for surgery, when they are sent for planned hospital treatment, to sanatorium and health institutions. The duration of the course in children is 5 days, over the age of 15 years - 14 days.

The choice of the drug for children over 15 years of age is carried out according to the results of a microbiological study of feces. The first course of correction can be carried out with monocomponent or polycomponent or combined preparations. With a low level of bifidobacteria, the correction of microflora disorders begins with the use of a bifid-containing drug, with a high level of bifidobacteria and a sharply reduced content of lactobacilli - a lacto-containing drug. Correction should not be started with the use of colibacterin, since normal E. coli can be restored with repeated courses of bifidus and lacto preparations without treatment with colibacterin.

In the case of incomplete normalization of the intestinal microflora in adults, a second course of therapeutic correction is carried out: sorbed bifid-containing drugs, complex lacto-containing drugs, and, if necessary, bificol are recommended. With a slow growth of bifidoflora, hilakforte, a complex immunoglobulin preparation (CIP), is additionally used. The duration of each repeated course of bifido-, lacto-containing drug is 14 days. The criterion of effectiveness is the normalization of indicators of intestinal microbiocenosis, which is assessed according to the control microbiological study of feces.

With the normalization of intestinal microbiocenosis, non-drug (dietary with the inclusion of probiotic products or dietary supplements) treatment continues.

Bifidumbacterin in dosage forms: powder, tablets, capsules, lyophilisate are taken by mouth, powder and lyophilisate are also intended for topical use.

For example, bifidumbacterin powder (for oral and topical use) before use by older children and adults is mixed with the liquid part of the food, preferably with a fermented milk product, or with 30-50 ml of boiled water at room temperature, without achieving complete dissolution of the powder; before using the drug by newborns and infants, it is mixed with mother's milk, formula for artificial feeding or baby food, the liquid part of other food.

From 0 to 6 months: 1 package of the dosage form in the form of a powder (activity 510 8 CFU) 1 time per day; 3 doses of a dry dosage form from a vial (ampoule) (activity 710 7 CFU) 1 time per day; 5 doses of dry dosage form in the form of capsules (activity 5-10 8 CFU) 1 time per day;

From 6 months to 3 years: 1 packet of the dosage form in the form of a powder 2 times a day; 5 doses of a dry dosage form in the form of capsules or from a vial (ampoule) 2 times a day;

From 3 years to 7 years: 2 packets of the dosage form in the form of a powder 1-2 times a day; 5 doses of dry dosage form in the form of capsules, tablets or from a vial (ampoule) 2 times a day;

From 7 years and older: 2 packets of the dosage form in the form of a powder 2 times a day; 5 doses of a dry dosage form in the form of capsules, tablets or from a vial (ampoule) 2 times a day.

Bifidumbacterin forte is given to children during feeding, mixed with breast milk or baby food. For older children and adults, the drug is mixed before use with the liquid part of the food, preferably a fermented milk product, or with 30-50 ml of boiled water at room temperature. When the drug is dissolved with water, a cloudy suspension is formed with black sorbent particles. The resulting aqueous suspension should be drunk without achieving complete dissolution. If necessary, the drug is used regardless of the meal.

From 0 to 12 months: 1 packet 1 time per day;

From 1 year and older: 1 sachet 2 times a day.

Bifilis for adults and children is prescribed orally, 5 doses 1 time per day 20-30 minutes before meals.

Algorithm for the treatment of intestinal dysbacteriosis with lactic acid preparations.

Lactobacterin is prescribed orally, 3 doses 2 times a day, dissolving with boiled water at room temperature, 40-60 minutes before meals 2-3 times a day.

Acipol is prescribed orally, 1 tablet 1 time per day 30 minutes before meals.

Acylact is prescribed orally, 5 doses 1 time per day 30 minutes before meals.

A course of colibacterin (only for adults) or bificol is carried out only with a persistent decrease in the level of Escherichia coli, the absence of its altered forms. The duration of the course of therapy is 14 days.

Colibacterin - appoint 6 doses or 6 tablets per day (possible in 2 doses) 20-30 minutes before meals. The duration of the course of therapy is 14 days.

Bifikol - appoint 6 doses 2 times a day for 30-40 minutes before meals.

Assign a diet that includes foods containing bifidobacteria and lactobacilli for a period of at least 3-4 weeks.

If these rules are observed, in 70% of cases there is a complete restoration of the intestinal normal flora, which is confirmed by the absence of clinical symptoms of dysbacteriosis, normal indicators of the intestinal microflora, and a good quality of life. In 20% of cases, the stabilization of the process is determined by the 21st day of the measures taken, which requires the appointment of a second course of corrective therapy. In 10%, despite treatment, the progression of microbiocenosis disorders is determined, which is characterized by the appearance of clinical symptoms of intestinal dysbacteriosis (nausea, flatulence, bloating, abdominal pain, stool changes, etc.).

Syndrome "Intestinal dysbacteriosis. Stage: subcompensated; phase: clinical"

Changes in the intestinal microbiocenosis in this case correspond to the II-III degree of microbiological disorders.

The presence of one or more (any combination) of clinical manifestations confirms the syndrome of intestinal dysbacteriosis: stool disorder (diarrhea, constipation or their alternation), dull or cramping pain in the abdomen, pain on palpation of different parts of the intestine, flatulence, skin and mucous membranes - seizures, dryness skin and mucous membranes, dermatitis, in children of the 1st year of life - regurgitation, aerophagia, increased salivation, increased gas emission, a decrease in the rate of body weight gain, the possibility of developing malnutrition.

When collecting an anamnesis, data are ascertained regarding past intestinal infections, previously diagnosed immunodeficiency conditions, allergic (dermatitis, asthma, etc.), endocrine (diabetes) and oncological diseases, courses of antibiotic treatment, hormonal and chemotherapy, professional and living conditions, including number of nutritional characteristics.

When collecting complaints, attention is focused on identifying and determining the nature of: stool disorders - diarrhea, constipation, their alternation; abdominal pain - dull or cramping.

Physical examination. On examination, clinical signs of dysbacteriosis are determined, attention is paid to changes in: skin (dryness and peeling, dermatitis) and subcutaneous fat (lack of body weight); mucous membranes - erosion in the corners of the mouth (seizures), cheilitis, aphthae, enanthemas, hyperemia and varnishing of the tongue (glossitis); areas of the abdomen (bloating, palpation - diffuse pain, splashing noise, spastic contraction of the colon), etc. In children of the 1st year of life, the presence of regurgitation, aerophagia, increased salivation, increased gas emission is noted.

Microbiological examination of feces is carried out in order to identify violations of the intestinal microbiocenosis, determine the sensitivity of microorganisms to bacteriophages and antibiotics. The obtained data on the qualitative and quantitative composition of the main intestinal microflora are compared with normal values. Identification of violations of intestinal microbiocenosis II-III degree confirms the correctness of the diagnosis.

With the help of a coprological study, the nature of intestinal dysfunctions is determined.

During treatment, a general examination of the patient should be carried out each time, focusing on the condition of the skin, oral cavity, abdomen (flatulence, pain on palpation), monitor compliance with the drug, dietary and health-improving regimens or adjust. The patient (if the patient is a child, then a trusted person) is explained the procedure and rules for taking medicines, the need for a repeated (control) microbiological examination of feces.

A microbiological study of feces is carried out 14 days after the end of therapy in order to assess the dynamics of intestinal microbiocenosis, determine the sensitivity to phages and antibiotics of the prevailing conditionally pathogenic microorganism.

The therapy is carried out in stages. They begin with the appointment of one of the drugs used for the prevention and treatment of dysbacteriosis, which suppresses the overgrowth of opportunistic microorganisms in the intestine. The following groups of drugs are used: bacteriophages, antibacterial (only in adults), antifungal, apathogenic representatives of the genus Bacillus. The duration of the course is 5 days. This is followed by a 21-day course of therapy with bifido- or lactose-containing drugs (bifidumbacterin, bifidumbacterin forte, florin forte, bifilis, lactobacterin, acipol, acilact), with the appointment of probifor, the course is 10 days.

In case of incomplete disappearance of clinical symptoms and the presence of II degree of microbiological disorders in the intestine, a second course of treatment is carried out using drugs to suppress the overgrowth of opportunistic microorganisms (5 days) and a course of therapy with drugs to restore normal microflora (bifidumbacterin forte, florin forte, bifilis, acipol, acilact - 21 days, probifor - 10 days). Additionally, according to indications, lactulose, hilak-forte are prescribed.

With a slow growth of bifidoflora, KIP is additionally prescribed.

Bacteriophage treatment algorithm

The drugs are prescribed from the 1st to the 5th day of treatment, taking into account the data of microbiological examination of feces: with excessive growth of staphylococcus a bacteriophage staphylococcal, E. coli bacteriophage coli, proteus bacteriophage proteus, etc.

Doses of bacteriophages are presented in table.

Table. Doses of bacteriophages

Bacteriophage staphylococcal liquid Bacteriophage coli-proteus liquid Pyobacteriophage combined liquid Pyobacteriophage polyvalent purified liquid Klebsiella bacteriophage polyvalent purified liquid	6-12 months - 20 ml, from 1 to 3 years - 30 ml, from 3 to 7 years -40 ml, 8 years and older - 50 ml
Staphylophage (staphylococcal bacteriophage, tablets with acid-resistant coating) Coliproteophage (bacteriophage coli-proteus, tablets with acid-resistant coating) Pyopolifag (pyobacteriophage combined, tablets with acid-resistant coating)	From 1 year to 3 years - 0.5-1 tablet, up to 3 to 8 years - 1 tablet, from 8 years and older - 2 tablets 3-4 times a day 1.5-2 hours before meals
Intesti-bacteriophage liquid	Give through the mouth 4 times a day on an empty stomach, 1-1.5 hours before meals. Children under 6 months - 10 ml, from 6 months to 1 year - 10-15 ml, from 1 year to 3 years 15-20 ml, over 3 years - 20-30 ml per dose. For children of the first months of life, the drug is diluted twice with boiled water in the first two days of administration, in the absence of adverse reactions (regurgitation, skin rashes), the undiluted bacteriophage can be used in the future. Before taking bacteriophage, children over 3 years of age should take a solution of baking soda 1/2 teaspoon to 1/2 glass of water or alkaline mineral water. In an enema once a day: up to 6 months - 10 ml, from 6 months to 1 year - 20 ml, from 1 year to 3 years - 30 ml, over 3 years - 40-60 ml

Antibiotic treatment algorithm

They are prescribed from the 1st to the 5th day of treatment, taking into account the data of the microbiological study of feces (only for patients over 15 years of age).

The drugs of choice are erythromycin and other macrolides, ciprofloxacin and other fluoroquinolones at usual therapeutic doses.

The duration of the course is 5 days.

They are prescribed from the 1st to the 5th day of treatment with high titers of yeast-like fungi in the feces. The drugs of choice are: nystatin, fluconazole.

Algorithm for treatment with drugs from apathogenic spore representatives of the genus Bacillus

They are used to reduce the overgrowth of microorganisms.

The drugs of choice are bactisporin (1 dose 2 times a day), biosporin (1 dose 2 times a day), sporobacterin (1 ml 2 times a day).

