B. D. Chatterjee

BACTERIAL CONTAMINATION OF THE UPPER SMALL BOWEL IN TROPICAL SPRUE

Abstract An abnormal bacterial flora was demonstrated in the upper small intestine of six patients with tropical sprue. Increased numbers of coliforms in the jejunum was the most consistent finding. This was in contrast to eight healthy Bengalis in whom no coliforms could be isolated from the jejunum. Longitudinal studies in two cases demonstrated a direct relationship between the abnormal microflora and mal-absorption of fat and vitamin B 12 .

Tropical sprue: a study of small intestinal function and the changes resulting from vitamin B12, folate, and tetracycline therapy.

J. G. BANWELL, S. L. GORBACH, B. CHATTERJEE, AND R. MITRA (The Johns Hopkins University Center, Calcutta) Six patients with tropical sprue in Calcutta, India, have been studied by standard gastroenterological procedure and repetitive intubation with a fine polyvinyl tube system. The latter technique has enabled intestinal fluid samples to be withdrawn from the stomach and all regions of the small intestine for bacteriological culture before measurements of water and electrolyte flux in the ileum and jejunum by a marker perfusion technique. Thirteen subjects from the same community without known gastrointestinal disease have served as controls for the study. The patients with tropical sprue were found to have bacterial contamination of the upper small intestine and malabsorption of vitamin B12, xylose, and fat. Five of the patients had evidence of water and electrolyte secretion into the intestinal lumen when compared with control subjects. The effects of vitamin B12, folate, and tetracycline were studied serially. Radical improvement of fat and vitamin B12 absorption and water and electrolyte defects was observed within 48 hours of tetracycline therapy. This was associated with suppression of abnormal small bowel microflora. However, a mild absorptive defect remained despite bacterial clearing, suggesting an underlying mucosal abnormality. The relationship between these features and the changes in intestinal bacterial flora will be discussed.