title: Is small bowel bacterial overgrowth of pathogenic significance in persistent diarrhea?
abstract: Bacterial overgrowth in the upper small intestine is postulated to cause persistent diarrhea. We compared the fecal and upper intestinal flora in 82 patients with persistent diarrhea aged < or = 36 months and weight-for-length < or = 90% of National Center for Health Statistics standards (NCHS) and 39 non-diarrheal children with age < or = 36 months, nutritionally matched with the patients and residing in the same environment. In the age groups < or = 12 months and > 12 months the duodenal fluid bacterial counts > or = 10(5)/ml were found with similar frequency in patients and controls for aerobic (p = 0.33; p = 0.1) and anaerobic (p = 1.0; p = 1.0) bacteria. However, the duodenal isolation rates of any aerobic bacteria (p < 0.05) without regard to counts and Enterobacteriaceae (p = 0.06) were higher in patients than in controls. Colonization with Enterobacteriaceae was directly correlated with increased stool weight over a 7-day observation period (p < 0.05; p < 0.01). One or more pathogens were isolated in the feces of 58% of the patients and 43.8% of the controls. Enteroadherent E. coli of the localized [EAEC-L] (p < 0.01) and aggregative [EAggEC] (p = 0.22) phenotypes were isolated more commonly from the feces of patients. The duodenal fluid detection rates for Klebsiella were significantly greater (p < 0.01) in patients, while Giardia lamblia was detected more commonly in the duodenal fluid of controls (p < 0.01). The presence of specific pathogens in the feces did not seem to be related to the extent of small bowel colonization.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Pediatrics, All India Institute of Medical Sciences, New Delhi.
authors.forename: S
authors.initials: S
authors.lastname: Bhatnagar
authors.forename: M K
authors.initials: MK
authors.lastname: Bhan
authors.forename: C
authors.initials: C
authors.lastname: George
authors.forename: U
authors.initials: U
authors.lastname: Gupta
authors.forename: R
authors.initials: R
authors.lastname: Kumar
authors.forename: D
authors.initials: D
authors.lastname: Bright
authors.forename: S
authors.initials: S
authors.lastname: Saini
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001420:Bacteria, Aerobic / Q000254:growth & development*; D001421:Bacteria, Anaerobic / Q000254:growth & development*; D001422:Bacterial Adhesion; D016022:Case-Control Studies; D015362:Child Nutrition Disorders / Q000150:complications / Q000382:microbiology / Q000469:parasitology; D002675:Child, Preschool; D002908:Chronic Disease; D015169:Colony Count, Microbial; D003967:Diarrhea / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*; D003968:Diarrhea, Infantile / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D004386:Duodenum / Q000382:microbiology* / Q000469:parasitology; D004926:Escherichia coli / Q000254:growth & development / Q000502:physiology; D005243:Feces / Q000382:microbiology* / Q000469:parasitology; D005872:Giardia / Q000302:isolation & purification; D006801:Humans; D007223:Infant
chemical_list: D000900:Anti-Bacterial Agents