The duration of the course of therapy is 5 days.

Algorithm of treatment with bifid-containing drugs

They are used to normalize the intestinal microflora with a low level of bifidobacteria on the 4th day from the start of the drug, which suppresses the excessive growth of microorganisms.

Bifidumbacterin - powder for oral and topical use; consumed during meals; diluted in 30-50 ml of boiled water at room temperature, without dissolving the powder, for children - mixed with mother's milk or baby food, the liquid part of other food.

Bifidumbacterin dry (tablets, capsules) is taken by mouth. The contents of the vial (ampoule) are dissolved in boiled water at room temperature; the contents of the opened capsule - a small amount of chilled boiled water. Tablets, as well as capsules, are consumed with a sufficient amount of liquid at room temperature.

Doses of various dosage forms of bifidumbacterin prescribed in different age groups are as follows:

From 0 to 6 months: 1 packet of the dosage form in the form of a powder 2-3 times a day; 3 doses of a dry dosage form from a vial (ampoule) 2-3 times a day; 5 doses of dry dosage form in the form of capsules 2-3 times a day;

From 6 months to 3 years: 1 packet of the dosage form in the form of a powder 3-4 times a day; 5 doses of dry dosage form in the form of capsules or from a vial (ampoule) 2-3 times a day;

From 3 to 7 years: 1 package of the dosage form in the form of a powder 3-5 times a day; 5 doses of a dry dosage form in the form of capsules or tablets or from a vial (ampoule) 2-3 times a day;

from 7 years and older: 2 packets of the dosage form in the form of a powder I I times a day; 5 doses of a dry dosage form in the form of capsules, tablets, or from a vial (ampoule) 2-3 times a day.

Bifidumbacterin forte. For children, the drug is given during feeding, mixed with breast milk or baby food. For older children and adults, the drug is mixed before use with the liquid part of the food, preferably a fermented milk product, or with 30-50 ml of boiled water at room temperature. When the drug is dissolved with water, a cloudy suspension is formed with black sorbent particles. The resulting aqueous suspension should be drunk without achieving complete dissolution. If necessary, the drug is used regardless of the meal.

Doses of bifidumbacterin forte prescribed in different age groups are as follows:

From 15 years and older: 2 packets 2-3 times a day;

Bifilis for adults and children is prescribed orally, 5 doses 2-3 times a day 20-30 minutes before meals. The duration of the course of therapy is 21 days.

Probifor appoint inside; before use, mix with the liquid part of the food, preferably a fermented milk product, or with 30-50 ml of boiled water at room temperature; infants and young children are given during feeding, mixed with any baby food product. When the drug is dissolved with water, a cloudy suspension is formed with black sorbent particles. The resulting aqueous suspension should be drunk without achieving complete dissolution. If necessary, the drug is used regardless of the meal.

The doses of probifor prescribed in different age groups are as follows:

1. premature newborns: 1 sachet 1-2 times a day;

2. full-term newborns and children under 3 years old, 1 sachet 2 times a day;

3. children from 3 to 7 years old - 1 sachet 3 times a day;

4. children over 7 years old and adults 2-3 sachets 2 times a day.

The duration of the course of therapy is 10 days.

They are used to normalize the intestinal microflora with a reduced content of lactobacilli on the 4th day from the start of the drug, which reduces the excessive growth of microorganisms. The duration of the course of therapy is 21 days.

Lactobacterin is taken orally, dissolved in boiled water at room temperature, 40-60 minutes before meals.

The doses of lactobacterin prescribed in different age groups are as follows:

Up to 6 months: 1-2 doses per day;

From 6 months to 1 year: 2-3 doses per day;

From 1 year to 3 years: 3-4 doses per day;

From 3 to 15 years: 4-10 doses or 1 tablet per day;

From 15 years and older: 6-10 doses or tablet per day.

Algorithm for treatment with coli-containing agents.

Bifikol - the course is carried out only with a persistent decrease in E. coli, the absence of its altered forms.

The drug is administered orally, children from 6 months to 1 year - 2 doses, from 1 year to 3 years - 4 doses, older than 3 years and adults - 6 doses 2-3 times a day. It is taken 30-40 minutes before meals. In tablets, the drug is used in patients from 3 years of age.

The duration of the course of therapy is 21 days.

The drug is consumed during a meal, if necessary - regardless of the meal. Before use, the drug is mixed with liquid food, preferably a fermented milk product; newborns and infants are given with mother's milk or formula for artificial feeding. The drug can be mixed with 30-50 ml of boiled water at room temperature, the resulting aqueous suspension should be drunk without achieving complete dissolution.

Age dosages:

1. children under the age of 6 months - 1 sachet 2 times a day, children from 6 months to 3 years - 1 sachet 3 times a day, children from 3 years and older - 1 sachet 3-4 times a day;

2. adults - 2 packets 3 times a day.

The duration of the course of treatment is 10-15 days.

Hilacforte treatment algorithm

The drug is taken orally: children of the first 3 months of life, 15-20 caps p. 3 times a day, older age groups - 20-40 drops 1 time a day, adults - 40-60 drops 3 times a day before or during meal time, mixing with a small amount of liquid (for milk urination). The duration of the course of therapy is 14 days. Do not prescribe simultaneously with lactose-containing drugs.

Algorithm for treatment with lactulose. Assign inside to children under 3 years 5 ml and a day until the effect is achieved, then for 10 days; from 3 to 6 years - 5 10 ml per day until the effect is achieved, then for 10 days; from 7 to 14 years - an initial dose of 15 ml per day until the effect is achieved, maintenance - 10 ml per day for 10 days; adults - 1st day 15 ml per day, 2nd day - 30 ml per day, 3rd day - 45 ml per day and then increasing by 15 ml per day until the effect is achieved (maximum daily dose - 190 ml), then a maintenance dose is prescribed, which is 50% of the effective dose for a course of 10 days. The daily dose is given in 2-3 doses. It is prescribed if lactose-containing drugs are not included in the drug correction scheme. It is a first-line remedy for dysbacteriosis that occurs with constipation. Diarrhea, severe prolonged abdominal pain are a contraindication for the use of lactulose.

Under the age of 15. Treatment begins with a 5-day course of therapy with a specific bacteriophage or a preparation from apathogenic representatives of the genus Bacillus, with high titers of yeast-like fungi - antifungal drugs. In the absence of the phage, the elimination of opportunistic microorganisms in children older than 1 year is carried out with spore-forming drugs (biosporin, bactisporin, sporobacterin). Continue the restoration of normal intestinal microflora with one of the multicomponent or combined bifido- and / or lactic-containing drugs (bifidumbacterin forte, probifor, bifilis, florin forte, acylact, acipol), which are prescribed from the 4th day of phage therapy or after a course of antifungal drugs, drugs from apathogenic members of the genus Bacillus.

Patients with a predominance of diarrheal syndrome. The main drug is probifor. The first 3 days the patient is prescribed probifor according to the scheme:

1. children under 6 months - 1 sachet 2 times a day (possibly with a short interval of 2-3 hours);
2. children over 6 months - 1 sachet 3-4 times a day (possibly with a short interval of 2-3 hours);

In addition to the main therapy, one of the pancreatic enzymes (abomin, mezim forte, pancreatin, pancitrate, creon, festal) is prescribed in a short course (on average 3 days), you can additionally give one of the listed drugs - enterodez, microsorb, polyfepam, smecta.

Constipation predominates. In addition to the main therapy, lactulose is prescribed. The course is 10 days.

With insufficiency of the enzymatic function of the pancreas. In addition to the main therapy, one of the pancreatic enzymes is prescribed (abomin, mezim forte, pancreatin, pancitrate, creon, festal). The duration of the course of therapy is 2 weeks. The course of therapy can be repeated as prescribed by the doctor.

Limiting surges and stressful situations, lengthening the hours of rest, sleep and exposure to fresh air is shown.

With the correct intake of drugs, the implementation of recommendations, diet within a month, the complete disappearance of clinical symptoms, normal indicators of intestinal microflora are observed in 70%, improvement in the patient's clinical condition (reduction of abdominal pain, flatulence, normalization of stool) - in 20%, the absence of both positive, and negative dynamics (stabilization) - in 6%, in 3% of patients progression of the disease is noted, which is manifested by fever, signs of intoxication, as well as new symptoms of intestinal dysbacteriosis or aggravation of previously existing ones (severe diarrhea or constipation, abdominal pain, progression of changes in mucous - aphthae, cheilitis, etc.); in 1% of patients, the development of iatrogenic complications was noted, i.e. the emergence of new diseases or complications that are not diagnosed at an early stage, occurring hidden and not recognized by the doctor. In the absence of positive dynamics in the treatment of the patient should be sent to a highly specialized medical institution.

Syndrome "Intestinal dysbacteriosis. Stage: decompensated; phase: clinical; complication: no complications

Changes in the intestinal microbiocenosis in this case correspond to the III degree of microbiological disorders.

Clinical manifestations:

The presence of fever and signs of general intoxication (chills, headache, weakness),

The presence of one or more (any combination) of clinical manifestations of intestinal dysbacteriosis: impaired stool, dull or cramping pain in the abdomen, bloating, pain on palpation of different parts of the intestine, flatulence, skin and mucous membranes, weight loss.

When collecting an anamnesis and complaints, the presence (or absence) of a patient of dull or cramping abdominal pain, diarrhea, constipation or their alternation, stools with mucus impurities, blood streaks, risk factors for the development of dysbacteriosis associated with a premorbid state, such as: and other infections, allergic diseases, immunodeficiency states, diseases of the endocrine system, oncological diseases, courses of treatment with antibiotics, hormonal and chemotherapy, etc.

During a physical examination, the presence of nonspecific signs of infection and intoxication is determined: changes in the frequency of breathing, pulse, heart rate, fever; signs of general intoxication: chills, headache, weakness; clinical signs of dysbacteriosis, for which they focus on the identification of pathology:

Skin (dryness and peeling, dermatitis);

Oral cavities (erosion in the corners of the mouth - seizures, cheilitis, glossitis, hyperemia and varnishing of the mucosa, aphthae, enanthema);

Areas of the abdomen (pain and bloating, palpation - splashing noise, spastic contraction of the colon);

And also on malnutrition (lack of body weight), etc.

In children of the 1st year of life, the presence of regurgitation, aerophagia, increased salivation, increased gas emission, etc. is detected.

Microbiological examination of feces is carried out in order to identify violations of the intestinal microbiocenosis, to determine the sensitivity of microorganisms to bacteriophages. The obtained data on the qualitative and quantitative composition of the main intestinal microflora are compared with normal values. Violations of the intestinal microbiocenosis corresponds to the III degree.

A coprological study is performed to determine the nature of bowel dysfunction.

Small-, large-intestinal endoscopy, sigmoidoscopy are performed to take the contents of the intestine in order to more accurately determine the indicators of microflora and the condition of the intestinal mucosa.

During treatment, a general therapeutic examination of the patient should be carried out each time, focusing on the condition of the skin, oral cavity, abdomen (flatulence, pain on palpation), monitoring compliance with the drug, dietary and health-improving regimens or adjusting them. The patient is explained the procedure and rules for taking medications, the need for a repeated (control) microbiological examination of feces.

