(Adnkronos) - Che un microbiota intestinale in equilibrio sia fondamentale per una serie di funzioni, a partire da quelle immunitarie per arrivare all’assorbimento degli alimenti e alla corretta esecuzione dei processi digestivi, è un fatto oramai ampiamente acquisito. Ma perché la complessa macchina del microbiota possa adeguatamente assolvere alle sue funzioni, occorre garantire il persistente mantenimento, nell’ambiente intestinale, di condizioni favorevoli. Figura, tra queste condizioni, la giusta acidità dello stomaco, indispensabile dunque non solo per i processi digestivi, ma anche per il mantenimento di un microbiota efficiente. Non sempre però è possibile mantenere quel giusto livello di acidità, tanto più nei casi in cui - e non sono affatto rari - si assumano, talvolta senza alcuna interruzione, farmaci ‘anti-acidi’ appartenenti al gruppo degli Inibitori della Pompa Protonica (IPP), anche detti, con terminologia apparentemente rassicurante, “protettori” gastrici. È noto, infatti, che l’inibizione dell’acidità dello stomaco, oltre a favorire transiti intestinali di microrganismi patogeni che ordinariamente verrebbero distrutti dall’acido cloridrico presente nei succhi gastrici, impedisce la pre-digestione degli alimenti. Accade, così, che questi ultimi, raggiungendo indigeriti i tratti più profondi dell’intestino, forniscano ricco nutrimento ai batteri che in quei tratti albergano con conseguente iperfermentazione a sua volta in grado di provocare meteorismo, flatulenza, diarrea, ma anche strane tachicardie, extrasistoli, tosse, talvolta dispnea e alterazioni del timbro della voce. È proprio allora che si rende indispensabile un approccio diagnostico, terapeutico e nutrizionale accurato e competente per gestire con efficacia un problema montante, e talvolta invalidante, che potrebbe non essere imputabile al classico “reflusso gastro-esofageo”. Quel che per ora mi limito a ribadire è che, come sempre, l’approssimazione non fa bene, tanto meno il ricorso a rimedi “fai da te”. Sarà questo il tema del nuovo servizio di “Igea, la Medicina dal mito all’intelligenza artificiale”, la videorubrica curata dall’immunologo Mauro Minelli, in programma il prossimo venerdì 8 novembre.
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00:00In this video, we are going to show you how to create a new microbiota with the help of a new method.
00:15The increasingly deep knowledge of the complex microbiota-intestinal universe has paved the way for new diagnoses,
00:24which, on the one hand, forces doctors to acquire new awareness on which to re-impose more targeted and effective therapies,
00:31on the other, precisely because of their originality, they risk remaining largely unknown, if not totally ignored.
00:39SIBO is a very widespread pathological condition characterized by an increased concentration of bacteria in the intestine.
00:48In fact, the term SIBO is nothing more than an acronym for Small Intestinal Bacterial Overgrowth,
00:56a condition in which an overgrowth of bacteria in the small intestine, that is, in the thin and thick intestine,
01:06is often associated with a situation of malabsorption due to an increased permeability of that tract of the intestine.
01:15On the clinical level, SIBO is characterized mainly by a marked condition of abdominal swelling,
01:23which in turn is often associated with flatulence, alveoli, stiffness or diarrhea, or more often alternation of stiffness-diarrhea,
01:33and still pain, an intense pain that is usually felt in the right quadrant of the abdomen.
01:41And then there is still a reflexive phenomenology with tachycardia, with raclase, that is, this dry cough,
01:49which is caused by a sort of constant constipation, constipation in the throat, and still dysphonia, that is, lowering of the voice,
01:58raucedine, dysphagia, that is, impediment, difficulty in swallowing, metallic taste, alitosis.
02:06Often, moreover, these symptoms are also associated with disorders of absorption, absorptive deficits,
02:15that is, vitamin deficiency, for example B12 or B9 or D3, and therefore also anemic state due to lack of iron,
02:25and still anomalies of the anus, hair, nails, osteoporosis, weight loss, muscle weakness.
02:34Still, the bacterial flora of the intestine, which, when unbalanced, is an important co-artifact of our well-being,
02:41can become responsible for various problems in cases in which that balance, for some reason, should be lost.
02:48SIBO, as well as intestinal pathological quadri, such as celiac disease, SNAS, or diverticulosis,
02:56is frequently associated with surgical practices, such as gastric resections, post-surgical adherence,
03:03ileocolic resections with the elimination of the ileocecal valve, gastrointestinal bypasses,
03:10and any alteration of the normal intestinal structure and function.
03:14But the most frequent cause of SIBO is certainly represented by a continuous intake of drugs
03:22that belong to the category of the so-called proton pump inhibitors,
03:27more simply, more commonly known as gastric protectors.
03:32It should be remembered that these drugs are practically able to inhibit the production of hydrochloric acid,
03:38and are often taken by patients for very long times, as if hydrochloric acid were an option,
03:45as if it were the production of something that the body has decided to produce, even if it was not necessary.
03:51Hydrochloric acid has a very important function, as it prevents food from being digested,
03:58that is, it eliminates the food that, after being digested, will continue its path in the various phases of digestion.
04:05Now, if this process is inhibited, it happens that the undigested food reaches the intestinal bacteria
04:12that are more downstream, which, receiving the undigested food, especially if FODMAP,
04:17that is, if it is fermentable, will produce fermentation, with all the consequences that this fermentation can generate
04:25and that we have previously pointed out.
04:28Among the other drugs that can contribute to the emergence of SIBO, I recall antibiotics,
04:34when, of course, they must be taken continuously,
04:38antibiotics that we know are able to profoundly alter the composition of the intestinal microbiota,
04:44and also antispastics that are often self-supplied,
04:50in the case, for example, of the irritable bowel,
04:53antispastics that, by blocking the peristaltic action of the intestine,
04:57slow down the intestinal transit, favoring the action of the fermentative bacteria,
05:02and then I also recall the states of anxiety as a possible cause of SIBO,
05:07as in the states of anxiety an altered production of serotonin is determined,
05:13which is important for regulating the intestinal transit,
05:17and, last note, I would like to reserve it for a nutrition that is practically free of fiber.
05:26It is essential to deal with SIBO temporarily,
05:29since untreated cases can lead to long-term complications and nutritional deficiencies.
05:35The correct treatment of SIBO necessarily involves the setting up of therapeutic protocols
05:41aimed at reducing the excessive growth of bacteria,
05:44together with changes in the diet to support the health of the intestine.
05:49SIBO diagnosis is based on the breath test,
05:52that is, a breath test that allows to measure the amount of hydrogen and methane gas
05:58produced by the intestinal fermentative bacteria,
06:01as well as a test of intestinal permeability conducted correctly,
06:07a test that is carried out on a urinary matrix,
06:10can allow to carry out a correct diagnosis.
06:15I say right away that diagnosis is essential,
06:18because it is from correct diagnosis that an equally correct therapy comes out,
06:22a therapy that, in the case of SIBO,
06:25obviously cannot be based on the use of gastric protectors,
06:29because rather than curing the pathology, they tend to induce it.
06:33So, diagnosis, I repeat, is essential,
06:36also because it is necessary to keep in mind that the acid produced by bacteria,
06:41which tends to generate reflux phenomena,
06:43is sulfhydric acid and not chloride acid,
06:46and on sulfhydric acid, gastric protectors have no effect.
06:51So, watch out for diagnosis,
06:53because it is from this that a therapy can derive,
06:56really capable of stabilizing the pathology.
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