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Blind loop syndrome

Definition


Disease: Blind loop syndrome Blind loop syndrome
Category: Surgical diseases

Disease Definition:

In case a part of the small intestine is surpassed and deprived from the normal flow of food and digestive juices, blind loop syndrome occurs.

Numerous problems may be caused by the bypassed portion of the intestine, which is known as the blind loop. Food ferments and encourages bacterial growth because it cannot pass through the loop. In turn, the bacteria interfere with the absorption of nutrients and often lead to diarrhea, weight loss and malnutrition.

Blind loop syndrome (or stasis or stagnant loop syndrome) usually occurs as a complication of abdominal surgery. It can also result from diseases or structural flaws. Even though most people respond well to antibiotics, but this condition may require surgery in some cases.

Work Group:


Symptoms, Causes

Symptoms:

Since blind loop syndrome affects digestion and absorption, it may cause some of these signs and symptoms:

 

  • Nausea
  • Bloating
  • Diarrhea
  • Loss of  weight
  • Loss of appetite
  • Abdominal pain
  • Feeling sated after eating
  • Fatty stools (steatorrhea), which are frothy, foul-smelling stools indicating poor fat absorption.

Causes:

Digestion begins in the mouth. Yet, the real job begins when breaking down and absorbing nutrients takes place in the intestine; the longest section of the digestive system. The small intestine is the part that connects the stomach and large intestine. There, food mixes with digestive juices from the pancreas, liver and gallbladder, and small nutrient molecules (amino acids from proteins, monosaccharides from carbohydrates and most fats) are absorbed into the bloodstream.

Unlike the large intestine, which accommodates a large number of bacteria that breaks down indigestible fiber, the small intestine contains a few microorganisms. The small intestine doesn't need the enzymatic action of bacteria because it is rich in enzymes, and stomach acid, as well as the secretions from the liver and pancreas act as antibacterial agents.  Moreover, the strong muscle contractions (peristalsis) that push food through the small intestine prevent the bacteria there from colonizing the area.

Food cannot go through the bypassed section of the bowel in blind loop syndrome, making the stagnant food a perfect environment for microorganisms to breed. This situation is called bacterial overgrowth syndrome. These bacteria may meddle with the absorption of nutrients and they may also produce toxins.


BLIND LOOP SYNDROME TRIGGERS:

Gastric surgery, such as Roux-en-Y or Billroth II procedures for ulcers and gastric bypass surgery for obesity may accidentally result in blind loop syndrome. In some cases, blind loop syndrome may also be caused by structural abnormalities and operations on the small intestine. Some medical conditions like Crohn's disease and scleroderma and diabetes, which can slow the rate at which food moves through the intestine, can lead to bacterial overgrowth.

Complications

Complications:

Blind loop can step up  a set of troubles including:

Poor absorption of fats:

The bacteria in the small intestine break down and absorb the bile salts necessary to emulsify and digest fat in food as well as the fat-soluble vitamins A, D, E and K. Thus, they are poorly absorbed, leading to diarrhea and often to steatorrhea, a condition in which the stool is fatty and foul-smelling, as well as to weight loss and vitamin deficiency disorders. As such, lack of vitamin (A) causes night blindness, for example, and low levels of vitamin (D) may lead to weakened bones because it affects the body's capacity to absorb calcium.

Damage to the intestinal lining:

Overgrowing bacteria can (directly or indirectly) harm the mucous (mucosa) of the small intestine. After the bacteria breaks down the stagnant food, toxic byproducts are discharged, a thing that could damage the mucosa exactly the same way bacterial enzymes do. This means most of the nutrients (proteins and carbohydrates) are inadequately absorbed, causing a serious nutritional inadequacy.

Vitamin B-12 deficiency:

Vitamin B-12 is important for the ordinary functioning of the nervous system and the production of blood cells and DNA. Vitamin b-12 is absorbed in the small intestine, but multiplying bacteria uses up the vitamin and so reduces the amount that is available to the body. In case this deficiency is severe, it may cause fatigue, weakness, tingling and numbness in the hands and feet, and, in advanced cases, mental confusion. The damage caused by a B-12 deficiency to the central nervous system can be permanent.

Brittle bones (osteoporosis):

Other products that are metabolized in the small intestine are calcium and vitamin D which helps in the absorption of calcium. The bacterial overgrowth which may cause poor absorption of calcium could lead to osteoporosis or other bone diseases.

Treatments:

As soon as the disorder is noticed, doctors can deal with blind loop syndrome by treating the underlying problems e.g. by repairing a postoperative blind loop or stricture in a surgery. However, sometimes blind loop is a permanent case. Here, the core of the treatment lies in finding ways to cut down bacterial growth and find ways to correct nutritional deficiencies.

Antibiotics:

Antibiotic therapy, for most people, is the best way to stop bacterial growth because doctors can start with it even when test results are equivocal.
This kind of therapy should be a long-term one simply because bacteria can return when the antibiotic is stopped.

To aid in preventing bacterial resistance to drugs, doctors try to mix and switch among medications. The funny thing is that antibiotics wipe out both normal and abnormal intestinal bacteria, causing the very problems the doctors trying to cure, such as an imbalance of bacteria in the digestive tract and diarrhea.

Nutritional support :

Curing nutritional problems is the very core of treating blind loop syndrome, especially for people with weight loss. Even though malnutrition could be treated, the damage it causes might not be.

Some of the procedures that may help the patient gain weight, reduce distress and improve vitamin deficiencies are:

Nutritional supplements:

People with this syndrome need vitamin B-12 intramuscular injections as well as oral vitamin and iron supplements.

Lactose-free diet:

The harm caused to the intestine might cause indigestion of lactose (milk sugar). Here, people are recommended to stay away from lactose-full products like milk and cheese and use lactase preparations that aid in digestion of milk sugar like ‘Lactaid’. Yogurt might be allowed because the bacteria used in producing yogurt help in breaking down lactose.

Medium-chain triglycerides:

Triglycerides are a type of fat comprised of a molecule of glycerol attached to three hydrocarbon chains. The way the body processes triglyceride depends on the varied length of the chains. Long-chain triglycerides are mostly dietary fats. The small intestine emulsifies and absorbs all food sources including many vegetable oils and animal fats.  On the other hand, medium-chain triglycerides, found in coconut oil, are absorbed with no aid of digestive enzymes. Medium-chain triglycerides are sometimes prescribed as a dietary supplement because they're more readily digested by people with this syndrome.

Prognosis:

Not available

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