A microbiological study of feces is carried out 14 days after the end of therapy in order to assess the dynamics of intestinal microbiocenosis, determine the sensitivity to phages and antibiotics of the prevailing conditionally pathogenic microorganism.

The therapy is carried out in stages. They begin with the appointment of one of the agents that suppresses the overgrowth of opportunistic microorganisms in the intestine. The following groups of drugs are used: antifungal, antibacterial (only in adults), bacteriophages (only in children). Simultaneously with bacteriophages, KIP is prescribed for enteral use. The duration of the course is 5 days. This is followed by a 21-day course of therapy with bifido-and / or lactic-containing drugs (bifidumbacterin, bifidumbacterin forte, florin forte, bifilis, lactobacterin, acipol, acilact), with the appointment of probifor, the course is 10 days.

In case of incomplete disappearance of clinical symptoms and II degree of microbiological disorders in the intestine, a second course of treatment is carried out using drugs to suppress the overgrowth of opportunistic microorganisms (5 days) and a course of therapy with drugs to restore normal microflora (bifidumbacterin forte, florin forte, bifilis, acipol , acylact - 21 days, probifor - 10 days). Additionally, KIP, lactulose, hilak forte are prescribed.

Algorithm of treatment with antifungal agents

At high titers in the feces of yeast-like fungi, nystatin, fluconazole are prescribed. The duration of the course of therapy is 5 days.

Antibacterial treatment algorithm (only used in adults)

Antibacterial agents are prescribed taking into account the data of microbiological research and the spectrum of sensitivity to antibiotics. The drugs of choice are antibiotics: erythromycin and other macrolides, ciprofloxacin and other fluoroquinolones. The duration of the course of therapy is 5 days.

Bacteriophage treatment algorithm (only used in children)

It is used to suppress the overgrowth of microorganisms, taking into account the data of a microbiological study of feces (with excessive growth of staphylococcus a bacteriophage staphylococcal, E. coli bacteriophage coli, proteus bacteriophage proteus, etc.). Simultaneously with bacteriophages, TIP is prescribed.

Treatment algorithm with a complex immunoglobulin preparation for enteral use

TIP is used to enhance the effect of elimination therapy with bacteriophages. Assign inside 1 dose 2 times a day. The course is 5 days.

Algorithm of treatment with bifid-containing drugs

It is used to normalize the intestinal microflora with a low level of bifidobacteria on the 4th day from the start of the drug, which suppresses the excessive growth of microorganisms.

Bifidumbacterin forte is given to children during feeding, mixed with breast milk or baby food. For older children and adults, the drug is mixed before use with the liquid part of the food, preferably with a fermented milk product, or with 30-50 ml of boiled water at room temperature. When the drug is dissolved with water, a cloudy suspension is formed with black sorbent particles. The resulting aqueous suspension should be drunk without achieving complete dissolution. If necessary, the drug is used regardless of the meal. The duration of the course is 21 days.

Doses of bifidumbacterin forte prescribed in different age groups:

From 0 to 12 months: 1 packet 2-3 times a day;

From 1 year to 15 years: 1 packet 3-4 times a day;

From 15 years and older: 2 packets 2-3 times a day.

Probifor is prescribed inside; before use, mix with the liquid part of the food, preferably with a fermented milk product, or with 30-50 ml of boiled water at room temperature; infants and young children are given during feeding, mixed with any baby food product. When the drug is dissolved with water, a cloudy suspension is formed with black sorbent particles. The resulting aqueous suspension should be drunk without achieving complete dissolution. If necessary, the drug is used regardless of the meal. The duration of the course is 10 days.

Probifor doses in different age groups:

• premature newborns - 1 sachet 1-2 times a day;
• full-term newborns and children under 3 years old - 1 sachet 2 times a day;
• children from 3 to 7 years old - 1 sachet 3 times a day;
• children over 7 years old and adults - 2-3 packets 2 times a day.

Algorithm of treatment with the combined preparation Florin forte

The drug is consumed during meals, if necessary - regardless of it. Before use, the drug is mixed with liquid food, preferably with a fermented milk product, given to newborns and infants with breast milk or formula for artificial feeding. The drug can be mixed with 30-50 ml of boiled water at room temperature, the resulting aqueous suspension should be drunk without achieving complete dissolution.

Age dosages:

• children under 6 months old - 1 sachet 2 times a day, children from 6 months to 3 years old - 1 sachet 3 times a day, children from 3 years and older - 1 sachet 3-4 times a day;
• adults - 2 sachets 3 times a day.

The duration of the course of treatment is 10-15 days.

Algorithm for treatment with lactose-containing drugs

It is used to normalize the intestinal microflora with a reduced content of lactobacilli on the 4th day from the start of the drug, which suppresses the excessive growth of microorganisms.

The duration of the course of therapy is 21 days.

Acipol is prescribed orally, for children from 3 months to 1 year - 1 tablet 2-3 times a day, for the rest of the age groups - 1 tablet 2-4 times a day 30 minutes before meals.

Atsilact is prescribed orally, for children under 6 months - 5 doses per day in 2 divided doses, for other age groups - 5 doses 2-3 times a day 30 minutes before meals.

Algorithm for treatment with coli-containing agents

Bifikol - the course is carried out only with a persistent decrease in the level of Escherichia coli, the absence of its altered forms.

The drug is prescribed orally, for children from 6 months to 1 year - 2 doses, from 1 year to 3 years - 4 doses, over 3 years and adults - 6 doses 2-3 times a day. Take 30-40 minutes before meals. In tablets, the drug is used in persons from 3 years of age.

The duration of the course of therapy is 21 days.

Additional funds to enhance the growth of normal microflora.

Hilak forte treatment algorithm

Assign inside, children of the first 3 months of life 15-20 drops 3 times a day, older age groups - 20-40 drops 3 times a day, adults - 40-60 drops 3 times a day before or during meals by mixing with a small amount of liquid (excluding milk). The duration of the course of therapy is 14 days. Do not prescribe simultaneously with lactose-containing drugs.

Algorithm for treatment with lactulose

Assign inside to children under 3 years of age 5 ml per day until the effect is achieved and then for 10 days;

from 3 to 6 years - 5-10 ml per day until the effect is achieved and then for 10 days; from 7 to 14 years, the initial dose is 15 ml per day until the effect is achieved, the maintenance dose is 10 ml per day for 10 days; adults -

1st day - 15 ml per day, 2nd day - 30 ml per day, 3rd day - 45 ml per day and then increasing by 15 ml per day until the effect is achieved (maximum daily dose 190 ml), then a maintenance dose is prescribed. dose (constituting 50% of the effective dose) for 10 days. The daily dose is given in 2-3 doses. Lactulose is used if the drug correction scheme does not include lactose-containing drugs; it is a first-line remedy for dysbacteriosis that occurs with constipation. Diarrhea, severe prolonged abdominal pain are a contraindication for the use of lactulose.

Under the age of 15 years. Treatment begins with a 5-day course of therapy with a specific bacteriophage along with a TIP or antifungal drug. Restoration of normal intestinal microflora is continued with multicomponent or combined bifidobacterin and / or lactic preparations (bifidumbacterin forte, probifor, florin forte, bifilis, acylact, acipol), which are prescribed from the 4th day of phage therapy or after therapy with antifungal drugs.

With a predominance of diarrheal syndrome. The main treatment is probifor. The first 3 days appoint probifor according to the scheme:

• children under 6 months - 1 sachet 2 times a day (possibly with a short interval of 2-3 hours);
• children over 6 months - 1 sachet 3-4 times a day (possibly with a short interval of 2-3 hours);
• children over 7 years old - 2-3 packets 2 times a day;
• adults - 2-3 packets 2 times a day.

In addition to the main therapy in a short course (on average for 3-5 days), pancreatic enzymes (abomin, mezim forte, pancreatin, pancitrate, creon, festal), as well as sorbents: enterodez, microsorb, polyphepam, smecta can be prescribed.

Constipation predominates. In addition to the main therapy, lactulose is prescribed. The duration of the course is 10 days.

With insufficiency of the enzymatic function of the pancreas. In addition to the main therapy, pancreatic enzymes (abomin, mezim forte, pancreatin, pancitrate, creon, festal) can be prescribed. The duration of the course of therapy is up to 1 month.

with severe pain symptoms. In addition to the main therapy in a short course (on average for 3 days), no-shpa, papaverine can be prescribed.

With skin allergic manifestations.

In addition to the main therapy, desensitizing drugs (suprastin, tavegil, diphenhydramine, fenkarol, etc.) can be prescribed.

With intestinal dysbacteriosis, limiting overstrain and stressful situations, lengthening the hours of rest, sleep and exposure to fresh air, and dietary nutrition are indicated.

With proper treatment and following the recommendations, after 1 month, the complete disappearance of clinical symptoms, normal indicators of intestinal microflora are observed in 68%, improvement in the patient's clinical condition (reduction of abdominal pain, flatulence, normalization of stool) - in 22%, in 6% stabilization of the process is observed ( lack of both positive and negative dynamics). In 3% of patients, progression of the process was noted: in the absence of fever, an increase in signs of intoxication, as well as the manifestation of new or aggravation of previously existing symptoms of intestinal dysbacteriosis, including: severe diarrhea or constipation, abdominal pain, progression of mucosal changes: (aphthae, cheilitis), the appearance of complications (sepsis, perforation of the ulcer, etc.). 1% of patients develop iatrogenic complications (appearance of new diseases or complications). With the progression of the process, the development of iatrogenic complications, hospital treatment is indicated.

Migraine is a severe headache due to a variety of reasons. Migraine can cause changes in atmospheric pressure, overwork

Colitis is an inflammation of the lining of the colon. Colitis is most often caused by an infection, although it is often caused by infections with protozoa.

Our gastrointestinal tract has its own microflora. It is practically absent in the stomach and duodenum, but in the distal (distant from the stomach) sections of the intestine, both E. coli and yeast-like fungi can be found. Enterococci and lactobacilli also live there - in general, up to 500 species of microorganisms live in the intestines. Their number has an optimal ratio, which allows the digestive organs to function normally. But as soon as the balance is disturbed, dysbacteriosis develops. The causes, symptoms, and treatments for this condition will be discussed later in the article.

What are microorganisms in the intestines for?

As can be seen from the foregoing, the microflora in the gastrointestinal tract is diverse and includes even its vital activity in the intestine is justified and has a certain weight in maintaining the general health of a person:

• it synthesizes vitamins, as well as enzymes that have an antitumor effect, is involved in the breakdown of protein and sugar;
• protects the mucosa from allergens, infections, as well as from an excess of microbes that can become pathogenic;
• due to the presence of microorganisms, there is a constant activation of immunity;
• toxins and harmful metabolic products are neutralized;
• cholesterol decreases;
• the process of absorption of water, iron, vitamins, calcium, etc. is stimulated, fatty acids are produced that ensure the safety of the colon mucosa.

Without understanding how important the balance of microflora and its normal functioning is for a person, it is difficult to fully understand the causes of dysbacteriosis.

