Overgrowth of bacteria in the small bowel can occur in a spectrum of change. An elderly patient may have increased bacteria in the small intestine without malabsorption but with mild symptoms.
Features of simple colonization of the small bowel in the elderly:
(1) The patient is an older adult (>= 60 years of age).
(2) The patient may have hypochlorhydria from gastric atrophic or acid-suppression therapy.
(3) The patient may have other risk factors for small bowel bacterial overgrowth.
(4) There is little or no evidence of malabsorption.
(5) The patient may have minimal or vague gastrointestinal complaints.
The patient may go undiagnosed or may be suspected based on:
(1) increased bacteria are found in a duodenal aspirate.
(2) an abnormal breath test.
(3) improvement after broad-spectrum antibiotic therapy.
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