Vitamins in SIBO

Q: Which of the following may be normal or elevated in a patient with Small Intestinal Bacterial Overgrowth (SIBO) syndrome? 

A) Vitamin A 

B) Vitamin B12 

C) Vitaminn K 

D) Vitamin D

E) Thiamine 

 

Answer: C 

In patients with SIBO, fat malabsorption leads to steatorrhea and deficiencies of fat-soluble vitamins. Vitamin A and D are fat-soluble vitamins. SIBO also leads to Vitamin B12 deficiency due to mucosal damage at the ileal binding site. Thiamine and nicotinamide deficiency occurs from bacterial utilization. In contrast, folate and vitamin K levels are usually either normal or elevated in SIBO patients due to bacterial synthesis. Moreover, increased intestinal permeability also contributes to either normal or elevated vitamin K levels. This may become of clinical importance in a patient who is on warfarin for anti-coagulation.

#gastroenetrology

#hematology

References:

1. Sherman P, Lichtman S. Small bowel bacterial overgrowth syndrome. Dig Dis 1987; 5:157. 

2. Conly J.M. Stein K. Worobetz L. Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol. 1994; 89: 915-923