What causes dysbacteriosis

Both in adults and in children, dysbacteriosis is, first of all, the death of beneficial microorganisms and the active development of pathogens. This state of affairs can be caused by various reasons. In particular, the cause of dysbacteriosis in adults often lies in the following:

• in the diet of the patient there is a lack of fiber and dairy products;
• the patient suffers from gastrointestinal diseases that cause changes in cell membranes and metabolism (gastritis, pancreatitis, peptic ulcer, hepatitis, etc.) or infectious diseases;
• he had an allergic reaction to something;
• the patient suffered prolonged psycho-emotional stress;
• changed climatic and geographical conditions;
• subjected to heavy physical exertion for a long time.

Problems with the balance of microflora can also be caused by postoperative disorders as a result of the removal of part of the stomach, intestines or gallbladder, etc.

Causes of dysbacteriosis in children

For children (especially at an early age), the violation usually has particularly severe consequences. Although they have dysbacteriosis, the causes of which we are considering, goes through almost the same scenario as in adults.

It can be provoked by both the features of the intrauterine development of the baby and his life after birth. For example, an imbalance in the bacterial balance of his intestines may develop as a result of a difficult pregnancy or complicated delivery, prematurity, late attachment to the breast, or the presence of bacterial vaginosis in the mother.

When does beneficial bacteria die?

The causes of dysbacteriosis in children, as in adults, lie in the death of beneficial intestinal bacteria. This happens in different cases:

• when the amount of digestive enzymes is insufficient, and undigested food begins to ferment, increasing the number of pathogenic microbes;
• if there is a decrease in the tone of the intestinal muscles or its spasms, which interfere with the normal advancement of the food mass;
• the patient is infected with helminths;
• or he was treated with antibiotics.

In infants, the appearance of symptoms of dysbacteriosis may be due to a lack of nutrients in the mother's milk, the development of mastitis in her, or the early transfer of the baby to artificial feeding.

How is dysbacteriosis classified?

The cause of the disease and the severity of its manifestations make it possible to divide the described condition into decompensated, subcompensated and compensated dysbacteriosis.

In the first case, the patient's well-being noticeably worsens due to vomiting, frequent stools and general intoxication. Against this background, bacteria can enter the bloodstream and cause the development of sepsis.

With a subcompensated form, dysbacteriosis, the causes of which we are considering, manifests itself moderately - in the form of poor appetite, lethargy, weakness, and weight loss.

In the latter case, there are no external signs of the disease.

Symptoms of dysbacteriosis

The manifestations of the described syndrome are diverse in their severity. How hard the patient tolerates microflora disturbances depends on many conditions - his age, lifestyle, immune status and the stage at which the disease is located. So, for example, if in one patient the use of antibiotics for a week can cause only small deviations in the intestinal microflora, then in another it can result in severe

Depending on what are the causes of dysbacteriosis, its symptoms can be expressed as follows:

• loose stools, which have a mushy structure, which are poorly washed off the walls of the toilet bowl and often become foamy;
• constipation;
• conditions in which constipation is continually replaced by diarrhea;
• flatulence, accompanied by copious release of gases (they may have a pungent odor or it may be completely absent);
• pain in the abdomen (it has different localization and often directly depends on bloating, disappearing with the passage of gases);
• general weakness.

A constant lack of vitamins and minerals caused by dysbacteriosis leads to the appearance of jamming and cracks on the lips, increased fragility of hair and nails, the appearance of edema, insomnia, and the development of neurological disorders.

It should be noted that in some patients, regardless of what the causes of dysbacteriosis were, the syndrome may not manifest itself in any way and be detected only after laboratory tests.

Diagnosis of the disease

In modern medicine, there are many methods that confirm the presence of dysbacteriosis. But more often than others in practice it is used for the presence of the named pathology.

True, it also has some disadvantages: it can only detect a small number of microorganisms, in addition, it takes about 10 days to wait for the results of sowing. And when collecting material for him, patients often break the rules. Recall them:

• in order to be able to objectively evaluate the test material, it must be collected only in sterile dishes and only with a sterile instrument (for this, pharmacies sell special jars equipped with a stool spatula);
• in addition, the feces should be on the study no later than 2 hours later - if this is difficult, it can be hidden in the refrigerator (but not more than 6 hours);
• preparing to collect material for analysis, the patient should not take products containing live microorganisms, otherwise the result may be completely distorted, and it will be impossible to identify the causes of dysbacteriosis.

In addition to feces, scrapings of the mucosa, aspirates of the small intestine, etc., are often sent to the study, materials that are taken during an endoscopic examination.

It helps to diagnose dysbacteriosis and chromatography (during it, waste products of microflora are recorded in the blood, feces and fluid from the small intestine). Also informative is the coprogram that helps to identify the iodophilic flora during microscopic examination of feces.

How is intestinal dysbiosis treated?

The causes leading to dysbacteriosis are the starting point for the appointment of its adequate treatment. That is, first of all, it is necessary to get rid of the underlying disease that caused intestinal dysfunction. Along with this, activities are carried out aimed at restoring the microflora - drug treatment and diet.

To suppress the development of pathogenic microbes, the patient is prescribed antibacterial drugs (Tetracycline, Cephalosporin, Penicillin, etc.). If the cause of dysbacteriosis is a fungal infection, the patient is prescribed "Nystatin" - a drug that suppresses the overgrowth of fungi.

To restore beneficial intestinal microflora, agents containing live cultures (Bifidumbacterin, Linex or Lactobacterin) are used.

Diet

To get rid of dysbacteriosis, dieting is not the only therapeutic effect, but it cannot be underestimated. A diet that includes vegetable fiber will not only cleanse the intestines, but also restore its functions. To do this, fruits, herbs, berries, nuts, vegetables, legumes and cereals (except semolina and rice) should be introduced into the patient's diet.

Fermented milk products containing lacto- or bifidobacteria also have a beneficial effect on the state of the microflora.

Remove from the diet all industrial canned food, carbonated drinks, muffins, whole and condensed milk, sweets, chips and ice cream.

Measures to prevent dysbacteriosis

Dysbacteriosis, the causes and treatment of which we considered in our article, is a pathology, the appearance of which can be prevented. But we note right away that its prevention is a rather difficult task. Its main sections include both the improvement of the ecological situation in general and the observance of an adequate diet in particular. Breastfeeding is very important for the future normal functioning of the intestines.

A significant role is played by the correct use of antibiotics and other drugs that can disrupt microbiocinosis (the association of microbial populations that inhabit the body of a healthy person), as well as the timely treatment of pathologies of the digestive tract, leading to a violation of the natural balance of its microflora.

A few last words

Dysbacteriosis is not an independent disease, but one of the symptoms of pathological processes occurring in the body. Therefore, changing the balance of microflora is not the main problem. As soon as the underlying disease is cured, the causes of dysbacteriosis also disappear. But if his manifestations are still disturbing, then the patient has not recovered. And in such a situation, it is necessary to treat the dysbacteriosis itself, and its root cause is the underlying disease.

Thanks

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Symptoms and signs of dysbacteriosis

There are many symptoms and signs that indicate a possible dysbacteriosis intestines. In most cases, they relate to the work of the gastrointestinal tract, but can also be associated with the work of other body systems. It is very difficult to single out individual independent symptoms in dysbacteriosis. This pathology is characterized by violations of a general nature, for which it is impossible to make a diagnosis. All symptoms of dysbacteriosis are very common in medical practice and are characteristic of many other diseases. That is why, if dysbacteriosis is suspected, it is imperative to do laboratory tests to confirm the diagnosis and exclude other diseases with similar manifestations.

It is important to note that dysbacteriosis does not have any characteristic combination of possible symptoms. In other words, in two patients with this pathology, the manifestations of the disease may be dissimilar. This is due to differences in the composition of the intestinal microflora in each person, a different state of the immune system, and different dominant pathogens.

If we talk in general about the manifestations of dysbacteriosis, then in most patients its symptoms are very mild, and many do not have any manifestations of the disease or complaints at all. Asymptomatic course of dysbacteriosis is very common. In these cases, pathology can only be detected using bacteriological methods. However, in the case of an asymptomatic course, the harm to the body is minimal, and the microflora most often recovers on its own over time. Severe disorders in patients are not so common. Usually these are patients with concomitant anatomical anomalies, chronic diseases, pronounced weakening of the immune system. In a severe course of the disease, various disorders and complications that threaten the patient's health are possible.

In patients with intestinal dysbiosis, the following symptoms are most common:

• Chair disorders. Stool disorders in dysbacteriosis are one of the most common and characteristic symptoms. They may be of a different nature and will be considered separately.
• Flatulence. Flatulence is called increased gas formation, which leads to the frequent emission of gases and bloating. Against the background of flatulence, the patient may experience dull pain due to stretching of the intestinal walls. The reason for the appearance of this symptom is the predominance of bacteria in the microflora that cause decay and fermentation. Instead of the normal breakdown of food, it is fermented, during which a lot of gas is released. It accumulates in the intestinal loops and gradually comes out naturally. In patients on a diet less meat, carbonated drinks, beer and kvass), flatulence is less pronounced.
• Stomach ache. Pain in the abdomen with dysbacteriosis can appear immediately for several reasons. Firstly, this is the flatulence and stretching of the walls mentioned above. Secondly, it is a spasm of smooth muscles. It may be associated with the absorption of toxic decay products that are not released during normal microflora. Thirdly, the cause may be a primary or secondary inflammatory process. In primary dysbacteriosis, pain usually appears later than other symptoms, and in secondary dysbacteriosis, it precedes them. The pain itself can also be associated with concomitant diseases that caused dysbacteriosis ( Crohn's disease, ulcerative colitis, etc.). In this case, there may be other symptoms that are not typical for dysbacteriosis. In general, abdominal pain does not appear in all patients with this disease. Most often it is absent, but many patients complain of discomfort. If pain appears, then it is more often localized in the lower abdomen and is a pain or dull, "migrating" pain. In general, the nature of this symptom can be different and there is no obvious pattern.
• Slimming. Normal intestinal microflora takes an active part in the absorption of nutrients. In its absence, the so-called malabsorption syndrome develops ( malabsorption of nutrients in the intestine). Thus, the patient can eat well and follow various diets, but still the body will not have enough nutrients. With prolonged dysbacteriosis against the background of malabsorption syndrome, the patient begins to gradually lose weight. The more serious the violations, the faster this process will become noticeable. Since chronic protracted dysbacteriosis is quite rare, then weight loss in patients is not so common.
• Rumbling in the stomach. Rumbling in the abdomen is due to the accumulation of gases that do not find an outlet in a natural way, as well as contractions of the intestinal muscles. Gases accumulate due to the fermentation process against the background of dysbacteriosis, and hyperactive muscle work can be explained by the absorption of various bacterial toxins. This symptom is especially characteristic of dysbacteriosis in children. In older people, dysbacteriosis often occurs with signs of paralytic ileus ( bowel muscles do not contract). Then there can be no rumbling in the stomach.
• Bad breath. Many patients go to the dentist when they experience bad breath. A thorough examination of most of them reveals dysbacteriosis ( mouth or intestines). Intestinal dysbacteriosis can give an unpleasant odor due to the processes of decay and fermentation caused by atypical microflora. As a result, gases are formed, some of which rises up the gastrointestinal tract. As a result, belching with an unpleasant odor or taste, or just bad breath, is possible. This symptom can appear even with minor deviations in the composition of the microflora and may be the only manifestation of the disease.

