Case based discussion- Gut dysbiosis.pptx

Gut dysbiosis
- CBL
Doha Rasheedy
Professor of Geriatrics and Gerontology
Faculty of Medicine
Ain Shams University

Patient: Sarah, a 32-year-old software engineer.
• Chief Complaint: "I'm constantly tired, my stomach is always upset,
and I just can't think clearly anymore. It's gotten much worse over the
last few months."
• History of Present Illness:
• For the past 9-12 months, Sarah has experienced intermittent bloating
and abdominal discomfort. However, she reports a significant
worsening of all symptoms over the past 4 months.
• This exacerbation began shortly after a course of treatment for
suspected gastritis. Her doctor prescribed a proton-pump inhibitor
(PPI - omeprazole) and a short course of a broad-spectrum antibiotic
(amoxicillin-clavulanate).
• Since then, her fatigue has become profound, with energy "crashes"
by mid-afternoon. Bloating is now severe and occurs after almost
every meal. Her bowel habits are highly irregular, alternating between
constipation and diarrhea. The "brain fog"—difficulty concentrating
and forgetfulness—has intensified, affecting her work performance.
Her low-grade anxiety and mood swings are also more frequent.

• Childhood allergies and asthma (resolved in teens).
• Two significant courses of broad-spectrum antibiotics for sinus infections in the
past 18 months.
• Frequent use of over-the-counter NSAIDs (ibuprofen) for tension headaches.
• Recent (4 months ago): Suspected gastritis treated with PPI and antibiotics.
Past Medical History:
• Diet: Typical "busy professional" diet. High in processed foods, takeout, refined
carbohydrates (pasta, bread), and sugary snacks. Low intake of fruits,
vegetables, and fiber.
• Lifestyle: High-stress job with long hours. Minimal physical activity. Poor sleep
(<6 hours/night).
Social History:
• Oral contraceptive pill (for 10 years), occasional ibuprofen. Recently completed a
2-week course of PPI and a 7-day course of antibiotics.
Medications:

Case 2
• Joseph, a 60-year-old man, presented to the clinic with a persistent history of gas and
bloating. These symptoms began long before he immigrated to the United States 15
years ago. Growing up traveling extensively, Joseph experienced frequent foodborne
illnesses and a significant history of antibiotic use during childhood and early adulthood.
• To this day, he uses antibiotics one to two times annually due to infections contracted
during his frequent travels.Joseph’s primary complaint was excessive nighttime belching,
which disrupted his sleep and often necessitated a bowel movement to alleviate the
symptoms. His gas production had increased and taken on a sulfurous odor, with
belching frequently bringing up the taste of recent meals.
• He also reported daily bloating, sometimes starting as early as waking. Despite previous
treatments for small intestinal bacterial overgrowth (SIBO) and intestinal candidiasis, his
symptoms remained unchanged, and his latest SIBO test, conducted two months prior,
was normal.

Group A, B
When to Suspect gut dysbiosis?
What is gut dysbiosis?

When to
Suspect
gut
dysbiosis?
Primary Digestive
Symptoms (The Most
Obvious Signs)
Systemic Symptoms (The
Whole-Body Effects)
Specific Conditions
related to gut dysbiosis

Primary
Digestive
Symptoms
GIT upset: Persistent gas, bloating, abdominal
pain, cramping, and heartburn (GERD).
Bowel Habit Changes: Diarrhea, constipation, or
alternating between the two (a hallmark of IBS).
Urgency and Incomplete Evacuation: Feeling like
you need to get to a bathroom quickly or feeling
like you haven't fully finished a bowel movement.
Food Intolerances: New or worsening reactions to
certain foods, especially FODMAPs (fermentable
carbs found in many foods like garlic, onions, and
beans). This is often due to a lack of the right
bacteria to properly break these foods down.

Systemic
manifestatio
ns
• Difficulty concentrating, poor
memory, and lack of mental clarity
• Mood changes
• Chronic fatigue
• Sleep problems
• Skin Issues: Conditions like acne,
eczema, or psoriasis
• New Allergies: The development of
seasonal or other allergies can be
linked to a dysregulated immune
system originating in the gut.

Specific
Conditions
related to
gut dysbiosis

Gut
dysbiosis
It is an imbalance in the gut microbiota, characterized
by:
• a loss of beneficial microbial species
• an overgrowth of potentially harmful microbes (pathobionts)
• reduction in overall microbial diversity.
The gut microbiome is predominantly composed of
Firmicutes, Bacteroidetes, Actinobacteria, and
Proteobacteria. Most of them are good and essential
for optimum health such as Bifidobacterium and
Lactobacillus.
When there is an imbalance of either of these phyla of
bacteria, dysbiosis can result. The typical signature of
dysbiosis is the expansion of Proteobacteria.

Group A, B
What are the risk factors for dysbiosis?

What are the
risk factors for
dysbiosis?
• Ageing
• life style factors (dental hygiene,
alcohol, smoking)
• Medications (broad spectrum
antibiotics, PPIs, laxatives)
• Environmental factors (air pollution),
exposure to pesticides on unwashed
fruits and vegetables
• Increased intake of sugar or protein
• Low fiber diet

Group A
How to investigate Gut dysbiosis?

