小肠细菌过度生长及其与克罗恩病关系的研究进展

Research Progress on Small Intestinal Bacterial Overgrowth and Its Association with Crohn’s Disease

摘要: 克罗恩病(Crohn’s disease, CD)作为一种病因未明的慢性非特异性肠道炎症性疾病，病变可累及全消化道，其发病机制涉及免疫、遗传、环境及微生物群等多方面因素。小肠细菌过度生长(Small intestinal bacterial overgrowth, SIBO)指小肠内细菌数量异常增多或种类发生改变，临床以腹胀、腹痛、腹泻等为主要表现，可能导致多种消化道症状和全身性疾病。近年研究表明，SIBO在CD患者中具有较高的发生率，且二者相互影响。一方面，CD的肠道炎症、结构改变及免疫紊乱为SIBO的发生创造条件；另一方面，SIBO可通过多种机制加重CD患者的肠道炎症、影响营养吸收及增加疾病复发风险。本文综述SIBO与克罗恩病的病理生理机制、诊断方法及治疗策略，以期为临床管理提供参考。

Abstract: Crohn’s disease (CD) is a chronic, non-specific inflammatory bowel disease of unknown etiology that can affect the entire gastrointestinal tract. Its pathogenesis involves immune, genetic, environmental, and microbial factors. Small intestinal bacterial overgrowth (SIBO) is characterized by an abnormal increase in the number or alteration in the types of bacteria in the small intestine, clinically manifesting as bloating, abdominal pain, diarrhea, and other symptoms, potentially leading to various digestive complaints and systemic disorders. Recent studies indicate a high prevalence of SIBO in CD patients, with the two conditions interacting bidirectionally. On one hand, intestinal inflammation, structural changes, and immune dysregulation in CD create conditions conducive to SIBO development. On the other hand, SIBO can exacerbate intestinal inflammation, impair nutrient absorption, and increase the risk of disease recurrence in CD patients through multiple mechanisms. This article reviews the pathophysiology, diagnostic approaches, and treatment strategies related to SIBO and Crohn’s disease, aiming to provide insights for clinical management.