With intestinal dysbacteriosis, other symptoms and manifestations are possible, but they will rather relate to complications of the disease or to an exacerbation of comorbidities. These symptoms are not directly related to a violation of the intestinal microflora. Possible, for example, signs of hypovitaminosis and beriberi. Vitamin deficiency is due to the fact that it is not absorbed normally in the intestines. What kind of vitamin deficiency occurs in a patient depends on specific changes in the composition of the microflora.

Diarrhea and constipation in intestinal dysbacteriosis

The most common symptom of dysbacteriosis are stool changes. Most patients develop diarrhea at some point in their illness ( diarrhea) . It is usually associated with the inability of the intestinal microflora to absorb various nutrients, as well as with overactive contractions of the walls. As a result of dysbacteriosis, food is poorly digested and absorbed. Each next section of the gastrointestinal tract receives an additional load, since the previous one did not fulfill its functions. In the large intestine, fluid absorption is disrupted, and it is too quickly emptied, which is manifested by diarrhea.

With dysbacteriosis, diarrhea has the following features:

• stool frequency is usually about 4-6 times a day ( but more in severe cases);
• diarrhea is not always accompanied by pain and pain in the abdomen;
• in most cases, the stool is not completely liquid, but simply "not formed" ( mushy);
• often the stool has a sharp unpleasant odor - the result of the processes of decay and fermentation;
• untreated diarrhea can last weeks or even months ( in this case, the patient's condition gradually worsens due to progressive dehydration);
• episodes of diarrhea may be followed by occasional constipation.

In general, diarrhea is not a mandatory symptom of dysbacteriosis. In many patients, it appears for only a few days and goes away on its own without any treatment. This is due to constant changes in the species composition of the intestinal microflora. Diarrhea with dysbacteriosis is the most common symptom in children. In childhood, the work of the intestines in general is often disturbed due to various pathological processes. In adults, diarrhea as a symptom of dysbacteriosis is less common.

Constipation in patients with dysbacteriosis is much less common than diarrhea. They are more typical for elderly patients, since dysbacteriosis often causes deterioration of motor skills in them ( cuts) intestines. As a result, food moves more slowly through the gastrointestinal tract, water from the feces is completely absorbed. Often there are also tenesmus - painful false urges.

Is there a temperature with dysbacteriosis?

The temperature in dysbacteriosis is more typical for young children, in which it is, in principle, a universal symptom. In adults, dysbacteriosis itself usually does not give temperature, but it may be associated with its complications or concomitant diseases. In particular, against the background of dysbacteriosis in the intestine, pathogenic microorganisms that have got there can easily multiply. In a healthy person, the ingestion of salmonella or shigella may not cause illness, since the normal microflora will suppress their growth. In people with dysbacteriosis, the likelihood of developing salmonellosis or dysentery is much higher. These diseases often occur with a slight increase in temperature. Cholera, on the other hand, is almost never found in most developed countries and usually does not cause an increase in temperature.

The temperature is more typical for secondary dysbacteriosis, which appeared against the background of other diseases. For example, subfebrile indicators ( 37 - 37.5 degrees) may occur in Crohn's disease or ulcerative colitis. Acute inflammatory processes in the abdominal cavity can cause a very significant increase in temperature ( 38 - 39 degrees), but they almost never occur in dysbacteriosis.

Chronic dysbacteriosis

The division of dysbacteriosis into acute and chronic is very conditional, since there are no clear and generally accepted criteria that would distinguish these forms. Most often, dysbacteriosis is a relatively short-term phenomenon. After certain procedures, operations, poisoning and other pathologies, the intestinal microflora is gradually restored. Of course, with the timely start of drug treatment, this process is faster. Thus, a significant number of patients with dysbacteriosis recover within a few weeks. This course of the disease can be attributed to acute. Restoration of microflora occurs gradually ( it takes time for bacteria to grow and spread throughout the gastrointestinal tract), so certain deviations in the delivery of tests will be detected for some time.

The chronic course of dysbacteriosis is somewhat less common. At the same time, disturbances in the composition and quantity of microflora do not return to normal for a very long time ( months, years). As a rule, there are prerequisites that do not allow the normal microflora to recover. However, in most cases, this problem can still be solved with the right treatment.

In the chronic course of dysbacteriosis, it is important to pay attention to the presence of the following factors:

• weakened immunity;
• chronic inflammatory bowel disease;
• non-compliance with the prescribed diet;
• self-medication and unskilled treatment;
• the presence of a constant source of infection ( poor quality drinking water, etc.);
• possible bacterial resistance to prescribed antibiotics ( checked by antibiogram);
• the presence of intestinal tumors;
• chronic diseases of the liver, pancreas, stomach.

In the presence of the above factors, prerequisites are created for changing the composition of the intestinal microflora. If these factors are not eliminated, the treatment in most cases will not have the desired effect. The disease takes on a chronic course.

Dysbacteriosis in children

Dysbacteriosis in children, according to statistics, is much more common than in adults. This is largely due to the anatomical and physiological characteristics of the growing organism. In addition, for each age there are own norms for the content of certain bacteria. So the normal intestinal microflora in an infant and in an adult is very different.

The development of microflora in the intestine is strongly influenced by several factors. First, it is the nature of the food ( mother's milk or formula). The intestine reacts differently to the food coming in the first year of life, and the limits of the norm for such children will be different. Secondly, age also affects. The older the child, the closer the composition of its microflora to the norm of an adult. Thirdly, it is necessary to take into account the possibility of anatomical and physiological abnormalities in young children, which often become the root cause of dysbacteriosis.

Normal composition of the intestinal microflora in children

Type of microorganisms	baby ( lactation)	baby ( artificial feeding)	Child aged 3 - 7 years
bifidobacteria
lactobacilli
Escherichia coli (E. coli) total
Typical E. coli species	95 - 99% of the total number of E. coli
Atypical species of E. coli
Enterococci
Protea
Klebsiella
Staphylococci
Clostridia
Mushrooms of the genus Candida

It can be noted that in children with breastfeeding, the normal microflora is more developed ( bifidobacteria and lactobacilli) and fewer opportunistic pathogens. In these cases, even the limits of the norm are different. This suggests that the child's body adapts to various conditions, and artificial feeding does not mean obligatory dysbacteriosis. However, the microflora of a breastfed baby is closer to normal in older children and adults. It is believed that these children are less likely to get dysbacteriosis, but there are quite a few other factors.

The functions of normal microflora in a child's body are the same as in an adult, but play a more significant role. The child's body is growing, and it constantly needs nutrients. For example, adults have a certain "reserve" of vitamins, while young children usually do not. With dysbacteriosis in these cases, vitamin deficiency B1 - B6, B12, K, E is most noticeable. The risk of allergic reactions and various metabolic disorders also increases. As a result, the growth and development of the child is delayed. It is believed that the younger the child, the more noticeable will be the violations in dysbacteriosis.

In addition to the causes characteristic of adults, dysbacteriosis may appear in children in the following cases:

• weakened immunity due to colds, tonsillitis, etc. ( which is very common in children.);
• the presence of congenital malformations of the intestine ( diverticula, narrowing, etc.);
• the use of hormonal and antibacterial drugs without consulting a doctor;
• a tendency to food allergies or intolerance to certain substances ( gluten, lactose, etc.).

Thus, children have a greater predisposition to dysbacteriosis than adults. There are also differences in the symptoms and manifestations of the disease. A small child cannot say what worries him, so parents have to pay attention to indirect signs of dysbacteriosis.

In children, the manifestations of dysbacteriosis depend on the severity of the disease:

• Compensated intestinal dysbacteriosis. The manifestations of the disease will be mild, and at first there may be no symptoms at all. In young children, rumbling in the stomach, loss of appetite, general anxiety, and poor sleep may appear. The chair usually becomes more frequent up to 2-3 times a day, but depending on the dominant pathogen, it can be 6-8 times a day ( during the reproduction of Klebsiella, the stool is also greenish in color). In the case of compensated dysbacteriosis, the symptoms of general intoxication are mild. Temperature, vomiting and severe pain may not be.
• Subcompensated intestinal dysbacteriosis. In addition to the above symptoms, signs of general intoxication and metabolic disorders may appear. The chair becomes more frequent up to 6 - 8 times a day, sometimes with blood impurities. Children who already know how to talk complain of severe abdominal pain. Blood test shows anemia ( low hemoglobin level), an elevated level of leukocytes ( left shift leukocytosis and eosinophilia), increased ESR ( sedimentation rate of erythrocytes) . All this indicates the reproduction of opportunistic bacteria. Sometimes they enter the bloodstream, forming infectious foci outside the intestines.
• Decompensated intestinal dysbacteriosis. The frequency of the chair is 8 - 10 times a day or more. It contains undigested food, mucus, blood impurities. There are marked deviations in the blood test. The child is pale, weak due to anemia. In a chronic course, the treatment of severe forms can take up to several months. During this period, there is a periodic increase in temperature ( up to 39 degrees or more in the presence of secondary infectious foci), clouding of consciousness, allergic rash, vomiting, severe headaches and abdominal pain, enlarged liver and spleen ( hepatosplenomegaly). In the absence of qualified treatment in young children, there is a serious risk to life.

Diagnosis of dysbacteriosis in children is not much different from diagnosis in adults. The main method also remains a coprogram ( fecal analysis). In principle, the number of bifidobacteria in 1 g of the sample more than 108 excludes dysbacteriosis. However, other intestinal infections are also possible. The rest of the diagnosis and treatment is done by a pediatrician or neonatologist. He assesses the general condition of the child and, if necessary, prescribes other research methods.

Treatment of dysbacteriosis in children involves proper nutrition ( for each age and under different conditions it is different), which will be explained in detail by the attending physician. To normalize the number of bifidobacteria in children on artificial nutrition, mixtures of NAN 1 and 2 are recommended. For children older than six months - NAN 3 and kefir.

Antibiotics may be prescribed for persistent diarrhea metronidazole, vancomycin, etc.). Bacteriophages, enzyme therapy, vitamin therapy are used. Sometimes enterosorbents are required ( enterodez, enterosgel, etc.) to absorb toxins and reduce intoxication.

Also, with dysbacteriosis in children, the following eubiotics can be used:

• lacidophilus;

The interpretation of the results of the analysis should be done by an experienced microbiologist, since the diagnosis of "dysbacteriosis" is not made in all cases. Sometimes certain deviations from the norm do not require specific treatment. Then loading the child with medicines can be harmful.

It is believed that treatment is not required at all in the following cases:

• when the number of E. coli with normal enzyme activity is more than 300 ml/g;
• number of E. coli ( lactose-negative and hemolytic) less than 10% of the total;
• an increase in the number of enterococci ( more than 125% of the norm) in the absence of symptoms and complaints;
• growth of cocci without hemolytic activity up to 125% of the norm in the absence of symptoms;
• an increase in the number of lactobacilli and bifidobacteria.

