This paper was presented in part at the 26th International Conference of Internal Medicine at Kyoto, Japan in May 2002.
Tropical sprue is associated with contamination of small bowel with aerobic bacteria and reversible prolongation of orocecal transit time
Article first published online: 15 APR 2003
Journal of Gastroenterology and Hepatology
Volume 18, Issue 5, pages 540–547, May 2003
How to Cite
GHOSHAL, U. C., GHOSHAL, U., AYYAGARI, A., RANJAN, P., KRISHNANI, N., MISRA, A., AGGARWAL, R., NAIK, S. and NAIK, S. R. (2003), Tropical sprue is associated with contamination of small bowel with aerobic bacteria and reversible prolongation of orocecal transit time. Journal of Gastroenterology and Hepatology, 18: 540–547. doi: 10.1046/j.1440-1746.2003.03006.x
- Issue published online: 15 APR 2003
- Article first published online: 15 APR 2003
- Accepted for publication 26 October 2002.
- breath test;
- gut transit time;
- malabsorption syndrome;
- small bowel aspirate;
- tropical enteropathy.
Background: In tropical sprue (TS), response to antibiotics may suggest a role for bacterial contamination of the small bowel, which is known in diseases with prolonged orocecal transit time (OCTT).
Methods: We studied 13 patients with TS (diagnosed by standard criteria) for frequency, nature and degree of bacterial contamination of the small bowel by quantitative culture of jejunal aspirate, glucose hydrogen breath test (GHBT), and OCTT by lactulose hydrogen breath test before and after treatment. Twelve patients with constipation-predominant irritable bowel syndrome (IBS) and 12 healthy subjects served as controls.
Results: Ten of 13 patients with TS had bacterial contamination compared with 3/12 with IBS (all aerobic, P < 0.05). Median colony count in TS (36 000 CFU/mL, 400 to > 100 000) was higher than IBS (700 CFU/mL, 100–1000, P < 0.05). Gram-negative aerobic bacilli were commonly isolated in TS but not in IBS. Median OCTT was longer in TS (180 m, 40 − 240) than IBS (110 m, 70 − 150, P = 0.008) and healthy subjects (65 m, 40 − 110, P = 0.0007, Wilcoxon rank sum test). Orocecal transit time in TS correlated with fecal fat (Spearman's rank correlation coefficient 0.69, P < 0.05). Orocecal transit time and fecal fat, repeated in 8/13 patients, decreased with treatment for TS (195 m, 130–240 vs 125 m, 90–200, P = 0.02; 8 g/24 h, 6.8–19.6 vs 7 g/24 h, 4.2–9, P = 0.04, respectively).
Conclusion: Aerobic bacterial contamination of the small bowel is common in patients with TS. Prolonged OCTT in TS correlated with fecal fat and normalized in a subset of patients after treatment.
© 2003 Blackwell Publishing Asia Pty Ltd