Enterotoxigenicity of Colonising Coliform Bacteria in Tropical Sprue and Blind-Loop Syndrome

Klipstein, Frederick A.; Engert, R F; Short, Helen B.

doi:10.1016/s0140-6736(78)92942-2

Cited by 41 publications

(19 citation statements)

References 19 publications

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“…In TS, many different bacteria have been isolated including Escherichia coli , Klebsiella pneumoniae and Enterobacter cloace , and patients can harbor one or more highly toxigenic strains. In contrast, patients with blind loop syndrome did not have toxigenic strains 7 …”

Section: Pathogenesis Of Tropical Spruementioning

confidence: 79%

What is tropical sprue?

Walker

2003

J of Gastro and Hepatol

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A simple definition of tropical sprue (TS) is 'an acquired disease of unknown etiology characterized by malabsorption, multiple nutritional deficiencies, and mucosal abnormalities in the small bowel'. 1 There are few recent studies on this entity and considerable confusion regarding the relationship of TS to tropical enteropathy and traveller's diarrhea. In issue 5 of the Journal, Ghoshal et al. 2 define a group of patients with TS by strict clinical and pathological criteria and show that aerobic bacteria contaminate the small bowel in patients with TS and that these patients have a prolonged orocecal transit time (OCTT) compared with healthy control subjects. It is speculated that bacterial contamination worsens steatorrhea and activates the 'ileal brake', which is reversible in the majority of patients on treatment with tetracycline and folic acid. The etiology of TS is presumed to be infective; however, attempts have failed to isolate a single organism and it might therefore be the result of an unfortunate coincidence of circumstances. Most likely 'hit and run' bacteria damage enterocytes, resulting in a cascade of events leading to small bowel stasis, bacterial overgrowth, disturbances in gut motility, malabsorption and loss of folate with further damage to the enterocyte, and a vicious cycle results. Elimination of bacterial overgrowth by tetracycline and mucosal repair by folate supplements results in the restoration of mucosal integrity. 3 The overlap of tropical enteropathy and TS corresponds to the particular geographical distribution of these conditions and a link is purely speculative. More studies are needed to unravel the nature of the enterocyte response in this spectrum of enteropathies resulting from antigen or pathogen insult. PATHOGENESIS OF TROPICAL SPRUEAlthough the pathogenesis of TS is unknown, speculation has centered around infection leading to bacterial overgrowth and disturbance of motility, but other factors such as genetic susceptibility, local environment, bacteria and food practices should be considered in the etiology.

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Section: Pathogenesis Of Tropical Spruementioning

confidence: 79%

What is tropical sprue?

Walker

2003

J of Gastro and Hepatol

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“…92 The organisms were Klebsiella, Enterobacter or Escherichia coli, and produced toxins that caused mucosal damage and secretion in intestinal loops of experimental animals. 93 Studies in rural southern India and in South Africa indicated that bacterial colonisation of the small intestine was present not only in patients with tropical sprue but also in apparently healthy people, and the two groups could not be distinguished on the basis of the numbers or kinds of bacteria isolated from the small bowel. 76 94 The presence of bacterial contamination of the proximal small bowel in healthy people was attributed to the contaminated environment.…”

Section: Aetiologymentioning

confidence: 99%

Tropical malabsorption

Ramakrishna

Venkataraman

Mukhopadhya

2006

Postgraduate Medical Journal

124

100

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Malabsorption is an important clinical problem both in visitors to the tropics and in native residents of tropical countries. Infections of the small intestine are the most important cause of tropical malabsorption. Protozoal infections cause malabsorption in immunocompetent hosts, but do so more commonly in the setting of immune deficiency. Helminth infections occasionally cause malabsorption or protein-losing enteropathy. Intestinal tuberculosis, chronic pancreatitis and small-bowel bacterial overgrowth are important causes of tropical malabsorption. In recent years, inflammatory bowel disease and coeliac disease have become major causes of malabsorption in the tropics. Sporadic tropical sprue is still an important cause of malabsorption in adults and in children in South Asia. Investigations to exclude specific infective, immunological or inflammatory causes are important before considering tropical sprue as a diagnosis. This article briefly reviews the management of tropical sprue and presents an algorithm for its investigation and management.

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“…MAS refers to a group of diseases of various causes in which nutrient absorption from the gut is impaired. Some patients with MAS, irrespective of its etiology, have been shown to be associated with small intestinal bacterial overgrowth (SIBO) (1)(2)(3)(4)(5). SIBO in patients with MAS may have clinical significance because it can perpetuate malabsorption of nutrients and cause refractoriness to specific treatments directed against the primary cause (6,7).…”

mentioning

confidence: 99%

Malabsorption syndrome with and without small intestinal bacterial overgrowth: A study on upper‐gut aspirate using ¹H NMR spectroscopy

Bala

Ghoshal

et al. 2006

Magnetic Resonance in Med

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Enterotoxigenicity of Colonising Coliform Bacteria in Tropical Sprue and Blind-Loop Syndrome

Cited by 41 publications

References 19 publications

What is tropical sprue?

What is tropical sprue?

Tropical malabsorption

Malabsorption syndrome with and without small intestinal bacterial overgrowth: A study on upper‐gut aspirate using ¹H NMR spectroscopy

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Enterotoxigenicity of Colonising Coliform Bacteria in Tropical Sprue and Blind-Loop Syndrome

Cited by 41 publications

References 19 publications

What is tropical sprue?

What is tropical sprue?

Tropical malabsorption

Malabsorption syndrome with and without small intestinal bacterial overgrowth: A study on upper‐gut aspirate using 1H NMR spectroscopy

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Malabsorption syndrome with and without small intestinal bacterial overgrowth: A study on upper‐gut aspirate using ¹H NMR spectroscopy