The treatment regimen is prescribed by the doctor after conducting tests and a thorough examination of patients. You need to contact a specialist already in the first days after the onset of diarrhea or the appearance of other signs of the disease. Self-medication can seriously worsen the condition of the child.

For children, preventive treatment for dysbacteriosis is prescribed in the following cases:

• if the mother suffered from colpitis or other urinary tract infections during pregnancy and childbirth;
• exacerbation of chronic diseases in children ( amygdalitis, sinusitis, etc.);
• frequent allergies in a child;
• anemia;
• if the mother received corticosteroids during pregnancy;
• children born by caesarean section;
• children born prematurely.

Dysbacteriosis during pregnancy

Intestinal dysbiosis during pregnancy is a very common problem. In varying degrees, it is present in more than 50% of women. Of course, not in all cases the disease manifests itself. In principle, mild forms of dysbacteriosis do not affect the mother's condition or the health of the fetus in any way and gradually disappear on their own. Some experts identify separate norms when analyzing the intestinal microflora in pregnant women.

In general, during pregnancy, there are the following prerequisites for the development of intestinal dysbacteriosis:

• Compression of intestinal loops. The growth of the fetus causes the intestinal loops to rise in the abdominal cavity, due to which its contents may be less likely to pass. As a result, atypical bacteria actively multiply in the formed "kinks".
• Diet change. Often, women during pregnancy try to change their diet in order to optimize the supply of nutrients to the growing fetus. However, the intestines may not be prepared for such changes. Unusually large amount of vegetable ( or, conversely, meat) food often causes dysbacteriosis.
• Hormonal changes. During pregnancy, a whole cascade of hormonal changes occurs, which, to one degree or another, affect almost all organs and systems of the body. For example, many women experience poor motor skills ( cuts) intestines, due to which its contents are worse excreted. As a result, pathogenic bacteria can develop in the intestines.
• Weakened immunity. During pregnancy, a woman's body is somewhat weakened. This is due not only to the increased intake of various nutrients ( they are consumed by both the mother's body and the fetus's body), but also by forced inactivity of the immune system. It weakens to allow the fetus to grow normally. This opens the way for pathogenic bacteria, including the prerequisites for their development in the intestines.

In principle, dysbacteriosis in pregnant women often resolves on its own after successful delivery. But there are certain problems that it can cause. First, most of the symptoms of this disease in pregnant women are more pronounced ( flatulence, diarrhea, abdominal pain, etc.). In addition, in severe cases, there may be a certain danger to the fetus. First of all, it is associated with a lack of certain vitamins, the absorption of which requires normal bifidobacteria and lactobacilli. As a result of developed beriberi, the fetus grows more slowly, there is a danger of premature birth, congenital anomalies.

In order to prevent the occurrence of serious problems, pregnant women are advised to donate feces for microbiological examination prophylactically. Changes in the composition of the intestinal microflora will allow you to notice the developing dysbacteriosis in time. Prescribing antibiotics during this period is not recommended ( they can harm the fetus and do not always help with dysbacteriosis). Therefore, it is important to compensate for the disorders caused by the disease ( for example, taking certain vitamins) and stimulate the growth of normal microflora. In most cases, dysbacteriosis in pregnant women is not so difficult to cure. The main thing is to contact a specialist in a timely manner for diagnosis and prescribing the right treatment. It will be individual for each patient, depending on the symptoms and test results.

What is the danger of frequent dysbacteriosis?

Dysbacteriosis itself is not a dangerous disease that could pose a threat to the patient's life. Most often, this is just a temporary functional disorder that causes certain symptoms and manifestations, and, as a result, discomfort in the patient's life. However, severe cases of dysbacteriosis can pose a certain danger. There are also complications of dysbacteriosis, which must be considered. To prevent their development, patients are advised to seek qualified medical help in a timely manner.

Also, to obtain a reliable result, patients must adhere to the following rules:

• Diet. It is advisable to start following a diet even before passing feces for analysis. For 2 - 3 days exclude beer, kvass, alcohol, lactic acid products. All of them can temporarily affect the composition of the microflora, and the results will be unreliable.
• Early stage of the disease. It is advisable to take feces for analysis in the first days after the onset of symptoms of the disease, before starting any treatment. Once antibiotics are started, many sensitive bacteria will already die, and the number of microorganisms in the sample will generally decrease. Because of this, it will be more difficult to make a correct diagnosis in the laboratory.
• Proper sampling. If possible, the analysis of feces is taken not from the toilet, but from a blank landscape sheet. It is recommended to take a sample from the middle portion, as this is where the greatest number of bacteria is.
• Repeat analyses. A single analysis does not always give an objective result. Sometimes, for a more accurate diagnosis, feces are taken for analysis 2 to 3 times with an interval of several days.

In the laboratory, there are various ways to look for microorganisms in a sample. Most often, doctors resort to microscopy ( preliminary examination under a microscope), after which the sample is inoculated on nutrient media, where colonies of microbes grow. After 1 - 2 days, the number of colonies is counted and approximately estimated how many of these or those bacteria were originally.

In the vast majority of cases, it is the microbiological analysis of feces that makes it possible to make a final diagnosis with dysbacteriosis. It also roughly determines the stage of the disease and its severity. The resulting colonies of pathogens can be tested for sensitivity to various antibiotics ( with an antibiogram). Based on the results of this analysis, the doctor will prescribe the correct treatment.

Where to get tested for dysbacteriosis?

An analysis for dysbacteriosis can be taken at any microbiological laboratory. As a rule, each large laboratory has a department dealing with intestinal infections. Specialists take a sample, analyze it and give the result, as a rule, for 2-3 days. Before contacting the laboratory, it is advisable to visit the attending physician ( therapist or gastroenterologist). He will carefully examine the patient and give direction in which the laboratory will be given specific tasks. In other words, the laboratory can provide various information, on the basis of which the doctor will make a diagnosis and prescribe treatment. It would be better if the specialist who observes the patient requests the information he needs.

Treatment of dysbacteriosis

Treatment of intestinal dysbiosis is quite a challenge. First of all, this is due to the fact that it is necessary to eliminate the causes and factors that caused dysbacteriosis. Sometimes this is associated with the treatment of very serious pathologies. For example, with Crohn's disease, it is almost impossible to achieve a complete recovery. The disease is chronic and occurs with periodic exacerbations. During exacerbations, the intestinal microflora will again change.

In a narrower sense, the treatment of dysbacteriosis is aimed at restoring the normal intestinal microflora. Also, in severe cases, supportive and symptomatic treatment may be necessary, which will improve the general condition of the patient.

The vast majority of patients with intestinal dysbiosis do not see a doctor in the early stages of the disease. In the absence of concomitant diseases and the normal functioning of the immune system, recovery occurs on its own, without taking any medications, and sometimes without dieting. In more severe cases, treatment is carried out on an outpatient basis ( the patient visits the doctor almost daily, but does not go to the hospital). If there are any complications or serious comorbidities are identified, the patient can be admitted to the gastroenterology department. The leading specialist will be, respectively, a gastroenterologist.

Also, the following specialists may be involved in the treatment of patients with intestinal dysbacteriosis:

• surgeon- with serious complications associated with inflammatory processes;
• family doctor/therapist– deals with the treatment of mild forms of dysbacteriosis, observes the patient for a long time;
• gynecologist- with dysbacteriosis during pregnancy;
• pediatrician/neonatologist- with dysbacteriosis in children;
• immunologist– rarely, for consultation and identification of possible causes;
• microbiologist- the main specialist who is engaged in diagnostics ( identification, classification, recommendation of antibacterial treatment) dysbacteriosis.

On average, the treatment of dysbacteriosis lasts several weeks. During this time, the patient still has the main symptoms of the disease that bothered him before the start of treatment ( diarrhea, flatulence, etc.). However, they gradually pass. It is almost impossible to cure intestinal dysbacteriosis completely in 1-2 days, since bacteria grow rather slowly, and the disease will not go away until representatives of normal microflora colonize the intestines.

Drugs for dysbacteriosis

With intestinal dysbacteriosis, a fairly wide range of drugs can be used that pursue various goals as part of complex treatment. Drug treatment should be prescribed by a specialist after conducting the necessary tests. Self-medication is dangerous, as the situation can greatly worsen. For example, taking the wrong antibiotics can kill the remnants of normal microflora and accelerate the reproduction of pathogenic bacteria.

In general, the following groups of drugs can be used in the treatment of intestinal dysbacteriosis:

• Eubiotics. This group of drugs contains representatives of the normal intestinal microflora and substances that promote their growth. In other words, the restoration of normal intestinal microflora is stimulated. The choice of a specific remedy is made by the attending physician. Eubiotics linex, lactobacterin, hilak-forte, etc. are very common.
• Antibacterial drugs. Antibiotics could be the main cause of dysbacteriosis, but they are often necessary for its treatment. They are prescribed for the isolation of an abnormal dominant microorganism ( for example, with staphylococcal intestinal dysbacteriosis). Of course, in this case, antibiotics are prescribed only after an antibiogram, which shows which drug is best suited for the treatment of a particular microorganism.
• Antifungal agents. They are prescribed when an increased amount of yeast fungi is found in the intestinal contents.
• Multivitamin complexes. With dysbacteriosis, the absorption of vitamins is often disturbed, hypovitaminosis and beriberi develop. This aggravates the patient's condition. Vitamins are prescribed to make up for the deficiency, as well as to maintain the immune system, which is also important in the fight against dysbacteriosis. Vitamin complexes of various manufacturers can be used ( pikovit, duovit, vitrum, etc.). In case of severe malabsorption in the intestine, vitamins are administered intramuscularly in the form of injections.
• Antidiarrheals. These funds are prescribed to combat diarrhea - the most unpleasant symptom of dysbacteriosis. In fact, there is no cure. The drugs worsen the contractions of the intestinal muscles, improve the absorption of water. As a result, the patient goes to the toilet less often, but there is no direct effect on the intestinal microflora. Antidiarrheal drugs are a temporary solution to the problem and should not be taken for a long time. The most common are lopedium, loperamide and a number of other drugs.
• Bacteriophages. Currently, this group of drugs is rarely used. in the intestines ( often in the form of a suppository) introduce special microorganisms ( viral), which infect certain bacteria. Bacteriophages are specific and affect only a certain group of microorganisms. There are, respectively, staphylococcal bacteriophages, coliproteic bacteriophages, etc.

If necessary, anti-allergic, anti-inflammatory and other groups of drugs can also be prescribed. They will be aimed at combating the corresponding complications and will not directly affect the intestinal microflora.

Diet for intestinal dysbacteriosis

Dietary nutrition is a very important component of the treatment of intestinal dysbiosis. All food that enters the body, one way or another, affects the formation of the internal environment in the intestine. Certain foods can cause the growth of pathogenic bacteria or, conversely, inhibit the growth of harmless microorganisms. With intestinal dysbiosis, the diet will depend on the stage or severity of the disease. The general principles are preserved for all patients.

Since the normal intestinal microflora is represented mainly by bacteria that decompose sugars, it will be beneficial to consume lactic acid products ( contain milk sugar - lactose). It is also important to consume enough vegetable fibers, which stimulate bowel contractions and normalize the mode of its emptying.

