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Non-invasive methods to detect small intestinal bacterial overgrowth often lack specificity in patients who have undergone an ileal resection or have an accelerated intestinal transit. Since elevated serum unconjugated bile acid levels have been found in patients with clinical signs of bacterial overgrowth, we studied the clinical value of unconjugated serum bile acids as a marker of small intestinal bacterial overgrowth. Patients with culture-proven bacterial overgrowth had significantly elevated fasting unconjugated serum bile acid levels (median and range: 4.5; 1.4-21.5 mumol l-1) as compared to healthy subjects (0.9; 0.3-1.7 mumol l-1, P less than 0.005), to persons with an accelerated intestinal transit (1.0; 0.3-1.9 mumol l-1, P less than 0.005) and to persons who have undergone an ileal resection (2.1; 0.7-3.6 mumol l-1, P less than 0.005). The same was true 30 and 60 min after ingestion of a Lundh meal. Serum unconjugated bile acid levels above 4 mumol l-1 were found in eight of 10 patients with culture-proven small intestinal bacterial overgrowth whereas serum levels above 4 mumol l-1 were found in none of the patients from the three control groups. These results suggest that determination of unconjugated serum bile acids is of clinical value in the evaluation of patients suspected of small intestine bacterial overgrowth.

The three most important enzymes present in duodenal fluid, α-amylase, trypsin and lipase, were determined by two different methods. Various dilution fluids for these determinations were compared. Some kinetic data are described together with the reproducibility of the assays. For α-amylase the Phadebas method was compared with an UV method. Trypsin was determined using an immunoreactive trypsin test and a titrimetric method, while lipase was determined with a titrimetric method and a Cu-soap method.There was very good agreement between the two α-amylase methods and between the two trypsin determinations. There was also good agreement between both lipase methods.The advantages and disadvantages of all the methods are discussed. Bestimmung von a-Amylase, Trypsin und Lipase in Duodenalsaft: Ein Vergleich von MethodenZusammenfassung: Die drei wichtigsten Enzyme im Duodenalsaft, α-Amylase, Trypsin und Lipase, wurden mit zwei verschiedenen Methoden bestimmt. Es wird ein Vergleich zwischen verschiedenen Fl ssigkeiten zur Verd nnung gezogen. Einige kinetische Angaben werden zusammen mit der Reproduzierbarkeit beschrieben. F r α-Amylase wird ein Vergleich zwischen der Phadebas Methode und einer UV-Methode gezogen. Trypsin wurde mit dem Test auf immunoreaktives Trypsin und einer Titrationsmethode bestimmt, w hrend Lipase mit einer Titrationsmethode und einer Cu-Seifen-Methode bestimmt wurde. Der Vergleich von beiden α-Amylase-Methoden war gut, ebenfalls zwischen beiden Trypsin-und beiden Lipase-Methoden.Die Vorteile und Nachteile aller Methoden werden besprochen.

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