The clinical and metabolic significance of jejunal diverticula

Studies on the pathogenesis of steatorrhea in the blind loop syndrome.

“…Although blunting of jejunal villi has been described in one case of jejunal diverticulosis (20), in most instances of either clinical (4,5) or experimental (7,21) malabsorption associated with excessive bacterial proliferation in the small intestine, the intestinal mucosa has been reported to be essentially normal by light microscopy. In this study no striking histological abnormality was encountered.…”

“…Fecal fat excretion was expressed as per cent of dietary fat intake. 4 diluted with corn oil. Both radioactive compounds were found to be homogeneous when chromatographed on thin layer silicic acid.…”

“…A similar explanation for steatorrhea seems less likely, however, since in the case of lipids, bacteria would have to compete for gram rather than microgram quantities. Reports of steatorrhea in clinical (2,4,5) and experimental (6,7) forms of the blind loop syndrome have demonstrated decreased fecal fat excretion after antibiotic therapy, but such studies have not provided evidence concerned with mechanisms whereby small bowel bacterial overgrowth might result in steatorrhea.…”

Enterokinase in Contaminated Small-Bowel Syndrome

“…trypsin, and amylase values. Moreover, there is some evidence that the bacterial flora of the intestine may inactivate proteolytic enzymes [3,7], and A basow [I] has shown that degradation of enterokinase is very extensive in the colon of normal subjects and probably depends on the duration of exposure to in testinal microorganisms. However, dilution and bacterial inactivation may be insufficient to explain the more pronounced decrease in enterokinase compared to trypsin and amylase.…”

“…In patients with contaminated small-bowel syndrome hypoproteinaemia and a clinical picture resembling protein-calorie deficiency may occur [3,12,14], Different factors seem to contribute to this disturbance of protein me tabolism. Gastrointestinal protein loss has occasionally been documented [2,8], Bacterial degradation of dietary protein by intestinal organisms such as Escherichia coli, Bacteroides, and some strains of Klebsiella appears to be more important [5], Mucosal abnormalities in patients with the blind loop syndrome have recently been described [2], and it has been suggested that dysfunction of the enterocytes is an important factor in pathogenesis of fat and possibly protein malabsorption in this condition.…”