With unexpressed dysbacteriosis, the following products must be included in the diet:

• kefir;
• yogurt;
• cheeses;
• curdled milk;
• cottage cheese.

This ensures the supply of lactic acid bacteria and creates favorable conditions for their growth and development. Since there are no other dominant microorganisms in the early stages, bifidobacteria are restored and inhibit the growth of pathogenic microbes. Often, this does not even require additional medication.

It is also important to exclude the following foods from the diet:

• carbonated drinks ( including beer and kvass);
• fried meat, tough meat, meat with blood;
• fruits that cause bloating apricots, plums, etc.);
• legumes ( may increase gas buildup and discomfort);
• cream cakes and other confectionery in large quantities;
• alcoholic drinks and coffee;
• canned and pickled foods;
• spicy and salty seasonings.

With severe intestinal dysbacteriosis, one diet is not enough for recovery. In severe cases, fasting for 1 to 2 days is recommended. During this time, the intestine calms down, does not contract, and the bacteria in its lumen weaken from a lack of nutrients. Sometimes patients are prescribed parenteral nutrition ( nutrients in the form of a drop) so as not to burden the intestines.

In general, there are features of the diet for various types of dysbacteriosis. It depends on the type of stool disorder ( constipation or diarrhea predominates), as well as the frequency and intensity of abdominal pain. In each individual case, the attending physician can adjust the diet at his discretion.

Folk remedies for intestinal dysbacteriosis

As mentioned above, with intestinal dysbacteriosis, patients can experience a variety of manifestations and symptoms. The problem itself, as a rule, is solved with medication, and the intestinal microflora is easier to restore by following a diet. Folk remedies in these cases can help fight the most common symptoms of dysbacteriosis. They will be less effective than pharmacological drugs with the same effect, but have virtually no side effects.

Folk remedies to combat the symptoms of dysbacteriosis

Symptom	Means	Cooking method	Mode of application
Flatulence		2 teaspoons of the seed are poured into 200 ml of boiling water and infused for at least 30 minutes.	Strain the infusion and take 100 ml 3 times a day.
		5 g of seeds are poured into 1 liter of boiling water and infused for 3-4 hours in a thermos.	The infusion is drunk three times a day before meals, cooled to room temperature.
		2 teaspoons of crushed dandelion root are poured into 250 ml of cold water and infused for 6-8 hours.	Infusion is taken 3 - 4 times a day before meals, 2 - 3 tablespoons.
Diarrhea		For 5 g of dry fruits, 250 - 300 ml of boiling water is needed. Insist 30 - 40 minutes, wrapped in a towel.	Drink 3 - 4 tablespoons during the day.
		Green buds of aspen ( 1 tablespoon) pour 2 cups boiling water and boil for 20 minutes over low heat. After that, the broth cools for an hour ( without straining).	Take 1 tablespoon three times a day before meals.
		1 tablespoon of chopped dry pomegranate peel is poured into 200 ml of boiling water. Insist night.	The infusion is filtered and taken 50 ml twice a day ( in the evening before bed).
Stomach ache		1 tablespoon of chopped rhizome pour 500 ml of boiling water. Insist in a thermos for at least 4 - 5 hours.	The infusion is drunk warm during the day in several sips. During the day you need to drink all 200 - 300 ml in uniform portions.
	Melissa officinalis	For infusion, flowers and young shoots of the plant are used. For 5 tablespoons you need half a liter of boiling water. It is better to insist in a thermos for several hours.	Take 1 tablespoon 5-6 times a day at regular intervals.
	Marshmallow officinalis	10 - 15 g of marshmallow collection is brewed in 500 ml of boiling water, tightly closing the vessel with a lid. After 1 hour, the lid is removed and the infusion cools to room temperature.	Infusion drink 100 ml three times a day. This remedy is not recommended if the patient suffers from diarrhea.

If we talk about the full treatment of intestinal dysbacteriosis, then folk remedies are practically powerless. Some medicinal plants have antibacterial activity and partly affect pathogenic microbes in the gastrointestinal tract. However, no infusion or decoction can sufficiently stimulate the growth of normal microflora. That is why the elimination of symptoms with the help of the above means is only part of the overall comprehensive treatment. After taking these infusions, the patient may feel better, but this does not mean that the problem with intestinal dysbacteriosis has been resolved.

Prevention of dysbacteriosis

Basically, the prevention of dysbacteriosis comes down to diet and doctor's prescriptions. The lifestyle of patients affects the composition of the intestinal microflora only indirectly. To reduce the likelihood of this disease, you should promptly seek medical help for other pathologies of the gastrointestinal tract. For example, gastric ulcer, with proper treatment, does not greatly affect the functioning of the intestines, and the likelihood of dysbacteriosis is quite low. If the peptic ulcer is neglected, food is digested worse, the environment in the intestine changes and prerequisites for dysbacteriosis are created.

In general, the following preventive measures can be distinguished to prevent intestinal dysbiosis:

• dieting;
• limited consumption of kvass and beer;
• eating fresh, quality products;
• timely treatment of chronic diseases;
• timely access to a doctor at the first signs of intestinal pathology;
• breastfeeding;
• rational and reasonable prescription of antibiotics;
• strict adherence to the prescribed antibacterial treatment by the patient.

It is also important to maintain basic personal hygiene and proper hygienic education of children. Most of the dangerous microbes that cause serious disturbances in the composition of the microflora enter the body with dirty hands or dirty food.

Is it possible to drink alcohol with dysbacteriosis?

Any alcoholic drinks are not recommended for dysbacteriosis, as they exacerbate problems with the intestinal microflora. In the normal state of the digestive system, incoming alcohol is absorbed in the intestines, indirectly affecting the microflora, and "neutralized" in the liver. Consumption of large amounts of alcohol ( one time or regularly) in a healthy person by itself can cause intestinal dysbacteriosis. If we are talking about already existing violations of the microflora, then all existing problems will be aggravated.

Strong alcoholic beverages in large quantities can in various conditions lead to diarrhea, dehydration, a weakened immune system, impaired motor skills ( cuts) intestines. All this does not directly affect the intestinal microflora, but creates the prerequisites for the reproduction of some pathogenic bacteria. Some varieties of wines, beer and other alcoholic beverages directly related to the fermentation process have a direct effect on the microflora. For example, brewer's yeast is a separate type of fungal microorganisms. Excess consumption of these drinks ( especially with pre-existing dysbacteriosis) stimulates the processes of fermentation and putrefaction in the intestines. As a result, all the symptoms of the disease will increase, and the risk of various complications will increase. That is why abstinence from alcoholic beverages is an indispensable component of the diet for patients with intestinal dysbacteriosis.

Before use, you should consult with a specialist.

Our health begins in the gut. It is in it that the breakdown of food and the absorption of nutrients take place, up to 80% of the cells responsible for immunity are located.

The intestines are inhabited by beneficial bacteria that interact with each other and perform different functions.

If the bacterial balance is disturbed, digestion processes worsen, the likelihood of pathogenic microbes and viruses entering the bloodstream increases, and the immune system weakens. When does dysbiosis occur? How to normalize the intestinal microflora?

General information about dysbacteriosis

Intestinal dysbacteriosis is an imbalance between the microorganisms that inhabit the intestines.

Bacteria that make up the normal intestinal microflora perform the following functions:

• Synthesis of a number of vitamins (folic and nicotinic acids, vitamins K, B) and amino acids;
• responsible for intestinal gas exchange;
• provide regeneration of the intestinal mucosa;
• regulate the work of intestinal lymphocytes;
• activate enzymes.

In addition to useful, the intestines and pathogenic microorganisms constantly inhabit. These are yeast-like fungi, streptococci, herpes viruses, eubacteria and others. In a healthy gut, their growth and numbers are controlled by beneficial bacteria. And with a disturbed microflora, these organisms begin to actively multiply and grow, causing many diseases.

Often, dysbiosis occurs as a consequence of a disease or after taking certain medications (for example, antibiotics). It may resolve on its own, but in severe cases, it may require medical treatment.

This problem should not be ignored. After all, the absorption of nutrients, vitamins, and the production of immunoglobulins depend on the disruption of the intestines. In addition, dysbacteriosis can become a catalyst for allergies.

History reference

Back in the early 20th century, the Russian scientist Mechnikov studied the bacteria that inhabit the intestines. He was the first to use bifidobacteria to treat digestive disorders in children.

The term "dysbacteriosis" was proposed in 1916 by the German scientist Nisle. In 1956, the first preparation for the restoration of microflora in adults, Eugalan, was developed in Germany.

And after 8 years, the drug for children Lactana-B-milk was also released. This was especially true for formula-fed children. Later, bacteria began to be added directly to baby food.

Dysbacteriosis (dysbiosis) is not included in the official list of diseases.

Prevalence

With dysbacteriosis occurs almost every person. Up to 90% of the adult population and over 95% of children suffer from a violation of the intestinal flora. This condition leaves no immunity and can recur.

This prevalence of the problem is associated with a deterioration in living conditions and nutrition, an increase in the amount of stress. And also with the fact that pathogenic bacteria are more tenacious. When exposed to harmful factors, beneficial microorganisms die faster than harmful ones.

Dysbacteriosis is often underestimated. And it is from this problem that many diseases begin, the body as a whole is weakened.

Risk factors

People are more prone to dysbacteria:

• after viral diseases;
• with diseases of the gastrointestinal tract;
• with a weakened immune system;
• after taking antibiotics, hormones, chemotherapy;
• living in an unfavorable ecological zone;
• travelers.

In addition, children on artificial feeding and during the introduction of complementary foods are at risk.

Causes

Dysbacteriosis occurs for the following reasons:

Bad habits (alcohol, tobacco, abuse of fatty, spicy, spicy, sweet foods) also help to reduce the level of bacteria.

Symptoms and methods of diagnosis

Dysbacteriosis is difficult to diagnose, the test data are not objective. When examining feces for dysbacteriosis, data are obtained on the content of bacteria in feces. And in order to assess the state of the microflora, it is necessary to take material from the small intestine. Such studies are impossible or risky for life and health.

The diagnosis is usually made on the basis of the clinical picture. Conventionally, 4 stages of intestinal dysbiosis are distinguished. Each has its own symptoms. The first stage is characterized by a slight imbalance. It is caused by a change in nutrition, the composition of water, taking medications.

The second stage of the disease can be diagnosed by the following symptoms:

• Lack of appetite;
• digestive disorders;
• , possible ;
• unpleasant taste sensations;
• bloating, .

Dysbacteriosis of the third stage requires rapid treatment. Since inflammatory processes begin in the intestines.

The signs are the following:

• Symptoms of the second stage are more pronounced;
• the appearance in the feces of fragments of undigested food.

At the fourth stage pathogenic microorganisms practically replace beneficial bacteria. Absorption is disturbed, anemia develops, there is a decrease in vitality.

Manifestations:

• Symptoms of the second and third stages;
• sleep disorders;
• chronic fatigue;
• depressive state;
• apathy;
• frequent colds.

In addition to the above, there may be: deterioration in the condition of hair and nails; a slight systematic increase in temperature (up to 37 degrees); acne; .