How to
investigate
Gut
dysbiosis?
• Comprehensive Stool Analysis (CSA) / Gut Microbiome Test: This is the
most direct way to assess the gut microbiome. These tests use genetic
sequencing to identify microbes. E.g. GI-MAP, Genova Diagnostics GI
Effects.
• Hydrogen or methane breath test: Taking a baseline breath
measurement. Then ingesting a standardized, indigestible sugar
solution (like lactulose). Taking breath samples every 20 minutes to
measure hydrogen and methane gases. A positive diagnosis for
bacterial overgrowth (dysbiosis) is indicated by a rapid and steady rise in
these gas readings, showing excessive bacterial fermentation in the
upper GI tract. The test can be repeated to monitor the effectiveness of
treatment.
• Urinary excretion of lactulose and mannitol after oral intake is a good
test for evaluating intestinal permeability and altered ratio indicates
leaky gut syndrome.
• Zonulin or Actomyosin antibodies are markers of gut barrier
dysfunction (leaky gut)
• Inflammation Markers: High-sensitivity CRP (hs-CRP) or ESR can indicate
systemic inflammation driven by dysbiosis.
• Vitamin & Mineral Deficiencies: Low levels of Vitamin D, B12, iron, or
magnesium can suggest malabsorption due to gut lining damage.
• Metabolomic measurements e.g. SCFA, secondary bile acids,
Tryptophan metabolites.

Group A, B
What are the different Lines of management of
Gut dysbiosis?

What are the
different Lines of
management of
Gut dysbiosis?
Stop any offending drug
Lifestyle Modifications
• Stress Reduction: Daily meditation, yoga, or walking. Critical for
modulating the gut-brain axis.
• Sleep Hygiene: Prioritize 7-8 hours of quality sleep per night.
• Gentle Movement: Regular walking to stimulate healthy gut
motility.
Dietary management.’
Gut Biotics.
FMT
Microbial by-products
Antibiotics

Gut biotics
• Prebiotic: high fiber diet e.g. Garlic, Onions, Oats, Bananas
• Probiotic:Yogurt, Kimchi, Supplements
• Symbiotic:A product that combines both probiotics and prebiotics.
For example, a yogurt (probiotic) that also contains inulin (a prebiotic
fiber) is a synbiotic.

Microbial by-products:postbiotic
compounds (like butyrate) are
produced by fermentation process
Fecal Microbiota Transplantation: The
most prominent achievement of FMT
in disease treatment is to cure
recurrent Clostridioides difficile
infections. Further extensive research
is still needed
Antibiotics, antifungals e.g.: Rifaximin,
Neomycin, Metronidazole or
Tinidazole, Diflucan, Nystatin

Group A,B
Dietary approach to dysbiosis

To follow a dysbiosis diet,
consider the following
recommendations:
• Best diet to enhance eubiosis is Meditteranian diet.
• Diet to avoid: western diet, high sugar, processed
food.
• Avoid any food sensitivities: gluten (Try an
Elimination Diet)
• Low FODMAP diet
• Try a Prebiotic-Rich Diet.
• Severe cases use 14-21 days of semielemental
(Peptamen) or elemental diet
The steps can be described as 4 R
• Remove, Replace, Reinoculate, Repair

Try an Elimination Diet
• Removing the following food groups from diet: gluten, dairy,
refined sugar, corn, soy, eggs, all grains, vegetable oils, shellfish,
tree nuts, legumes, and nightshade vegetables.
• After a two-week elimination phase, introduce foods to diet one
by one.
• Make sure to eat a new food for two to three days and watch
symptoms.
• Using a food diary can be helpful at this stage. If symptoms
occured from a new food, remove this food. Add a new food,
notice symptoms, and continue.

FODMAP
• FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols,
• High FODMAP:
• Fructose: Fruits (including apples, mangos, pears, watermelon), honey, high-fructose corn syrup
• Lactose: Dairy (milk from cows, goats, or sheep), custard, yogurt, ice cream
• Fructans: Rye and Wheat, asparagus, broccoli, cabbage, onions, garlic
• Galactans: Legumes, such as beans (including baked beans), lentils, chickpeas, and soybeans
• Polyols: Sugar alcohols and fruits that have pits or seeds, such as apples, apricots, avocados, cherries, figs, peaches,
pears, or plums.
• Low FODMAP foods to enjoy instead include:
• Dairy: Almond milk, lactose-free milk, rice milk, coconut milk, lactose-free yogurt, and hard cheeses.
• Fruit: Bananas, blueberries, cantaloupe, grapefruit, honeydew, kiwi, lemon, lime, oranges, and strawberries.
• Vegetables: Bamboo shoots, bean sprouts, bok choy, carrots, chives, cucumbers, eggplant, ginger, lettuce, olives,
parsnips, potatoes, spring onions, and turnips.
• Protein: Beef, pork, chicken, fish, eggs, and tofu.
• Nuts/seeds: (limit to 10-15 each) Almonds, macadamia nuts, peanuts and walnuts.
• Grain: Oats, oat bran, rice bran, gluten-free pasta, quinoa, white rice, and corn flour.
Phases: elimination, reintroduction, personalization (Because FODMAPs are prebiotics (food for
good gut bacteria), long-term strict avoidance is not advised.

Case based discussion- Gut dysbiosis.pptx

More Related Content

Similar to Case based discussion- Gut dysbiosis.pptx

More from Doha Rasheedy

Recently uploaded

Case based discussion- Gut dysbiosis.pptx