Bacteria, bile and the small bowel

Abstract

SUMMARY Microbial populations of the small bowel and bile salt metabolism were studied in 15 patients with lesions of the stomach and small intestine. These types of microorganism could be correlated with the site and extent of stasis in the small bowel and the presence of a normally functioning stomach. The presence of obligate anaerobes (bacteroides) and free bile acids could be correlated with areas of stagnation. When these abnormalities were detected throughout the small bowel, steatorrhoea was also noted. However, bacteroides and free bile acids in localized regions of either proximal or distal small bowel were generally associated with normal faecal fat excretion. Vitamin B12 malabsorption appeared to be related to the total number of bacteria colonizing the small bowel rather than to any specific type of microorganisms.The effect of antibiotics on intestinal function and bacteriology was studied in three patients. In one patient, the broad-spectrum antibiotic tetracycline was effective in eradicating an abnormal bacterial flora. In the other two, lincomycin, which is specifically effective in eradicating the anaerobic flora, restored intestinal function to normal.Under normal circumstances the lumen of the upper gastrointestinal tract in man contains low concentrations (less than 103 per ml) of predominantly Grampositive microorganisms (Van der Reis, 1925; Gorbach, Plaut, Nahas, Weinstein, Spanknebel, and Levitan, 1967b). Anaerobic lactobacilli (bifidobacterium) and Gram-negative organisms, such as coliform and bacteroides, are usually confined to the large bowel, although the distal ileum may also contain such bacteria, possibly derived by retrograde flow from the caecum. These microorganisms, however, are not normally found in the stomach and upper small intestine of healthy individuals.A luxuriant and abnormal intestinal bacterial flora may develop in association with certain diseases of the stomach and small intestine. Faecal-type microorganisms may colonize the upper small intestine in patients with gastrectomy, jejunal diverticulosis, blind loops, strictures, resections, and fistulae (Goldstein, Wirts, and

Effects of a glucoside-hydrolase inhibitor (Bay g 5421) on serum lipids, lipoproteins and bile acids, fecal fat and bacterial flora, and intestinal gas production in hyperlipidemic patients.

“…Fuchs et al (1976) also observed that the fecal anaerobes increased significantly after a fiber-rich diet accompanied by an increased fecal weight. The changes in such fecal flora seem to accelerate bile acid deconjugation resulting in an increase in bile acid excretion into the feces and therefore bile acid turnover (Gorbach and Tabaqchali 1969;Neale et al 1972). Under these conditions the fecal fat excretion is known to increase (Neale et al 1972), as shown in this study.…”

The importance of duodenal diverticula in the elderly

“…This seems to be the only reported case where other causes of malabsorption have been excluded. There seems little doubt that bacterial overgrowth may occur in the presence of solitary duodenal diverticula (Gorbach and Tabaqchali, 1969;Tabaqchali and Booth, 1970;Tabaqchali, Hatzioannou and Booth, 1968) and that steatorrhoea and nutritional deficiency may occur in the presence of duodenal diverticula (Brey et al, 1971;Clark, 1971;Gillespy, 1957;Goldstein et al, 1963). That the malabsorption and the diverticula are causally related, however, seems seldom to have been demonstrated.…”

Intestinal bacterial flora and bile salt studies in hypogammaglobulinaemia

“…In the present study, an attempt is made to correlate the gastrointestinal disturbance in patients with hypogammaglobulin-Received for publication 28 November 1971. aemia with the number of bacteria in the jejunum and with possible abnormalities of bile salt metabolism. Deconjugation of bile salts can be the cause of steatorrhoea in patients without immunological deficiency (Gorbach and Tabaqchali, 1969).…”