Treatment

To restore the microflora, both medicines (probiotics and prebiotics) and natural products are used - sources of beneficial microorganisms and a nutrient medium for them.

Probiotics are foods or medicines that contain beneficial bacteria, while prebiotics create a suitable environment for the beneficial microorganisms to live.

Treatment includes three stages:

1. Neutralization of pathogenic flora.
2. Removal of intoxication.
3. Restoration of healthy intestinal microflora.

Drugs for the treatment of dysbacteriosis

Drug treatment is prescribed by a gastroenterologist. Approximate scheme:

• Proper nutrition.
• Taking drugs that inhabit the intestines with beneficial bacteria. , and the like.
• Taking prebiotics - drugs that create a nutrient medium for beneficial microorganisms. Lysozyme, Inulin and others.
• To improve digestive function, taking enzyme preparations. , Pancreatin , .
• Symptomatic treatment of constipation and diarrhea. Dufalac, Regulax, Bisacodyl, and others.
• If pathogenic flora is detected, you must first drink a course of antibiotics or bacteriophages.

Treatment takes from 2 weeks to 2 months, sometimes longer. Taking medications must be agreed with the doctor. All of them have different effects, and only a doctor can assess which medications are needed in a particular case.

Treatment with folk remedies

In folk medicine, the treatment of dysbacteriosis is based on natural remedies that eliminate the symptoms and remove the cause of the disease:

• Plants with antimicrobial effect. Coltsfoot, calamus, St. John's wort, sage, chamomile, wild rose, raspberry, cranberry. Beekeeping products also have a pronounced antimicrobial effect.
• Yarrow, oak bark, St. John's wort, chamomile, calendula have an anti-inflammatory effect.
• Flaxseed, elecampane, marshmallow, angelica, oats have a protective enveloping effect.
• With diarrhea, oak bark, bird cherry, burnet will help.
• Peppermint, fennel, dill, buckthorn, aloe have a laxative effect.

The most popular means:

• Potentilla decoction. It has anti-inflammatory and astringent effects. Good for diarrhea.
• Decoction of oak bark.
• For breakfast, eat steamed oatmeal with dried fruits.
• Take a collection of peppermint, dandelion root, chamomile, currant leaf, burdock root.
• Within 2 weeks, an hour before the first meal, swallow a whole clove of garlic.

What is intestinal dysbiosis. How to treat dysbacteriosis?

Prevention

Dairy products are a source of beneficial bacteria, and foods rich in fiber create a breeding ground for them. By eating the right food, you can prevent the development of dysbacteriosis. Fresh vegetables and fruits suppress pathogens and create favorable conditions for normal bowel function.

You can not self-medicate and choose drugs on your own. The attending physician will warn if the medicine affects the intestinal flora.

After taking potent drugs, in severe stressful situations, after suffering viral diseases, preventive courses of probiotics should be drunk.

For infants, the best prevention is breastfeeding for at least a year. No formula can replace the unique composition of mother's milk. Also, do not rush to feed. All products should be introduced in a timely and gradual manner. With a negative reaction to any food with its introduction, it is better to wait.

Forecast

Dysbacteriosis leaves no immunity. The risk of re-development of such a condition always remains. The intestinal flora is very sensitive and is influenced by both external factors and internal disorders of the body.

Dysbacteriosis is a violation of the normal intestinal microflora. Occurs with eating disorders; taking antimicrobial medications; as a consequence of viral infections, stress and other factors that weaken the body. At the first stage of dysbacteriosis, the body itself copes with the problem. In other cases, medical treatment is required. It is important to maintain a healthy gut, as it starts with the health of the whole body.

Intestinal dysbacteriosis (DK) is a pathological condition associated with a violation of the intestinal microflora. The number of lactobacilli and bifidobacteria is reduced to a critical level. Harmful microorganisms begin active reproduction. The consequence of a decrease in the number of beneficial bacteria and the predominance of pathogenic microbes is a violation of the digestive tract.

In the absence of therapy, the level of protective functions of the body decreases, and failures occur in vital systems. Intestinal dysbacteriosis can develop independently or accompany the progression of other pathologies. At the initial stages, the violation of the microflora occurs in a latent form. Therapy of dysbacteriosis implies the mandatory use of special medications.

Dysbiosis is a pathological condition of the microflora, provoked by an imbalance of beneficial bacteria and harmful microorganisms. The consequence of an imbalance can be deviations in the work of all body systems (digestive tract, genitals, immunity, etc.). Dysbiosis is always provoked by specific factors. However, in some cases, the diagnosis of pathology is difficult.

For a long time, pathology can develop in a latent form. A man may take the symptoms that appear as temporary deviations in the work of the digestive organs or the consequences of fatigue. Dysbiosis must be treated. Otherwise, pathological processes can spread to the vital systems of the body and significantly reduce the quality of life.

Dysbacteriosis in infants is quite common - it affects up to 95% of children under one year old. This is especially true for weak, premature, sickly babies. Dysbacteriosis refers to an imbalance in the normal intestinal microflora.

In European countries, this condition is often not treated at all, believing that the body must cope with it on its own. However, many experts have a different opinion on this matter: it is necessary to treat dysbacteriosis, but choose gentle and safe methods for this that will not harm the baby. Much also depends on the correct diagnosis.

Despite the increased quality of life and nutrition, the symptoms of intestinal dysbacteriosis in women still periodically make themselves felt. Almost every woman at least once in her life faced with this unpleasant disease.

Manifestations of this disease can be accompanied not only by bloating, but also by bacterial discharge from the vagina. What is this disease? How to treat dysbacteriosis?

In my previous note, I touched on the topic of intestinal microflora. In Russia, it sounds especially loud, since not only manufacturers of fermented milk products and probiotic preparations, but also practicing doctors continue to speculate on it. The favorite Russian diagnosis-myth "dysbacteriosis" (according to the latest fashion "dysbiosis") remains practically indestructible.

Nowhere in developed countries such a disease simply does not exist. Neither the bourgeois nor the brethren from poorer countries want to suffer from it and be treated from it. There is no such illness in the international classification of diseases (ICD-10), according to which diagnoses should be made in Russia. "Dysbacteriosis" is also not mentioned in the normative document of the Ministry of Health of the Russian Federation "Standards (protocols) for the diagnosis and treatment of diseases of the digestive system", which all our doctors should be guided by.

Nevertheless, as a tribute to the dense soviet traditions, "dysbacteriosis" continues to fly off the tongue of many practicing doctors, especially pediatricians. As before, the standards for physical examinations of babies include testing feces for "dysbacteriosis". At the same time, it has long been known that looking for a correlation between the composition of the flora in the feces and its real ratio in the intestinal crypts is like guessing on coffee grounds. First, the basis of the intestinal flora is bacteroids, which do not grow on nutrient media. Secondly, the ratio of bacteria at the exit has very little to do with what lives in the gut. Thirdly, all the time while you are collecting and carrying your priceless feces to the laboratory, life in them does not stop, and after a few hours the entire flora and fauna of the feces changes radically. Therefore, all conclusions about the "predominance of pathogenic flora over normal" in such an analysis are simply ridiculous.

In general, we all need to understand that there is no such independent disease as dysbacteriosis in nature.

There are only a number of temporary conditions of the body (the same viral diarrhea or prolonged antibiotic therapy) that can lead to a temporary imbalance of the normal flora. At the same time, this imbalance, as a rule, is not qualitative, but quantitative. An example is the overgrowth of the bacterium Clostridium difficile with the development of pseudomembranous colitis on the background of long-term antibiotic therapy.

Most often, discomfort in the abdomen is not caused by mythical diseases, but by a completely real rebellion of the body against any cola and other poppy rubbish. If your child in the stomach does not stop “noise and din”, first of all look at what he eats with you.

In adults, "dysbacteriosis" often hides irritable bowel syndrome, bacterial overgrowth syndrome in the small intestine, lactase deficiency, and other undiagnosed conditions in which the balance of the intestinal flora is disturbed. These disorders must be treated by treating the cause of such imbalance, and not the imbalance itself, which is only a consequence.

As I explained in the column on gut flora, probiotic bacteria can only become transit colonists, while the goal of all treatment is to restore the balance of OWN microflora.

Among the numerous drugs for the correction of dysbacteriosis, I want to highlight a particularly absurd class of drugs - bacteriophages. Bacteriophages are viruses that infect bacteria. Once upon a time, scientists suggested using them against staphylococci, Escherichia coli and other diarrhea pathogens. However, studies have shown that bacteriophages are completely destroyed in the stomach, and such drugs have long been abandoned worldwide. More precisely, all over the world, except for Russia - these pseudo-drugs are popular in our country to this day, and ineffective drugs treat non-existent dysbacterioses especially well.

If your doctor confidently states that your microflora is unbalanced, and you are already "suffering with dysbacteriosis" with might and main, do not panic! Try to find a competent specialist who will not juggle non-existent diagnoses and prescribe fuflomycins, but will engage in generally accepted diagnostics that will distinguish an infectious or organic pathology of the intestinal tract from physiological and psychosomatic disorders. And do not rush to go broke in pharmacies! It is better to save money on good nutrition for yourself and your children, "feed" the microflora in a natural way - with healthy food. Plant fibers from vegetables, fruits and grains are the best support for

Interestingly, each animal species has its own intestinal microflora. Moreover, within each population of one species, its own strains of bacteria circulate.

If a bacterium from the intestines of another mammal or bird (for example, chicken salmonella) enters our intestines with food, we will develop gastroenteritis. Not so long ago, the media unanimously decried American chicken meat for salmonella found in chicken legs. The scandal around "Bush's legs" was fanned worse than mad cow disease! However, at the same time, for some reason, they did not explain to the people that salmonella is a normal component of the intestinal flora of any chicken, even "state", even ours. If you make swabs from Russian chicken meat, salmonella is sown in exactly the same way. And there are especially many salmonella on eggshells, which are inevitably smeared with droppings, since eggs are laid through the cloaca. Here is the clearest example of manipulating the minds of citizens: we need to support domestic poultry farms (and the real motives were much more unattractive) - we will intimidate the consumer with stupid information.

Even if a completely human bacterium penetrates our body, but is characteristic of a different population, diarrhea cannot be avoided. That is why when traveling after 7-10 days we inevitably become weak, and some develop real diarrhea, and this is not "dysbacteriosis" at all. This phenomenon is called traveler's diarrhea, which is most often caused by various strains of E. coli, quite normal for the flora of other populations, but alien to our intestines. Fortunately, in people with good activity of gastric juice and pancreatic enzymes, "foreigners" slip into the colon much less frequently. If you're traveling far away for just a week or two, try to be careful: wash your hands after using public toilets and before eating, eat only freshly cooked cooked food, and thoroughly wash and peel fresh fruits and vegetables. In addition to E. coli, viruses play an important role in travelers' diarrhea, and besides, it can simply weaken from the abundance of fiber from exotic fruits, which we, once in the tropics, begin to absorb immoderately.

In some cases, even your own intestinal bacteria can cause a lot of suffering. So, Escherichia coli, less often other inhabitants of our own intestines, as soon as they penetrate into other organs, they become the cause of cystitis and pyelonephritis in women and prostatitis in men. But this is a completely different topic.