Anaerobic Bacteria and Deconjugated Bile Salts in the Upper Small Intestine of Infants With Gastrointestinal Disorders

SUMMARY The aerobic and anaerobic bacterial flora of the duodenum were studied in 10 infants with transient monosaccharide intolerance. 5 infants had protracted diarrhoea after an episode of acute gastroenteritis and 5 had acute gastroenteritis. The duration of monosaccharide intolerance ranged from 1 to 20 days. Serial intubations were performed on 8 infants. In 5 of 8 cases the bacterial flora were of a normal type at the first intubation at 0-4 days after the onset of monosaccharide intolerance. In 4 of those 5 patients there was an increase in bacterial count a few days later and anaerobes appeared. These findings are not consistent with the suggestion that monosaccharide intolerance is caused by abnormal bacteria in the upper small bowel.

Section: Discussionmentioning

confidence: 92%

Duodenal bacterial flora in early stages of transient monosaccharide intolerance in infants.

Kilby¹,

Dolby²,

Honour³

et al. 1977

“…At high concentrations this bile acid produces gross structural abnormalities of the jejunal mucosa Sladen and Harries, 1972;Guiraldes et al, 1975). Deoxycholate and other free bile acids are present in the duodenal contents of some infants with protracted diarrhoea (Gracey et al, 1969;Challacombe et al, 1974a;Schneider and Viteri, 1974), and may contribute to the pathogenesis of the diarrhoea. In addition to bile acids, bacterial production of hydroxy fatty acids may also contribute to the diarrhoea (Bright- Asare and Binder, 1973;Ammon et al, 1974).…”

Section: Discussionmentioning

confidence: 99%

Protracted diarrhoea in infancy. Analysis of 82 cases with particular reference to diagnosis and management.

Larcher¹,

Shepherd²,

Francis³

et al. 1977

125

SUMMARY Eighty-two cases of protracted diarrhoea in infancy presenting over a 6-year period have been analysed, with particular reference to diagnosis and management. The patients fell into 1 of 2 categories according to whether a specific diagnosis was established or not. A diagnosis (category 1) was established in 59 (72 %), the commonest diagnoses being coeliac disease (33 2 %), secondary disaccharide intolerance (12 2 %), and cows' milk protein intolerance (11 3 %). Other diagnoses included primary sucrase-isomaltase deficiency, Shwachman's syndrome, ulcerative colitis, ganglioneuroma, defective opsonization, staphylococcal pneumonia, and Hirschsprung's disease.Despite intensive investigation a diagnosis could not be established in 23 (28 %) infants (category 2). Age of onset of symptoms in this group tended to be earlier than in category 1 patients, and 6 (7 %) presented with diarrhoea dating from birth. Of particular interest in these 6 patients was the high incidence of associated extraintestinal anomalies, and of sibs who had died after protracted diarrhoea dating from birth. 4 of these 6 infants died, accounting for a mortality of 5 % for the whole series. The remaining 17 (21 %) patients in category 2 presented at a mean age of 4 9 weeks with a range of 1-18 weeks. All these 17 patients made an excellent response after institution of a chicken-based dietary formula, the details of which are presented. The pathophysiological mechanisms which may be operating in infants with protracted diarrhoea are discussed.An infant presenting with protracted diarrhoea and failure to thrive often presents major problems in diagnosis and management, particularly if the patient's general condition precludes intensive investigation. There have been very few reported series of protracted diarrhoea in infancy, and in each report the numbers of patients have been small, varying from 10 to 20 cases (Avery et al., 1968; Hyman etal., 1971;Lloyd-Still et al., 1973). Mortality rates of 45 % (Avery et al., 1968) and 70% (Hyman et al., 1971) reflect the difficulties in management which these infants pose, and the nonresponsiveness to dietary treatment in patients in whom a specific diagnosis cannot be established has been emphasized.We report 82 infants with protracted diarrhoea, paying particular attention to the differential diagnoses, and to the management of those patients in whom a specific diagnosis could not be established.

“…Deconjugated bile acids were not detected in infants in group A, but cholic acid (0 13 mmol/l; 5.3 mg/100 ml), chenodeoxycholic acid (0 57 mmol/l; 22-3 mg/100 ml), and lithocholic acid (0 25 mmol/l; 9 4 mg/100 ml) were found in the duodenal juice of one infant in group B who had secondary lactose intolerance. In this infant, who has been previously reported (Challacombe et al, 1974a), Bacteroides sp. (obligate anaerobes with known bile acid deconjugating properties in vitro) were isolated from the duodenal juice.…”

Section: Resultsmentioning

confidence: 64%

Duodenal bile acids in infants with protracted diarrhoea.

Challacombe¹,

Brown²,

Edkins³

1979

SUMMARY Bile acids were estimated in the duodenum of infants with protracted diarrhoea and compared with those in a control group. Significantly lower levels of total bile acids were found in infants with protracted diarrhoea, a finding which may be due to ileal dysfunction. Low concentrations of total bile acids may contribute to the poor nutritional state of these patients by impairing the normal digestion and absorption of dietary fat and fat-soluble vitamins. The absence of deconjugated bile acids in the duodenal juice of most infants with protracted diarrhoea suggests that they do not contribute significantly to the pathophysiology of this disorder.