![]() Malabsorption of carbohydrates can result from sugars being digested in the gut lumen by bacteria, along with secondary disaccharidase deficiency, because of damage to the brush border. This may account for pallor and fatigability in patients with SIBO. Iron deficiency can also occur, which may result in macrocytic or microcytic anemia. In prolonged multi-nutrient deficiency, neuropathies, retinopathies, and T-cell defects are observed. However, this is very rare as the vitamin K level is rarely reduced, because it is synthesized by luminal bacteria. ![]() Vitamin K reduction may prolong bleeding times. The former presents with a softening of the bones, while the latter has muscle spasms that occur intermittently. In a few very severe cases the vitamin A deficiency may cause night blindness, while that of vitamin D may result in osteomalacia or tetany. The severity and frequency of these symptoms are likely to be related to the intensity of bacterial overgrowth and resulting mucosal inflammation. However, this is rarely the case, and therefore most diagnoses are based on the overall clinical findings. The classical picture of SIBO comprises steatorrhea, abdominal bloating, and weight loss.
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